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Grass Pollen Allergies in the Washington, DC Metropolitan Area

• May 26, 2015
• BY BLACK & KLETZ ALLERGY

In the Washington, DC, Northern Virginia, and Maryland metropolitan area (DMV area), grass begins to pollinate in late-April to early-May, peak in late-May or early-June, and end in August.  In addition to the grass pollen during this time period, molds spore counts are also highly elevated which further complicates one’s allergies.  There is also an overlapping with tree pollens in the early Spring, meaning that all three allergens (trees, grasses, and molds) are in the environment at the same time during some periods in the Spring.

The most common types of grasses include Timothy, Sweet vernal, Bermuda, Rye, Kentucky blue, Orchard, Meadow fescue, Red top, Bahia, and Johnson.  Grass pollens, unlike other environmental allergens, are very similar in their microscopic appearance.  This fact is the reason why an individual who is sensitized with one type of grass may have allergy and/or asthma symptoms when exposed to many other types of grasses.  The one major exception to this rule is Bermuda grass, which does not cross react with many other grasses.

As with the other allergens that cause hay fever (allergic rhinitis), allergic conjunctivitis, and/or asthma, it is the wind disbursement of the grass pollen into the air that sensitizes individuals.  Since the grass pollen is very light in weight, the wind causes the pollen to be carried in the air where people inhale the pollen and have direct contact with the pollen and their eyes.  It is this interaction that causes some people to develop allergies to the grass pollen which in turn causes the classic symptoms of hay fever, allergic conjunctivitis, and/or asthma. These symptoms may include some or all of the following:  sneezing, itchy nose, runny nose, nasal congestion, post-nasal drip, sore throat, hoarseness, itchy eyes, watery eyes, puffy eyes, sinus congestion, sinus pain, wheezing, coughing, shortness of breath, and/or fatigue.

Grasses tend to pollinate more the longer they grow.  Therefore, keeping one’s lawn mowed reduces the grass pollen that enters the air.  It is the tall grasses found in empty lots and by the sides of the roads, etc. that is the primary cause of the high grass pollen counts found in the Spring in the Washington, DC area.  Warm, windy, and dry days tend to increase the grass pollen counts.  The grass pollen counts also tend to be the highest in the early mornings.

There are preventive measures that should be practiced by all grass allergy sufferers and include the following:

1. Although it is better to have the lawns mowed, the allergic individual should avoid mowing lawns. If he/she must mow the lawn, wearing a filtered mask may help reduce grass pollen exposure.
2.  Turn air conditioning on.
3.  Change air filters monthly.
4. Keep sunroofs and windows closed.
5. Shower, wash hair, and change clothing after coming back inside.
6. Avoid yard work or wear a filtered mask.
7. Wash pets after they go outdoors.
8.  Re-circulate air in car so it doesn’t come in from the outside.
9. Drive a car that has an air filter, if possible.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating grass pollen allergies in children and adults in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than half a century.  If you experience any of the above symptoms in the late Spring and Summer, you may suffer from grass allergies.  It is important for a board certified allergist to perform a detailed history and physical examination.  Allergy testing can be performed via the skin or blood to determine if one has an allergy to grass or other environmental allergen such as trees, molds, etc.  Treatment begins with prevention.  It may not be possible to completely avoid exposure to grass pollen, however, certain preventive measures can still help alleviate some of the suffering.  There a wide array of medications that can be tried which may include tablets, capsules, syrups, powders, nasal sprays, eye drops, and/or asthma inhalers.  Allergy immunotherapy (also referred to as allergy shots or allergy desensitization) is a very effective means to treat grass and other environmental allergies.  It is effective in about 80-85% of patients.  They have been around for over 100 years.  They can be given to almost anyone, including children and pregnant women.

If you would like to be seen at one of our 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), or Manassas, VA, please call us to make an appointment.  Alternatively, you can click Request an Appointment and we will get back to you within 24 hours by the next business day.  We have parking at each office location and we are Metro accessible at our Washington, DC and McLean, VA locations.  Black & Kletz Allergy provides a friendly and caring environment for you to get the top quality allergy, asthma, and immunology treatment that we have been providing the community for more than 50 years and that you deserve.

Is it Wheat Allergy, Gluten Sensitivity, or Celiac Disease?

• April 20, 2015
• BY BLACK & KLETZ ALLERGY

Over the past decade, more people are interested in gluten-free diets in order to get relief from a variety of symptoms.  It is therefore important to know a little about the differences between celiac disease, gluten sensitivity, and true wheat allergy.

CELIAC DISEASE (CELIAC SPRUE; NONTROPICAL SPRUE; GLUTEN ENTEROPATHY):

Gluten is a protein normally present in wheat, rye, and barley.  Gluten is what gives dough its elasticity, ability to rise, and contributes to the dough’s chewiness.  It is found mainly in foods, but may also be found in everyday products such as medicines, hair products, vitamins, cosmetics, lipsticks and lip balms, and other dermatologic preparations.  Gluten is found in so many unexpected foods as additives and can be found in unsuspecting foods such as beer, ketchup, ice cream, soy sauce, processed lunch meats, to name a few.  Celiac disease is a hereditary (runs in families) autoimmune disorder of the small intestine found in all age groups (infancy through adulthood) that occurs in approximately as many as 3 million Americans.  It occurs when people with celiac disease eat gluten.   Their body’s immune system reacts to the gluten by attacking the lining of their small intestine.  The immune system’s reaction to gluten damages small, fingerlike growths called villi.  When the villi are damaged, the body cannot get the nutrients it needs.

Symptoms of celiac disease can include:

• Abdominal pain/cramping
• Flatulence/bloating
• Diarrhea/constipation
• Extreme tiredness/fatigue
• Change in mood/depression/irritability
• Weight loss/decreased appetite
• Joint pains
• Iron deficiency anemia
• Osteoporosis due to decreased absorption of calcium
• Very itchy skin rash with blisters (Dermatitis herpetiformis)
• Delayed growth in children

The diagnosis is suspected when blood tests detect elevated levels of certain antibodies to gluten.  An upper endoscopy is needed to confirm the diagnosis, as one needs a biopsy that shows the abnormal villi of the small intestine.

The only treatment for celiac disease at this time is avoidance of gluten in diet.  When it is no longer exposed to gluten, the villi of the small intestine heal and can absorb nutrients again.

NON-CELIAC GLUTEN SENSITIVITY (NCGS) (GLUTEN SENSITIVITY; GLUTEN INTOLERANCE):

“Non-celiac gluten sensitivity” (NCGS) is used to describe individuals who cannot tolerate gluten as they experience the same symptoms as those with celiac disease.   The main difference is that individuals with NCGS do not have the gluten antibodies in the blood and there is no villi damage in the small intestine as is seen in celiac disease.  Research suggests that non-celiac gluten sensitivity is an innate immune response (nonspecific first line of defense), as opposed to an adaptive immune response (or “learned” response such as an autoimmune reaction) or allergic reaction.  As many as 18 million Americans may have NCGS.

People with NCGS can also have other symptoms such as headache, “foggy” feeling in the head, lack of concentration, and numbness in the legs, arms, and/ or fingers.  Symptoms typically appear hours or days after gluten has been ingested, a response typical for innate immune conditions.

New research shows that it is possible that gluten may not even be responsible for the symptoms produced by NCGS.  FODMAP’s (fermentable oligo-, di-, and monosaccharides and polyols), a group of poorly digested carbohydrates, may be the cause of the symptoms instead.  It is also interesting to note that wheat, rye and barley – the 3 grains that contain gluten – are all high in FODMAP’s.  Even though wheat, rye, and barley contain high amounts of FODMAP carbohydrates, many other foods such as peaches, apples, beets, garlic, onion, asparagus, kidney beans, soybeans, milk, ice cream, and many sweeteners (fructose, mannitol, agave, sorbitol, etc.) also contain high amounts of FODMAP’s.

There are currently no confirmatory tests for NCGS and the diagnosis is by ruling out other conditions that may cause similar symptoms.  As stated above, blood tests and biopsies that are positive with celiac disease are normal in these individuals.  Improvement of one’s symptoms when gluten is removed from the diet makes NCGS more likely.  However, there is a risk of self-diagnosis and starting oneself on a gluten-free diet.   The risk is that there may be a serious gastrointestinal and/or other disorder that will be missed without the proper work-up.  It is therefore important for individuals with these symptoms to see their physicians so that serious disorders can be ruled out by using proper testing to exclude them.  Assuming there is no other disorder, a gluten-free diet and a FODMAP-free diet may be beneficial.

WHEAT ALLERGY:

One or more of the wheat proteins, albumin, globulin, gliadin, or gluten, can cause an allergic reaction involving IgE antibodies.  The reactions usually take place within a few minutes to several hours after exposure to the allergen.  The symptoms may include some or all of the following:  itching in the mouth, swelling of lips and/or tongue, hives, eczema, runny or stuffy nose, itchy or watery eyes, tightening of the throat and/or trouble breathing, wheezing, drop in blood pressure, vomiting, diarrhea, abdominal cramps, abdominal pain, and/or anaphylaxis.

A thorough medical history and physical examination in conjunction with skin prick tests and/or allergen-specific IgE blood testing are useful in the diagnosis of wheat allergy.  A food challenge may be necessary in some individuals.  For wheat allergy, strict avoidance of wheat and wheat products is necessary.

Although classic IgE-mediated allergic reactions are most common with wheat, non-IgE-mediated reactions to wheat may occur, usually with a slower onset of symptoms and these symptoms are generally confined to the gastrointestinal tract.

The board certified allergists at Black & Kletz Allergy can provide answers to your questions and offer evidence based diagnostic and treatment options.  We have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for many years.  We have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Each of our 3 convenient office locations has on-site parking and the Washington, DC and McLean, VA locations are easily accessible by the Metro.  Black & Kletz Allergy has been diagnosing and treating wheat and other food allergies for over 50 years.  We also have the expertise to help diagnose and treat many gastrointestinal diseases associated with allergies and autoimmune disorders as well as rule out food allergies as a source of your gastrointestinal problems.  Please call our office for an appointment if you have any of the above symptoms or alternatively, you can click Request an Appointment and we will be in touch with you within 24 hours of the next business day.

Allergy Doctor Vienna VA

• April 14, 2015
• Black & Kletz Allergy

Black & Kletz Allergy provides expert allergy and clinical immunology services from an allergy doctor Vienna VA residents have long trusted as the board certified allergists have more than 50 years of experience.

Our allergy doctor Vienna VA inhabitants trust is a specially trained physician with expertise in the treatment of allergic and immunological diseases. After successfully completing internship and residency training in either pediatrics or internal medicine, our allergy doctor Vienna VA residents desire underwent further training for 2 to 3 years in an accredited allergy and immunology fellowship training program. During training, our allergy doctor Vienna VA residents trust learned to diagnose and treat various disorders affecting the immune system.

The disorders affecting the immune system may include allergic sensitivity to environmental allergens (e.g., dust mites, molds, pollens, pets, cockroaches), foods, medications, insect sting venoms, etc. Environmental allergies usually affect the respiratory system causing conditions such as allergic rhinitis (hay fever), allergic conjunctivitis, and asthma.

The most common allergens affecting the respiratory system are aeroallergens that are inhaled such as the aforementioned dust mites and their droppings, mold spores, pollens (e.g., trees, grasses, weeds), animal dander, and cockroaches. The allergy doctor Vienna VA inhabitants respect is trained in identifying the specific allergens that cause allergic rhinitis, allergic conjunctivitis, and asthma. Our allergist is able to identify the specific allergies by performing diagnostic allergy tests such as skin tests and/or blood tests. The allergy doctor Vienna VA residents trust then provides detailed information to the patient about the various ways of avoiding exposure to these specific substances by way of environmental controls. The symptoms of respiratory allergies may include nasal congestion, runny nose, post-nasal drip, itchy nose, itchy throat, itchy eyes, watery eyes, redness of the eyes, puffy eyes, sneezing, facial pressure, headaches, sinus pain, sinus congestion, throat irritation, coughing, wheezing, chest tightness and/or shortness of breath. The allergy doctor Vienna VA inhabitants have confidence in will prescribe medications in order to relieve these symptoms. Our allergist will also explain the medications to the patient as well as their potential side effects. In addition, our allergy doctor Vienna VA residents respect may offer a desensitization treatment (i.e., allergy shots, allergy injections, allergy immunotherapy, allergy hyposensitization) protocol, which will build up tolerance to these allergens and help prevent future allergy and/or asthma symptoms. This process is especially useful when the environmental controls are not feasible and/or when medications are not helping enough or causing undesirable side effects. The allergy doctor Vienna VA inhabitants admire will give detailed information to the patient about allergy shots including possible benefits and risks from the procedure. It should be noted that allergy shots are efficacious in about 80-85% of patients receiving them. Allergy shots have also been given to allergy sufferers for more than 100 years and are generally taken for 3-5 years.

Food allergens may cause generalized itching (i.e., pruritus), hives (i.e., urticarial), swelling (i.e., angioedema) and rarely life-threatening allergic reactions (i.e., anaphylaxis). The most common foods that cause allergic reactions in children and adults include peanuts, tree nuts, wheat, milk, eggs, soy, fish, and shellfish. The allergy doctor Vienna VA residents trust will perform diagnostic tests in order to identify the specific food allergens that a person is sensitized to and the allergist will then educate the patient in methods of avoidance. Our allergy doctor Vienna VA inhabitants respect will also prescribe an epinephrine self-injectable device such as an EpiPen, Auvi-Q, or Adrenaclick for use by the patient or parent in case of inadvertent exposure resulting in a systemic reaction.

Insect venom allergies affect thousands of patients annually in the U.S. They can cause life-threatening allergic reactions after stings by honey bee, yellow jacket, yellow faced hornets, white faced hornets, wasps, and fire ants. Our Allergy doctor Vienna VA residents trust performs allergy skin tests in order to detect one’s sensitivity to insect venoms. Our allergist may offer desensitization injections (i.e., allergy shots) to individuals with positive skin tests along with a convincing history of a systemic reaction in order to reduce the risks of a life-threatening reaction after such a sting.

The board certified allergy doctors at Black & Kletz Allergy have been treating patients for allergies, asthma, and immunologic conditions for over many years and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 5 decades and treat both adult and pediatric patients. All 3 offices at Black & Kletz Allergy offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please call one of our offices to schedule an appointment. You may also click Request an Appointment and we will reply within 24 hours by the next business day. At Black & Kletz Allergy, we strive to improve the quality of life in allergic individuals in a professional and compassionate setting.

Asthma in the Spring

• April 6, 2015
• BY BLACK & KLETZ ALLERGY

Asthma is chronic inflammatory condition of the airways of the lungs.  Asthma can affect both allergic and non-allergic individuals.   There is an increased risk of developing asthma if there is a family history of asthma or allergies.  Most people that have asthma also have allergic rhinitis (hay fever).  On the other hand, about half of the individuals that have allergic rhinitis also have asthma.  About 8% of the U.S. population has asthma.  Asthma is the most common chronic condition in children.  Asthma prevalence has been increasing over the last few decades.  The average child with asthma misses between 4 to 5 days of school per year due to asthma.  The average adult with asthma misses about 5 days of work per year due to asthma.  The annual cost on the U.S. healthcare system just due to asthma is about $20 billion.  There is an additional $10 billion per year added to the healthcare system just due to allergies alone.  The statistics above are staggering and people with allergies and asthma need to realize how prevalent their diseases are and that allergists (who specialize in treating allergies and asthma) can help reduce their suffering and help reduce unnecessary emergency room visits and admissions to the hospital, which greatly increase the costs of these diseases.

As we are in the Spring season, many individuals with allergic asthma may begin to experience a worsening of their asthma.  The symptoms that one experiences typically can be any or all of the following:  wheezing, shortness of breath, chest tightness, and/or cough.

Asthma can be life-threatening and it is imperative that one is taught about the symptoms and what should be done depending on the severity of one’s symptoms.

It is important that the asthmatic individual understand their triggers and to try to avoid the offending trigger.  In the Spring, tree pollens, grass pollens, and molds are largely responsible for causing asthma exacerbations.  It is thus important for individuals with asthma to practice pollen avoidance measures which include the following recommendations:

1. Monitor pollen counts daily.
2. Stay indoors wherever possible when the pollen count is high (generally on dry warmer days).  Note that rain washes pollen from the air causing pollen counts to be lower on wet cooler days.
3. Since pollen is released in the early mornings, try to avoid exercising during this time.
4. Avoid drying clothes outdoors when the pollen count is elevated.
5. Avoid contact lenses which may trap pollen in one’s eyes.
6. Turn on the air conditioner and change air filters regularly (about once a month).
7. Keep one’s windows and sunroof closed.
8. Use the re-circulate feature in the car so that the air is not coming into the vehicle from the outside.
9. Choose an automobile that has a filter in its air conditioning unit, if possible.
10. Avoid yard work and mowing lawns.  If a person needs to do yard work, wear a filtration face mask in order to diminish exposure to the pollen.
11. If one goes outdoors, shower, wash one’s hair, and change one’s clothing upon returning home to decrease pollen exposure.
12. Wash your pets regularly and avoid close contact with a pet that goes outdoors during the pollen season since they carry pollen on their coats.

The board certified allergists at Black & Kletz Allergy have the expertise in diagnosing and treating asthma in adults and children.  We have been treating the people of the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years.  It is important that the allergist take a thorough history and examination from the individual as not everyone that has “asthma symptoms” ends up having asthma.  There is an important saying in medicine which states that “All that wheezes is not asthma.”  This means that there are many other medical conditions that can present with wheezing that are not asthma.  Some of these medical conditions include heart disease, COPD (emphysema and/or chronic bronchitis), GERD (acid reflux), etc.  Once diagnosed, there are a multitude of treatment options to control one’s asthma.  The allergists and staff at Black & Kletz Allergy are diligent in educating the patient with asthma on what to look for and how to assess their severity of disease at any given time.  An asthma plan is discussed with individuals and inhaler technique is demonstrated to the patients.  Research shows that patients notoriously use their inhalers incorrectly unless they are shown the correct method.  Medications used to treat asthma can include several types and classes of lung inhalers, tablets, capsules, syrups, granules, and Xolair (omalizumab) injections in select patients.  Allergy shots (i.e., allergy immunotherapy, allergy injections) are a very effective way to treat asthma and have been used very successfully for more than 100 years.  The allergists at Black & Kletz Allergy also make themselves available 24 hours a day/ 7 days a week for any questions or concerns that you might have regarding your allergies and/or asthma.

If you would like a consultation for your asthma symptoms, please call us at Black & Kletz Allergy to make an appointment.  Alternatively, you can click Request an Appointment and we will get back in touch with you within 24 hours of the next business day.  We have 3 convenient locations in the Washington, DC metropolitan area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA) and Manassas, VA.  There is parking at each location and the Washington, DC and McLean, VA locations are also accessible by using the Metro.  We would be happy to assist you in diagnosing your asthma symptoms and helping you manage your asthma so that you can participate in the things you enjoy without the constant fear of your asthma symptoms.

Peanut Allergy – New Developments

• March 23, 2015
• BY BLACK & KLETZ ALLERGY

The vexing question about what to do about the alarming increase in peanut and other food allergies may have been finally answered.  The prevalence of peanut allergy tripled in the U.S. in the past decade while also rising in Africa and Asia.  It affects more than 1% of the U.S. population and is the leading cause of anaphylaxis and death from food allergy.  The American Academy of Pediatrics recommended in the year 2000, that parents refrain from feeding peanuts to children until 3 years of age hoping to reverse the trend.  However in 2008, after reviewing the published literature, the American Academy of Pediatrics retracted its recommendation, stating that there was insufficient evidence to call for early food avoidance.  Last month, (February of 2015), at the annual conference of the American Academy of Allergy, Asthma, and Immunology, the results of a landmark prospective, randomized controlled study addressing this issue were revealed and simultaneously published in the New England Journal of Medicine online.  The data strongly suggested that feeding peanut products regularly to infants with eczema, egg allergy, and a family history of food allergies from 6 months of age dramatically reduces the risk of peanut allergy, compared to children who avoided exposure to peanuts.  The differences in the two controlled groups were so stark that the guidelines are likely to be revised soon to promote early introduction of peanut products into the diets of at-risk children.

Prick skin testing with peanut extract and a blood test to measure antibodies to peanut protein are routinely employed in detecting allergic sensitivity to peanuts.  The recent availability of tests to measure antibodies to specific components of peanut proteins increased the predictability of adverse reactions on exposure to peanuts in sensitized children and adults.  These tests are also helping physicians to identify the appropriate patients and the clinical situations for in-office oral challenges with peanut products, which is the gold standard in the accurate diagnosis of peanut allergy.

In the past decade, a number of small, largely uncontrolled clinical trials have suggested that oral immunotherapy (giving children with peanut allergies increasing doses of peanut flour or peanut extract by mouth over time) can effectively desensitize many children with peanut allergy.  Although peanut oral immunotherapy shows promise, the evidence currently available on its effectiveness, risk benefit, and potential long-term consequences is insufficient to support its use in clinical practice.  Until more data is available, strict peanut avoidance is the current standard of care.

The board certified allergists/immunologists at Black & Kletz Allergy are can answer your questions and address your concerns regarding peanut allergies or any other type of allergy.  We have been serving the Washington, DC, Northern Virginia, Maryland metropolitan area for over 50 years and offer 3 convenient locations with parking.  Our office locations are in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our Washington, DC and McLean, VA are accessible by the Metro.  Please call us at one of our locations to schedule an appointment or you can Request an Appointment online on our website and we will respond within 24 hours by the next business day.

Vaccinations and Food Allergies – What Should You Know?

• February 16, 2015
• BY BLACK & KLETZ ALLERGY

With the recent resurgence of vaccine-preventable diseases like measles in the United States, in addition to the ongoing active influenza (flu) season, the issue of food allergies and vaccinations has become a hot topic.

Some vaccines like the MMR (measles, mumps, and rubella), influenza, yellow fever, and certain rabies vaccines are grown in chicken embryo cultures and may contain small amounts of egg protein in them, raising concerns about potential adverse reactions in children and adults with egg allergies.

Other vaccines contain small amounts of gelatin which can cause adverse reactions in patients allergic to gelatin.  Some of these vaccines include MMR, influenza, varicella, DTaP (diphtheria, tetanus, and acellular pertussis), yellow fever, rabies, shingles (herpes zoster), and Japanese encephalitis.

Below are the most current recommendations as of February 2015:

1. MMR vaccine:
   • Can be safely given in a single dose without prior testing in all children and adults with a history of egg allergy.
2. Influenza vaccine:
   • People with a history of egg allergy who have experienced hives (urticaria) after exposure to should not receive the live influenza vaccine (FluMist).  They can, however, receive a recombinant (egg-free) influenza vaccine (Flublok) if they are 18 years of age or older, or they can receive an inactivated vaccine. Either the recombinant or the inactivated influenza vaccine must be administered by a health care provider familiar with the potential manifestations of egg allergy. The patient must also be observed by the provider for at least 30 minutes for signs of a reaction after administration of each vaccine dose.  Note that neither the recombinant (Flublok) nor the inactivated influenza vaccines contain any live influenza virus, unlike the live attenuated (weakened) influenza vaccine (FluMist) which does contain live influenza virus.  FluMist is given intranasally (in the nose) rather than the inactivated influenza vaccine which can be given either as an intramuscular or an intradermal injection.  The recombinant influenza vaccine is given as an intramuscular injection.  Also note that FluMist is only given to individuals from ages 2 through 49.  FluMist should not be given to pregnant women or in patients with an immunodeficiency (weakened immune system) without consulting their physician.  FluMist should not be given to children and adolescents through age 17 years of age who are receiving aspirin therapy or aspirin-containing therapy because of the association of Reye’s Syndrome with aspirin and wild-type influenza infection.
   • People who have had more severe reactions to egg such as dizziness and/or lightheadedness, angioedema (swelling), vomiting, breathing difficulties (i.e., wheezing, shortness of breath), and/or who have been treated with epinephrine in the past for an egg allergy can also receive the recombinant influenza vaccine (egg-free) if they are 18 years of age or older or an inactivated influenza vaccine.  This must only be given by a physician, such as an allergist, with experience in the recognition and management of severe allergic conditions like anaphylaxis.  These individuals must also be observed for at least 30 minutes after vaccination.
3. People who have had anaphylactic reactions to the previous doses of any vaccine due to sensitivity to any of its components (i.e., gelatin, thimerosal, antibiotics) of the vaccine, should not receive any further doses of that particular vaccine.  Note that thimerosal-free influenza vaccines can be obtained for those who are either allergic to thimerosal or do not want thimerosal.
4. Individuals who have had Guillan-Barré Syndrome (a severe paralyzing illness) should not get any vaccine without consulting their physician.
5. People with egg allergies should also not get the vaccinations for yellow fever and certain rabies vaccines since they also may contain small amounts of egg protein.  The rabies vaccine Imovax can however be given to people with egg allergies, as Imovax is not cultured in chicken embryos and therefore does not contain egg proteins.  Desensitization to the yellow fever vaccine can be performed by an allergist in a medical setting.  If either the yellow fever or rabies vaccine is necessary, please consult with your physician.

The board certified allergists of Black & Kletz Allergy have over 50 years of experience in addressing the vaccination needs of people with food allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area based on the latest evidence-based clinical guidelines.  If you need to consult us on vaccinations, please make a appointment at one of our 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA) or Manassas, VA.

Dr. Michael R. Kletz has done clinical research on the topic of the administration of egg-derived vaccines in patients with a history of egg sensitivity.  Please click his research article that was published in the Annals of Allergy in the following link: http://www.ncbi.nlm.nih.gov/pubmed/2346238

Respiratory Tract Infections

• February 16, 2015
• BY BLACK & KLETZ ALLERGY

In the winter, everyone seems to either have had a “cold” or knows someone who has a “cold.”  When people refer to a “cold,” they are actually referring to some sort of respiratory tract infection.  To understand a respiratory tract infection, one must first know the parts of the body that make up the respiratory tract.  The respiratory tract can be broken down into two parts:  the upper respiratory tract and the lower respiratory tract.

The upper respiratory tract is located outside of the chest and is made up of the following:

1. Nasal cavity – The space inside the nose
2. Sinuses – The air-filled cavities in the skull
3. Pharynx – The space inside the mouth where the passages of the nose connect to the mouth and throat
4. Epiglottis – The flap that covers the trachea (windpipe) during swallowing, so that food does not enter the trachea and thus the lungs. It is on top of the larynx (voice box)
5. Larynx – The voice box (part of the throat that contains the vocal cords which is just above the trachea or windpipe)

The lower respiratory tract is located in the chest and is made up of the following:

1. Trachea – The windpipe or breathing tube
2. Bronchi – The trachea splits into 2 different smaller tubes.  One tube goes into the right lung and the other goes into the left lung.
3. Lungs – Consists of bronchioles (very small divisions of the bronchi within the lungs) and alveoli (very small air sacs within the lungs where air exchange of oxygen and carbon dioxide occurs)

Infections of each site above can occur and each has a corresponding name associated with the location.  Infections of such areas are usually named by putting the suffix “itis” (which means “inflammation of”) at the end of the anatomical location. The names of the infections of each location are listed below:

1. Nasal cavity – Rhinitis
2. Sinuses –  Sinusitis
3. Pharynx – Pharyngitis (i.e., Strep. throat, tonsillitis)
4. Epiglottis – Epiglottitis
5. Larynx – Laryngitis
6. Trachea – Tracheitis
7. Bronchi – Bronchitis
8. Lungs – Pneumonia (Note that one can also have bronchiolitis and/or alveolitis)

The cause of most respiratory tract infections is viruses.  There are over 200 known viruses that cause these infections.  In addition to viruses, a bacteria, fungus, or parasite can also be the cause of a respiratory tract infection. Most of the viruses that cause respiratory tract infections are the following:  rhinovirus, adenovirus, influenza virus (the “flu”), parainfluenza virus, enterovirus, coronavirus, and respiratory syncytial virus (RSV).

The symptoms of a respiratory infection range in type and severity depending upon the duration, and the virulence of the virus, bacteria, fungus, or parasite.  It also depends if the individual has any pre-existing risk factors or medical illnesses such as diabetes, immunodeficiency, elderly, underlying lung disease (asthma, COPD or chronic obstructive pulmonary disease, cystic fibrosis, etc.), smoking, allergies, congestive heart failure, crowded living conditions (i.e., dormitories, nursing homes, hospitals), exposure to others with a “cold” or flu, and/or lack of vaccination [i.e., influenza (flu), Pneumovax 23 and/or Prevnar 13 (pneumonia shots)].  Common symptoms include:

1. Malaise
2. Runny nose
3. Stuffy nose
4. Sore throat
5. Headache
6. Post-nasal drip
7. Cough (with or without sputum)
8. Fever and/or chills
9. Body aches
10. Wheezing
11. Shortness of breath
12. Chest pain

The diagnosis involves taking a detailed history followed by a careful physical examination.  Laboratory studies may include blood work, throat culture, chest X-ray, and CT scan of the sinuses.

Prevention of respiratory tract infections can never be 100%, but there are some common sense things that should be done in order to minimize contracting and passing on the infection.  One should avoid contact with other sick individuals, wash one’s hands frequently, stay home from school and/or work if one develops symptoms, get vaccinations for influenza ( flu) annually, if appropriate for that individual, get the Pneumovax 23 and/or Prevnar 13 vaccination (pneumonia shots) if elderly or immunocompromised, consult your physician within 48 hours for known exposure to the flu so that an antiviral medication such as Tamiflu can be prescribed within 48 hours of the beginning of flu symptoms.  Note that there are rapid diagnostic tests which entail a quick painless nasal swab to diagnose the flu. The result of the test is back within 15 minutes. It can be done in order to determine if you have the flu.  Keep in mind that the tests are between 50-70% accurate, but can help the physician in the diagnosis.

Treatment may range anywhere from supportive care such as drinking plenty of fluids, rest, gargling with salt water, and over the counter medications, to treatment with antibiotics, antiviral medication, corticosteroids, bronchodilator medications, intravenous therapy, oxygen administration, and very rarely a surgical procedure may be necessary. The vast majority of upper respiratory infections will resolve on their own, since most of them are of viral origin.

The board certified allergists of Black & Kletz Allergy have been treating respiratory tract infections in the Washington, DC Northern Virginia, and Maryland metropolitan area for over 5 decades.  If you are experiencing any of the above symptoms, please contact us for an appointment at any one of our 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), or Manassas, VA.  You can also click Request an Appointment and we will answer you within 24 hours of the next business day to schedule you an appointment. We strive to provide excellent care to our patients in a friendly, comfortable, and professional setting.