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Many patients who experience seasonal allergic rhinitis (i.e., hay fever) and allergic conjunctivitis (i.e., eye allergies) symptoms (e.g., sneezing, runny nose, nasal congestion, post-nasal drip, sinus congestion, itchy nose, itchy throat, sinus headaches, itchy eyes, watery eyes, redness of the eyes) caused by sensitivities to tree, grass, and weed pollens also may experience an itchy mouth and throat after eating certain fresh fruits and vegetables. As the symptoms are usually limited to the mouth and throat, this condition is known as “pollen food allergy syndrome” (PFAS). It is also known by the name “oral allergy syndrome” (OAS).

Most people with food pollen allergy syndrome have oral symptoms such as itching, burning, tingling, and occasionally swelling of the lips, mouth, tongue, and/or throat where the fresh fruit or vegetable touches the mouth. This represents a form of contact urticaria, since there is direct contact of the food to the mouth region. The symptoms usually only last a matter of seconds to a few minutes. The symptoms are also more likely to occur in the season that the cross-reactive pollens are also prevalent.

The oral symptoms occur only when a pollen-allergic individual is exposed to raw or fresh vegetables, fruits, and/or nuts. Food pollen allergy syndrome typically does not occur with cooked or baked fruits, vegetables, or processed fruits such as in applesauce as the cooking process inactivates or denatures the protein allergens in the foods. The exception to this rule is with celery and nuts where the oral allergy symptoms typically occur even if they have been cooked.

The cause for food pollen allergy syndrome is thought to be a cross-reactivity between the protein allergens in the pollen and the fresh fruits and/or vegetables. Fruit and vegetable proteins (i.e., allergens) share varying degrees of structural similarities with allergens found in pollens as well as other fruits and vegetables. This structural homology confuses the immune system and causes an allergic reaction to occur. The patient’s body “sees” the fruit or vegetable protein allergen as the pollen allergen and reacts to the food because it “thinks” it is the pollen. This homology or similarity between the food allergen and the pollen allergen is referred to as cross-reactivity.

Certain pollens are more likely to be cross-reactive with certain fruits, vegetables, and/or nuts. Below is a list of the cross-reactivity that may occur between common pollens and common raw or fresh fruits, vegetables, and/or nuts:

• Alder pollen: almonds, apples, celery, cherries, hazelnuts, peaches, pears, parsley
• Birch pollen: almonds, apples, apricots, avocados, bananas, carrots, celery, cherries, chicory, coriander, fennel, fig, hazelnuts, kiwi, nectarines, parsley, parsnips, peaches, pears, peppers, plums, potatoes, prunes, soy, strawberries, wheat, peanuts
• Grass pollen: fig, melons, tomatoes, oranges
• Mugwort pollen (i.e., celery-mugwort-spice-syndrome): carrots, celery, coriander, peppers, fennel, parsley, sunflower
• Ragweed pollen: banana, cantaloupe, honeydew, watermelon, cucumber, zucchini, Echinacea, artichoke, dandelions, hibiscus tea, chamomile tea

Note: Any of the above pollens may cross-react with berries (e.g., strawberries, blueberries, raspberries), citrus (e.g., oranges, lemons), grapes, mango, fig, peanut, pineapple, pomegranates, and/or watermelon.

When a fruit or vegetable allergy develops in the absence of a pollen allergy, patients may be sensitized to nonspecific lipid transfer proteins (nsLTPs) or to gibberellin-regulated proteins (GRPs). In general, sensitization to these proteins is associated with higher rates of systemic reactions as well as higher rates of food-dependent, exercise-induced anaphylaxis. The allergens responsible for isolated food allergy are typically resistant to both heat and digestion and therefore have a greater potential to cause systemic symptoms.

There are also several syndromes that are associated with pollens and foods:

• Celery-mugwort-birch-spice syndrome — The celery-mugwort-birch-spice syndrome is a potentially severe form of celery allergy seen in children and adults who are sensitized to both birch and mugwort pollens. Patients with this syndrome react to celeriac (i.e., root of the celery plant or celery tuber).
• Mugwort-pollen food allergy syndrome — Patients sensitized to mugwort (Artemisia vulgaris) may develop a systemic food allergy (e.g., to mustard).
• Latex-fruit syndrome — Approximately 30-50% of individuals who are allergic to natural rubber latex show an associated hypersensitivity to some plant-derived foods, especially fresh fruits. An increasing number of plant foods, such as avocado, banana, bell pepper, chestnut, kiwi, peach, tomato, and white potato, have been associated with this syndrome.

Diagnosis: The diagnosis is suspected when a comprehensive history is suggestive of pollen food allergy syndrome. Allergy tests such as prick skin testing, food elimination, and oral food challenges are helpful in establishing the diagnosis. Food prick skin testing with fresh foods is more reliable than commercial extract food prick skin testing because the process of making the extract can destroy the responsible protein allergen.

Treatment: The treatment of pollen food allergy syndrome involves avoiding exposure to the involved fresh or raw fruits, vegetables, and/or nuts to prevent the uncomfortable feeling in the mouth and throat, as well in order to reduce the risk of rare systemic symptoms. Taking antihistamines can minimize the severity of the symptoms however systemic reactions need treatment with epinephrine injections. Patients with a history of a systemic reaction should be prescribed a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) and instructed on when and how to use it. It is important that the patient go immediately to the closest emergency room once a self-injectable epinephrine device is used.

Some studies have demonstrated that treating pollen allergies with allergy immunotherapy (i.e., allergy shots, allergy injections, allergy hyposensitization) can reduce the symptoms associated with cross-reacting fruits and vegetables that cause pollen food allergy syndrome.

The board certified allergy doctors at Black & Kletz Allergy will eagerly respond to your needs for further information and services in dealing with food allergies, pollen food allergy syndrome, and other allergic and immunologic disorders.  The allergists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We offer on-site parking at all of our offices and our 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.  To make an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond to your inquiry within 24 hours by the next business day.  Black & Kletz Allergy treats both adults and children and we strive to provide the best and most current diagnostic and treatment modalities in the Washington, DC metro area, as we have done for more than 5 decades.

Corn (i.e., maize) is a popular staple food worldwide, providing essential nutrients such as vitamins, minerals, and fiber. Corn is also a common component of processed foods. Despite its nutritional value and popularity, for those individuals with corn allergies or corn intolerance, consuming corn or corn-derived products may lead to adverse health effects.

Although corn allergies and intolerance are relatively uncommon compared to other food allergies and intolerances, they can still cause significant discomfort and health issues for affected individuals. Corn allergies are caused by an overreaction of the immune system to proteins found in corn whereas corn intolerance typically results from the body’s inability to digest or process corn.

Corn Allergy:

There may be a genetic predisposition to developing a corn allergy, as it is more common in individuals with a family history of allergies or other allergic conditions, such as asthma or eczema (i.e., atopic dermatitis). Corn allergy is not a very common food allergy. The prevalence of corn allergy is approximately 2% in whites, 7% in Hispanics, and 15% in African Americans. Corn allergy occurs when the immune system mistakenly identifies corn proteins as harmful substances. As a result, an allergic reaction ensues against the corn protein. In this allergic reaction, the body produces immunoglobulin E (IgE) antibodies which trigger the release of chemical mediators such as histamine, leukotrienes, prostaglandins, as well as other inflammatory chemicals. In doing so as a mechanism to “kill” or “get rid of” the allergen (e.g., corn protein), the individual experiences classic allergy symptoms such as itching (i.e., pruritus), hives (i.e., urticaria), swelling (i.e., angioedema), gastrointestinal symptoms, wheezing, shortness of breath, or anaphylaxis.

Zein is the major storage protein found in corn. It makes up about 45% of the protein in corn. Zein is used as a coating for nuts, pills, candy, fruit, as well as other encapsulated foods and medications. In addition to zein, lipid transfer protein and profilin are two other proteins that are found in corn. These 2 proteins are primarily responsible for most of the corn allergy that occurs. Allergies to the heat-stable lipid transfer protein in corn may cause severe allergic reactions whereas an allergy to the heat-sensitive profilin protein usually only cause mild to moderate reactions.

Symptoms:

Mild to moderate corn allergy symptoms may include sneezing, itchy mouth, itchy throat, runny nose, nasal congestion, post-nasal drip, generalized itching, hives, and/or gastrointestinal issues such as nausea, vomiting, and/or diarrhea.

In rare instances, corn allergy may lead to anaphylaxis, a severe and potentially life-threatening allergic reaction. The symptoms of anaphylaxis may include hives, swelling of the throat or tongue, wheezing, shortness of breath, rapid or weak pulse, and/or a sudden drop in blood pressure.

Diagnosis:

The diagnosis of corn allergy requires a thorough history of the timeline of consumption of the corn-containing food(s) and the symptoms experienced. The diagnosis can be confirmed by identification of corn specific IgE antibodies either by skin prick testing or by blood testing. The gold standard for establishing the diagnosis of corn or any other food allergy however is an oral food challenge.

Corn allergy may be associated with cross-reactivity to other food allergens such as certain grains, legumes, and seeds. A high degree of cross-reactivity has been demonstrated among the lipid transfer proteins of corn (maize), peach, apple, apricot, walnut, hazelnut, peanut, rice, sunflower seeds, and French beans. This cross-reactivity means that individuals with a corn allergy may also experience allergic reactions to other foods containing similar proteins.

Occupational exposure to maize, maize dust, or maize flour may result in occupational asthma or rhinitis, in particular in mill workers, bakery workers, and those working in the animal feed industry. Allergic reactions have also been reported to cornstarch powder when used as a glove lubricant. Symptoms include hives, swelling episodes, sneezing, runny nose, nasal congestion, post-nasal drip, itchy eyes, watery eyes, redness of the eyes, asthma, and/or intermittent episodes of shortness of breath.

Corn has been implicated as one of the foods that can cause eosinophilic esophagitis, a disorder with symptoms suggestive of gastroesophageal reflux disease (GERD) but unresponsive to conventional anti-reflux therapies.

Treatment:

The treatment of corn allergy usually includes the use of antihistamines. Antihistamines can relieve the mild symptoms of allergic reactions such as itching and rashes. Severe reactions such as anaphylaxis usually require epinephrine injections either with a syringe and a needle or with a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick). It should be noted that if an individual uses a self-injectable epinephrine device, they must go immediately to the closest emergency room.

Prevention:

The avoidance of foods containing corn products is the only definitive preventive measure. It is essential to read food labels carefully, as corn-derived ingredients can be found in various foods under different names, such as cornstarch, corn syrup, dextrin, and maltodextrin. It is essential to be vigilant about identifying hidden sources of corn and choosing alternative products when necessary. Corn may be present in salad dressings, sauces, processed meats, and in certain medications and supplements.

Corn Intolerance:

Certain enzymes such as amylase are necessary to break down complex carbohydrates into simple digestible sugars. The deficiency of these enzymes can result in bothersome gastrointestinal symptoms such as abdominal bloating, cramping, abdominal pain, and diarrhea after consuming corn products.

Sensitivity to specific corn components, such as cornstarch or corn syrup, may also contribute to corn intolerance. Though less common, intolerance can also result in skin manifestations such as rashes and itching, as well as respiratory symptoms such as cough, chest tightness, wheezing, and/or shortness of breath.

Corn is a low FODMAP food. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. Foods high in FODMAPs may cause symptoms of food intolerance, thus affecting the gastrointestinal system. These symptoms of intolerance however can be mistaken for a true food allergy. Note that even though corn is a low FODMAP food, corn syrup, on the other hand is a high fructose food and thus considered a high FODMAP food.

Corn, like other grains, contains a moderate amount of lectins. Lectins are another cause of food intolerance. Cooking foods with lectins makes them more digestible and can reduce the symptoms of food intolerance however.

Corn allergy has been associated with a condition called “latex food syndrome.” The syndrome occurs when an individual who has a latex eats a food that has proteins in it that are similar to the proteins found in latex. The rubber tree plant Hevea brasiliensis which is involved in latex allergy, has an allergen called Hev b 11 which is a chitinase protein. Many plant and animal tissues contain chitinase proteins which are allergenic. Corn, kiwi, chestnut, mango, banana, avocado, pomegranate, and dates all contain chitinase proteins. Those that are sensitized to latex may have allergic reactions from foods containing similarly shaped proteins. Approximately 30% to 50% of individuals with latex allergies have a cross-reaction to foods with these proteins. The symptoms are primarily oral symptoms (e.g., itchy mouth, lips, tongue and throat) and are often referred to as oral allergy syndrome or pollen food allergy syndrome. Oral allergy syndrome mostly affects people who already suffer from pollen allergies and seasonal allergic rhinitis.

Prognosis:

Healthcare professionals, patients, and caregivers all play a vital role in the successful management of corn intolerance and allergies. Working together to identify triggers, develop individualized management plans, and provide ongoing support can help ensure that individuals with corn allergies or intolerance can live healthy and fulfilling lives.

If you suffer from a corn allergy or other food allergy or intolerance of any kind, the board certified allergists at Black & Kletz Allergy have the expertise in order to diagnose and manage this condition. We treat both pediatric and adult patients and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have on-site parking at each location and both the Washington, DC and McLean, VA offices are Metro accessible. Please either call us for an appointment or you may alternatively click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy have been treating allergy, asthma, and immunology patients in the Washington, DC metropolitan area for more than 5 decades and we strive to provide state-of-the-art allergy care in a professional and amiable setting.

Snoring is not an uncommon symptom in patients with allergic rhinitis (i.e., hay fever). Snoring is the harsh sound that arises when air flows past the relaxed tissues in the throat. The actual snoring sound is a result of the vibration of the throat’s tissues as one breathes. Mild intermittent snoring is quite common and occurs in almost everyone. Chronic moderate or severe snoring however is not normal and may indicate a serious health malady. It may also point to an underlying health condition such as sleep apnea, allergic rhinitis, nasal polyps, obesity, enlarged tonsils, etc.

Sleep apnea is a condition in which one’s breathing is continually interrupted. The result is the inability to get enough deep sleep that is essential to revitalize the body. The characteristic symptoms of this condition include extreme daytime somnolence which often results in falling asleep at inappropriate times. Sleep apnea should not be taken lightly as it can be very serious and is a potentially fatal disorder. In addition to falling asleep and daytime sleepiness, other symptoms may include snoring (as mentioned above), fatigue, depression, diminished productivity at work and/or school, decreased memory, decreased quality of life, and a reduced ability to learn. As mentioned above, allergic rhinitis (i.e., hay fever) has also been linked to many of the same symptoms. Allergic rhinitis in combination with sleep apnea can have harmful effects including heart disease, stroke, sexual dysfunction, and an increased risk for motor vehicle accidents. As a result, sleep apnea should be taken seriously. Although it is estimated that roughly 25 million adults in the U.S. have sleep apnea. The actual numbers are probably much higher since cases are underdiagnosed due to a variety of reasons. In addition, many individuals with sleep apnea are simply unaware that they have the condition.

There are 2 types of sleep apnea, “obstructive sleep apnea” and “central sleep apnea.” In obstructive sleep apnea, the breathing or air flow is blocked or “obstructed.” The obstruction is often caused by the tongue sliding back in the throat. In addition, the relaxed airway that occurs during sleep changes shape to a more oval shape. This change in shape of the airway contributes to the decrease in air that reaches the lungs. In essence, the muscles of the throat relax and fail to hold the airway open during sleep. As a result, oxygen levels are decreased in the tissues. In central sleep apnea, the normal unconscious breathing basically stops, usually due to the brain not sending the normal signals to the muscles that control breathing. Central sleep apnea is much less common than the obstructive type of apnea and not associated with allergies. For the purposes of this blog article, only obstructive sleep apnea is discussed.

The severity of the sleep apnea can be put into 3 categories: mild, moderate, and severe. The severity is based on the number of episodes or events of apnea that occur per hour of sleep. An episode or event is described as a complete stoppage of breathing for at least 10 seconds or shallow breaths for at least 10 seconds. Sleep apnea is considered “mild” when there are 5-14 episodes of apnea or hypopnea (i.e., shallow breathing) per hour. It is deemed “moderate” when there are 15-29 episodes of apnea or hypopnea per hour. It is called “severe” when there are 30 or more episodes of apnea or hypopnea per hour.

The diagnosis of sleep apnea is best done with a sleep study. Historically, patients were asked to come to a sleep center for an overnight sleep study. During the sleep study the individual’s blood pressure, heart rate, respiratory rate, oxygenation level, and brain electrical activity is monitored throughout the night. More recently, the sleep study is often done in the patient’s home with some of these measures closely monitored and recorded. In addition allergy skin testing or blood testing may be performed in individuals exhibiting allergic rhinitis symptoms. Some of these symptoms may include sneezing, itchy nose, runny nose, nasal congestion, post-nasal drip, snoring, sinus pressure, sinus headaches, fatigue, itchy throat, itchy eyes, watery eyes, and/or redness of the eyes.

The most efficacious management of sleep apnea is the use of CPAP (continuous positive airway pressure) while sleeping. CPAP machines are used in order to deliver a continuous flow of pressure which as a result forces open the obstruction in the airway. The patient has 3 options how to receive the continuous airflow delivered by the CPAP machine which includes a full face mask, a nasal mask, or nasal pillows or prongs. The full face mask is the most cumbersome whereas the nasal pillows or prongs are the least awkward. The choice is completely up to the patient and many individuals try all 3 until they find the best match for themselves. It should be pointed out that the main obstacle in the treatment of sleep apnea is compliance, as more than half of patients do not use CPAP when prescribed, mostly due to it being uncomfortable and annoying.

The use of dental or mouth devices are controversial but may help lessen symptoms in patients with mild obstructive sleep apnea. Surgery can also be performed in order to improve obstructive sleep apnea. The “Inspire Sleep Apnea Innovation” is a form of upper airway stimulation (UAS). It is a surgical procedure in which a monitoring device is implanted into one’s chest and a neurostimulator device is implanted below one’s chin in order to monitor one’s breathing and send a gentle pulse to the nerve that controls tongue motor function, moving it forward and out of the way so one can breathe properly. This treatment received FDA approval in 2014. Other surgical procedures are somewhat controversial in regards to their efficacy. One of these is a uvulopalatopharyngoplasty which is one of the most common surgical procedures for treating obstructive sleep apnea, although as mentioned above, not necessarily the most effective. It is performed to remove excess tissue in the throat such as the uvula, adenoids, tonsils, and parts of the soft palate.

Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. The board certified allergy doctors at Black & Kletz Allergy are extremely knowledgeable regarding the diagnosis and treatment of snoring and sleep apnea. In our practice we also treat patients with environmental allergies (i.e., allergic rhinitis or hay fever), eye allergies (allergic conjunctivitis), asthma, eczema (i.e., atopic dermatitis), hives (i.e., urticaria), contact dermatitis, medication allergies, generalized itching (i.e., pruritus), swelling episodes (i.e., angioedema), insect sting allergies, food allergies, eosinophilic esophagitis, Mast cell disorders, and immune disorders. To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day. We have been serving the greater Washington, DC metropolitan region for more than 50 years and we look forward to providing you with exceptional allergy care in a welcoming and professional environment.

The Eustachian tube is a small canal that connects the middle ear to the back of the nose and upper throat.  It is normally closed but opens when we swallow, yawn, or chew.

Normal functions of the Eustachian tube:

Dysfunction of the Eustachian tube or Eustachian tube dysfunction (ETD) may occur when the mucosal lining of the tube is swollen or does not open or close appropriately.

Causes:

Risk Factors:

Symptoms:

Complications:

Diagnosis:  

The inability to “clear” or “pop” the ear with changes in barometric pressure, together with other patient-reported symptoms (e.g., aural fullness, pain, muffled hearing) is consistent with Eustachian tube dysfunction.

Tests: 

Treatment:

Non-Surgical:

Surgical:

Of note:  The opposite condition of Eustachian tube dysfunction is called patulous Eustachian tube.  In this malady, there is an abnormal patency of the Eustachian tube.  Instead of being in the normal closed position, the Eustachian tube stays intermittently open, causing an echoing sound of the person’s own heartbeat, breathing, and/or speech.  These sounds will then vibrate directly onto the eardrum causing a “bucket on the head” sound effect.  This condition can usually be managed by nasal sprays.  Rarely, surgical intervention is warranted.

The board certified allergists at Black & Kletz Allergy has 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  The allergy specialists of Black & Kletz Allergy diagnose and treat both adult and pediatric patients.  For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy have been helping patients with Eustachian tube dysfunction, allergic rhinitis (i.e., hay fever), asthma, sinus disease, eczema (i.e., atopic dermatitis), hives (i.e., urticaria), insect sting allergies, immunological disorders, medication allergies, and food allergies for more than 50 years.  If you suffer from allergies, it is our mission to improve your quality of life by reducing or preventing your undesirable and annoying allergy symptoms.

The term “chronic sinusitis” is defined as an inflammation of the sinus or sinuses lasting more than 12 weeks in duration. The inflammation can be of any etiology however it is implied and commonly agreed upon that infection is the primary cause of chronic sinusitis. In order to understand chronic sinusitis, it is important to know the anatomy of a sinus. A sinus is a cavity in any organ or tissue, but in reference to allergies, it is a cavity in the skull and often referred to a “paranasal sinuses.” There are 4 paired sinuses in the cranial bones. They are named for their location with regards to the head and face. The names of the sinuses include the frontal, ethmoid, sphenoid, and maxillary sinuses. The frontal sinuses are located in the forehead region above the eyes. The ethmoid sinuses are situated between the eyes on each side of the upper nose. The sphenoid sinuses are positioned behind the eyes and bridge of the nose and lie in the deeper areas of the cranium. The maxillary sinuses are located on either side of the nostrils in the cheekbone areas.

The symptoms of inflammation of the sinuses or a chronic sinus infection may include a sinus headache, facial pressure or pain, post-nasal drip, discolored nasal secretions, cough and/or fatigue. It should be noted that it is not uncommon for an individual to present with just a chronic cough without many additional sinus symptoms. The diagnosis of chronic sinusitis requires a comprehensive and physical examination. There is often a history of onset of the infection as well as a progression of specific symptoms which may help diagnose the sinus infection. In some instances, sinus X-rays and/or CT scans of the sinuses may be helpful in the diagnosis.

The treatment of chronic sinusitis varies depending upon how severe the symptoms are in each individual patient. Oral antibiotics are the most common treatment however a longer course of antibiotics is usually prescribed due to the chronicity of the infection. It is not uncommon to treat these patients with 30 days of continuous oral antibiotics. Topical corticosteroids are sometimes useful in the local treatment of bacterial infections.  The effects are usually short-lived however. The nasal corticosteroids are not currently recommended for routine use; however, they offer the potential for improved directed treatment of the sinuses. Saline irrigation or saline nasal strays are useful in the mechanical clearance of allergens, irritants, and microorganisms (i.e., bacteria, viruses) from the nasal and sinus cavities.  Saline irrigation is an inexpensive and easy to use method of “cleaning” the nasal and sinus cavities. It is often used in conjunction with other treatments such as nasal corticosteroids and oral antibiotics to treat chronic sinusitis. It should be noted that some individuals do not like saline irrigation as it may cause some discomfort in the nasal or sinus passages. Topical antibiotics are sometimes useful in the local treatment of bacterial infections. As with nasal corticosteroids, the effects are usually short-lived and topical antibiotics are not currently recommended for routine use; however, they offer the potential for improved directed treatment of the sinuses.

Occasionally, a more aggressive treatment regimen for chronic sinusitis is necessary and other medications are then utilized. Oral corticosteroids are implemented in more severe or recalcitrant cases. Oral corticosteroids reduce inflammation and are particularly useful for shrinking nasal polyps, though they also may result in the multisystem improvement of symptoms.  Nasal polyps (i.e., nasal polyposis) are soft, benign growths that develop from the lining of the sinuses and nasal cavity. Approximately 4-5% of the general population has nasal polyps.  Nasal polyps cause increased nasal congestion and may block the normal drainage pattern of the sinuses. As a result, sinus infections are more likely to develop in these individuals. It should be pointed out that oral corticosteroids carry a risk for significant systemic side effects such as weight gain, peptic ulcers, cataract formation, thinning of one’s bones, depression, and/or endocrine dysfunction. They should be used judiciously and only for brief periods of time. In addition to oral corticosteroids, biological medications are being used more often to treat chronic sinusitis with nasal polyps. Biological medications can offer targeted and more effective treatment than other therapies.  The potential advantages of biological medications include the reduced need for oral or topical corticosteroids as well as the need for sinus surgery. A few of these biological agents are currently being used for the control of asthma but only one of them, Dupixent (dupilumab) has been approved for chronic sinusitis with nasal polyps.

Prevention is always the goal in any malady if at all possible. For chronic sinusitis, preventive measures include the identification of specific allergen sensitivities and the subsequent avoidance or preventive treatment for these allergies. Allergy testing should be done by skin testing or blood testing. Aggressive treatment of any seasonal or perennial allergic rhinitis (i.e., hay fever) promotes proper sinus drainage and as a result improves upper airway function. Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a very effective tool to treat allergies and asthma as it works in 80-85% of patients that take them. The average treatment length of allergy shots is typically 3-5 years.

The board certified allergists at Black & Kletz Allergy treat both pediatric and adult patients. We diagnose and treat chronic sinusitis as well as other types of sinus disease, allergic rhinitis (hay fever), allergic conjunctivitis (i.e., eye allergies, asthma, allergic shin disorders , anaphylaxis, food allergies, medication allergies, insect sting allergies, eosinophilic esophagitis, mast cell disorders, and immunological disorders. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and the McLean, VA office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line. You may also click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been a fixture in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years for our outstanding services for the diagnosis and management of allergic, asthmatic, and immunological conditions.

Allergic reactions to sesame are increasing in incidence over the past several years. Sesame is the 9th most common food allergy among children and adults. Approximately 0.23% of the U.S population are allergic to sesame. Although 0.23% seems like a small number, the National Institute of Health’s (NIH) researchers estimate that 17% of food-allergic children have a sesame allergy.

In the past, according to the Center for Science in the Public Interest, only 14 out of 22 major food companies clearly labeled sesame ingredients on their product labels. However, on April 23, 2021, the FASTER (Food Allergy Safety, Treatment, Education, and Research) Act was passed into law. This law requires that sesame be labeled on all packaged foods in the United States. This sesame labeling began earlier this year on Jan. 1, 2023.

Sesame joins the 8 other foods that are already declared as major food allergens by federal law. The 9 major food allergens are as follows:

• Milk
• Eggs
• Fish (e.g., bass, flounder, cod)
• Crustacean shellfish (e.g., crab, lobster, shrimp)
• Tree nuts (e.g., almonds, walnuts, pecans)
• Peanuts
• Wheat
• Soybeans
• Sesame

The protein that is contained in sesame seeds, sesame oil, tahini, etc. binds to the specific antibodies in one’s serum and causes reactions that cause the release of histamine and other chemical mediators which are responsible for the allergic symptoms that occur. Most allergic reactions to sesame are caused by oleosins, the proteins in sesame.

Symptoms: Individuals with a sesame allergy may experience a variety of symptoms that can range from mild to severe. The symptoms may include itchiness of the throat or mouth, generalized itching (i.e., pruritus), hives (i.e., urticaria), swelling (i.e., angioedema), nausea, vomiting, diarrhea, abdominal pain, flushing of the face, hoarseness, coughing, wheezing, and/or shortness of breath

A person with a severe reaction to sesame may experience anaphylaxis. Anaphylaxis is a life-threatening reaction that requires immediate medical attention. Some of the symptoms of anaphylaxis may include hives, shortness of breath, generalized itching, swelling, wheezing, fainting, dizziness, drop in blood pressure, rapid heartbeat, and/or cardiac arrest. Individuals who experience anaphylaxis due to sesame should carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) with them at all times. If the self-injectable epinephrine device is used, they should go immediately to the closest emergency room.

In packaged foods manufactured prior to January 1, 2023, sesame may appear undeclared in ingredients such as flavors or spice blends. Some foods that may contain sesame:

• Asian cuisine – Sesame oil is commonly used in cooking
• Baked goods (e.g., bagels, bread, breadsticks, hamburger buns, rolls)
• Bread crumbs
• Cereals (e.g., granola, muesli)
• Chips (e.g., bagel chips, pita chips, tortilla chips)
• Crackers (e.g., melba toast, sesame snap bars)
• Dipping sauces (e.g., baba ghanoush, hummus, tahini sauce)
• Dressings, gravies, marinades, and sauces
• Falafel
• Hummus
• Flavored rice, noodles, risotto, shish kebabs, stews and stir fry
• Goma dango (i.e., Japanese dessert)
• Goma dofu (i.e., Japanese sesame “tofu”)
• Herbs and herbal drinks
• Margarine
• Pasteli (i.e., Greek dessert)
• Processed meats and sausages
• Protein and energy bars
• Snack foods (e.g., pretzels, candy, Halvah, snack mix, rice cakes)
• Soups
• Sushi

Some non-food items that may contain sesame:

• Cosmetics
• Medications
• Supplements
• Pet food

Diagnosis: Skin Prick Testing – A safe and low-risk test in which the skin is lightly pricked with a suspected allergen. This can result in a raised bump or hive, with more severe reactions pointing to a greater likelihood of an allergy.

Blood Test – Measures the amounts of IgE antibodies (i.e., “allergy” antibodies) that the immune system has deployed as an allergic response to sesame.

Like tree nut allergies, sesame allergies are sometimes cross-reactive. In other words, if you are allergic to sesame, you could be allergic to similar seeds and nuts.

Treatment: Mild allergic reactions to sesame can be treated with antihistamines. Systemic reactions with generalized symptoms needs to be treated with injectable epinephrine.

Prevention: Diligent reading of the labels and strict avoidance of exposure to all sesame-containing products is necessary in order to prevent allergic reactions to sesame. Most patients with sesame allergy unfortunately do not “outgrow” the sensitivity.

If you suffer from or suspect a sesame allergy or any other type of allergy, the board certified allergists at Black & Kletz Allergy have the expertise in diagnosing and treating your condition. We treat both pediatric and adult patients and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have on-site parking at each location and both the Washington, DC and McLean, VA offices are Metro accessible. Please either call us for an appointment or you may alternatively click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy have been treating allergy, asthma, and immunology patients in the Washington, DC metropolitan area for more than 5 decades and we strive to provide state-of-the-art allergy care to its residents and visitors.

It is quite common for individuals to be allergic to mold, particularly in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Not only is the humidity elevated in this region, but Washington, DC was built on a swamp. In the Spring, it rains quite often contributing to an increase in moisture and thus mold. In the Summer, the metro area tends to be hot and humid which is ideal for mold growth. During the Fall, the leaves fall from the trees and get wet which is the perfect environment for the development and progression of mold. Even during the Winter mold can flourish particularly since mold lives both indoors and outdoors. In the home, molds tend to be more prevalent in bathrooms, kitchens, and basements, where moisture is more common. It is interesting to note that some molds can survive in very arid environments such as a desert. Any way you slice it, mold is year-round problem for residents and visitors of the Washington, DC metropolitan area.

Mold is a fungus that grows in the form of multicellular filaments that are known as hyphae.  There are over 400,000 types of molds. Mildew is also a fungus that closely resembles mold. Mold typically looks fuzzy in appearance while mildew characteristically is flat in appearance. The color of mold tends to be black, blue, green, or red whereas the color of mildew tends to be white, brown, or gray. Mold and mildew produce undesirable odors that many people find offensive or downright problematic as they can cause “sicknesses” to those exposed. Fungi that grow in a single-celled environment are called yeasts.  Regardless of their characteristics, mold, mildew, and yeast can all play havoc to individuals who are either sensitive or allergic to them. Regarding allergies to mold, mildew, yeast, and fungi, an allergy to any one of them is generally grouped into one category as “allergy to mold,” as opposed to an allergy to mildew, an allergy to yeast, or an allergy to fungi.

Molds produce tiny microscopic which are their reproductive structures. The diameter of a mold spore generally varies between 3 to 45 microns which is less than half the width of a typical human hair. The mold spores begin are released into the air and since they are tiny in size, they are able to float in the air, where they can be easily inhaled by sensitive individuals. Mold spores flourish in any milieu with a constant source of moisture. As mold grows, the tiny spores begin to undergo chemical reactions that allow them to consume nutrients and further replicate.  These chemical reactions produce fumes which are released into the atmosphere. These fumes are responsible for the unpleasant musty odor that everyone is familiar with.

Mold generally can cause annoying symptoms in 4 different ways. The first is from a true allergy to the mold. The most common type of symptoms from mold allergy are the kinds of symptoms one may experience from other environmental allergens such as dust mites, pollens, pets, or cockroaches. These allergic rhinitis (i.e., hay fever) and allergic conjunctivitis (i.e., eye allergies) symptoms may include sneezing, runny nose, post-nasal drip, nasal congestion, itchy throat, sore throat, sinus headaches, snoring, itchy eyes, watery eyes, puffy eyes, and/or redness of the eyes. Severely affected individuals as well as asthmatics may also develop asthma symptoms or an exacerbation of their asthma which may include wheezing, chest tightness, coughing, and/or shortness of breath. The diagnosis of mold allergy necessitates a comprehensive history and physical examination in conjunction with allergy testing (skin tests and/or blood tests). The treatment of mold allergy always begins with prevention. Avoiding mold is always preferable if at all possible. Some of the ways to help reduce mold exposure may include decreasing outdoor activities when mold counts are high, repairing any leaks, lowering the humidity, using a dehumidifier, using air conditioner with a HEPA filter, removing carpets in locations where they are in danger of becoming wet, and masking when engaging in yardwork. The treatment of mold allergy consists of allergy medications (e.g., antihistamines, decongestants, nasal corticosteroids, nasal antihistamines, leukotriene antagonists, eye drops, asthma inhalers) to help relieve one’s symptoms.  Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are extremely effective in the treatment of mold allergy.  They are effective in 80-85% of the patients who receive them. Allergy injections have been given in the U.S. for more than 100 years as they get more to the root of the underlying problem by allowing a patient to develop protective antibodies against mold as well as other allergens such as dust mites, pollens, pets, and/or cockroach.

An unusual allergy to mold exists in roughly 1-2% of individuals with asthma. These individuals have an allergic reaction to a specific type of mold known as Aspergillus fumigatus.  Similarly, between 2-15% of children with cystic fibrosis have the same reaction to this same mold. Asthmatic and cystic fibrosis patients that react to this mold have a condition known as allergic bronchopulmonary aspergillosis (ABPA). The symptoms of ABPA are similar to that of asthma except they may also cough up sputum with brownish flecks and they may also have a mild low-grade fever. Such patients should be worked up for ABPA via X-rays/CT scans, pulmonary function tests, sputum cultures, blood tests, and allergy skin tests. The treatment of ABPA usually involves the use of medications to treat asthma with the possible addition of oral corticosteroids and/or antifungal medications.

The second way mold can affect an individual is from a non-allergic irritant reaction. Molds can release substances known as volatile organic compounds (VOC’s) which can irritate skin and mucus membranes inside the mouth, nose, and eyes resulting in burning sensation of the skin, itchy throat, runny nose, itchy eyes, watery eyes, and/or cough. Avoidance is the best way to prevent irritant reactions. Using air filters may also be of help.

The third manner in which a mold can cause bothersome symptoms is via a toxic reaction usually by way of inhaled or ingested toxic compounds called mycotoxins, which are produced by the mold. The molds that produce mycotoxins can pose serious health risks to humans and animals.  Some studies claim that the exposure to high levels of mycotoxins can result in neurological complications and prolonged exposure may be particularly harmful. The research on the health effects of these types of molds is somewhat controversial and it has not been conclusive. The term “toxic mold” refers to molds that produce mycotoxins, such as Stachybotrys chartarum and not to all molds in general. Mold remediation by a professional mold remediation service is the best way to remedy this situation.

The fourth method in which a mold can cause unwanted symptoms is by causing an infection. This results from the growth of a pathogenic mold within the body. The most common way that molds/fungi cause infections is through the skin. It should be noted that different types of molds/fungi can cause infections in other organ systems which may lead to gastrointestinal, respiratory, and/or neurological problems. Antifungal medications and occasionally other medications are used in order to eliminate the fungal infection.

The board certified allergy doctors at Black & Kletz Allergy will promptly respond to any questions regarding mold allergy or any other allergic or immunologic disorders. We have been treating mold allergies for more than 50 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 a long time and treat both pediatric and adult 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. If you are concerned that you may have a mold allergy or any other allergy, asthma, sinus, skin, or immunology problem(s), please call us to schedule an appointment. You may also click Request an Appointment and we will answer within 24 hours by the next business day. At Black & Kletz Allergy, we strive to improve the quality of life in allergic and asthmatic individuals in a professional and compassionate environment.

Nasal polyps (i.e., nasal polyposis) are soft, benign growths that develop from the lining of the sinuses and nasal cavity. Approximately 4-5% of the general population has nasal polyps. They look like glistening moist grapes and are typically in the shape of teardrops. These new growths result from chronic inflammation of the tissues inside the nasal and sinus cavities. When the nasal polyps grow large enough, they may obstruct the nasal passages which will block the flow of air through the nose. The mechanical obstruction may also block the passage of secretions from the sinuses into the nose which may result in the predisposition of individuals to develop recurrent or chronic sinus infections.

CAUSES: Any condition which ends in chronic inflammation inside the sinuses and nose may lead to the formation of nasal polyps.   Some of these conditions may include: 1. Allergic sensitivity to indoor or outdoor environmental allergens mediated by an the IgE antibody and elevated levels of interleukin 5 (IL-5) cytokine. 2. Chronic sinus infections from bacteria such as Staphylococci as seen in chronic rhinosinusitis with nasal polyposis (CRSwNP). 3. Allergic response to fungal organisms in the inhaled air which is called allergic fungal rhinosinusitis (AFRS). 4. Systemic inflammatory disorders such as aspirin exacerbated respiratory disease (AERD) and cystic fibrosis (CF). Aspirin exacerbated respiratory disease is also called Samter’s triad because it consists of 3 features: asthma, nasal polys that re-occur, and an intolerance to aspirin and NSAID’s (nonsteroidal anti-inflammatory drugs). Between 6% and 48% of individuals with cystic fibrosis develop nasal polyps, so cystic fibrosis should be entertained in anyone who presents with nasal polyps. 5. Eosinophil (i.e., a type of white blood cell) disorders such as eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome. 6. Chronic irritation from smoke, strong odors, and pollutants in the air. 7. Immunodeficiencies such as common variable immunodeficiency, selective IgA deficiency, and primary ciliary dyskinesia

SYMPTOMS: The symptoms of nasal polyps usually include nasal congestion and a runny nose in the early stages. As time goes on, nasal congestion resulting in a difficulty in breathing through the nostril(s) may occur. The nasal congestion usually worsens as the size of the polyp increases. Other symptoms of nasal polyps may include post-nasal drip, facial pain, headache, decreased or loss of taste (i.e., ageusia) and/or smell (i.e., anosmia), and snoring.

DIAGNOSIS: The diagnosis of nasal polyps is generally made by examining the nasal cavity with a light source. The presence of nasal polyps will be revealed by shiny, mobile, smooth, gray, and semi-translucent masses. These Inflammatory polyps are usually present in both nostrils. It is important to note that some neoplastic polyps may only be present on one side (i.e., in one nostril). Rhinoscopy is often utilized to visualize the nasal cavity. Imaging of the sinuses with a CT scan may be needed in order to estimate the extent of the polyposis and to plan for surgical removal, if indicated. Allergy testing (e.g., skin testing, blood testing) is often performed to check for environmental allergies. A sweat chloride test may also be performed particularly in children in order to rule out cystic fibrosis.

COMPLICATIONS: Some complications may arise from having nasal polyps. The problems may include nose bloods (i.e., epistaxis), recurrent or chronic sinusitis, asthma exacerbations, obstructive sleep apnea/snoring, and rarely double vision (i.e., diplopia).

TREATMENT: 1. Intranasal corticosteroid sprays on a daily basis. 2. Short courses of oral corticosteroids can shrink nasal polyps. 3. Saline irrigation: High-volume, low-pressure nasal saline irrigations are safe and non-expensive. Irrigation increases the clearance of antigens, biofilms, and inflammatory mediators. 4. Topical antihistamine nasal sprays 5. Irrigation or nebulization with anti-inflammatory agents such as budesonide or mometasone in cases of CRSwNP. 6. Allergy testing and allergy immunotherapy (i.e., allergy shots, allergy desensitization, allergy hyposensitization) with relevant inhaled environmental allergens is effective in the treatment of allergic rhinitis, allergic conjunctivitis (i.e., eye allergies), and asthma in 80-85% of the patients that take them. 7. Deposition of corticosteroid medications higher into the nasal cavity by exhalation devices such as Xhance (i.e., fluticasone). 8. Biologic medications such as dupilumab (i.e., Dupixent) given by injections under the skin every 2 weeks, omalizumab (i.e., Xolair) given under the skin every 4 weeks, or mepolizumab (i.e., Nucala) given under the skin every 4 weeks. 9. Aspirin desensitization for AERD. 10. Functional endoscopic sinus surgery (FESS) and excision of the nasal polyps, restoring the patency of the nasal cavity. 11. Polyps have a tendency to recur after surgery and/or aggressive allergy treatments and intranasal corticosteroids can delay or prevent the recurrence. 12. Placing tiny, corticosteroid-coated implants (e.g., Sinuva) in the sinuses.

PREVENTION: The aggressive management of predisposing conditions such as allergic rhinitis, controlling one’s environment [i.e., reducing one’s exposure to offending allergens such as dust mites, molds, pollens, cats, dogs, and cockroaches, allergy medications, and allergy immunotherapy (i.e., allergy shots, allergy injections, allergy immunotherapy, allergy hyposensitization) may all work together to inhibit polyp formation.  In addition, avoiding exposure to strong odors, chemicals, and smoke is important in order to diminish nasal irritation and excessive tissue growth.

Individuals with established chronic sinusitis may require antibiotics, nasal or sinus irrigations, and/or sinus surgery.  Patients with a history of aspirin sensitivity should do better after desensitization to aspirin in terms of improved asthma control, as well as a reduction in the recurrence of nasal polyps.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating both children and adults in the Washington, DC, nNorthern VA, and Maryland metropolitan area for over 50 years. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. There is on-site parking at all of the offices. The Washington, DC and McLean, VA office locations are Metro accessible and there is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line. The allergy doctors at Black & Kletz Allergy specialize in all types of allergic conditions including nasal polyps, hay fever, asthma, sinus disease, hives (i.e., urticaria), eczema (i.e., atopic dermatitis, swelling problems (i.e., angioedema), food and medication allergies, and immunological disorders. If you would like to schedule an appointment, please call us or alternatively you can click Request an Appointment and we will respond back to you within 24 hours on the next business day. We look forward to providing you with comprehensive state-of the-art allergy care in a friendly and professional environment.

As we approach the end of Summer in the coming month, many individuals will begin to experience an increase of their allergy symptoms. In the world of allergies, these symptoms are considered Fall allergies. Typically in the Washington, DC, Northern Virginia, and Maryland metropolitan area, ragweed begins to pollinate in mid-August. The release of ragweed pollen into the air can be dreadful for many ragweed-allergic individuals. As the ragweed pollen count climbs through the rest of August and throughout most of September, the allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), and/or asthma symptoms of patients with ragweed allergy usually increase proportionally. The end of ragweed season coincides with the first frost which is usually in late October in the Washington, DC metro area. Approximately 10% of the population in the U.S. has a ragweed allergy. There are 17 species of ragweed in North America. Each ragweed plant produces about 1 billion pollen grains per season. The only state in the U.S. without ragweed is Alaska. Ragweed is more common in the Midwest and eastern U.S. Warm temperatures and increased humidity are factors that augment the release of ragweed pollen.

The classic symptoms that people with ragweed allergy experience may include runny nose, nasal congestion, post-nasal drip, sneezing, itchy nose, itchy throat, sinus congestion, sinus pain, headaches, snoring, itchy eyes, watery eyes, puffy eyes, redness of the eyes, chest tightness, coughing, wheezing, and/or shortness of breath. Ragweed may also increase the likelihood of sinus infections (i.e., sinusitis) in some susceptible individuals.

An itchy mouth, throat and/or lips can occur in some ragweed-allergic individuals after eating certain ragweed-associated foods. The foods that may be associated with ragweed pollen allergy include banana, melon (e.g., watermelon, cantaloupe, honeydew), white potato, chamomile tea, cucumber, zucchini, artichoke, sunflower seeds, and dandelion. In general, no other allergy symptoms beyond an itchy mouth, throat, and/or lips occur. This condition is called oral allergy syndrome or pollen-food allergy syndrome. The syndrome in general is caused by allergens in foods that are derived from plants. Furthermore, these foods are usually raw or uncooked fruits, vegetables, and nuts. Only foods that come from plants can cause the syndrome. Extra caution needs to be taken into account where nuts cause symptoms because many individuals can have nut allergies that are not associated with plants which may be life-threatening. Ironically, when the fruit or vegetable is cooked or canned, the protein is denatured and destroyed which usually prevents the allergic reaction from occurring. In most instances, individuals can tolerate cooked and/or canned fruits and vegetables.

In addition to ragweed as a cause of Fall allergies, molds, dust mites, pet dander, and cockroaches are also major sources of Fall allergies. Molds are perennial in nature and occur naturally in both indoor and outdoor settings. Washington, DC is notorious for its mold content as it was built on a swamp. In addition, the amount of mold tends to be worse in the Washington, DC metro area in the Spring with all of the rain and in the Fall with the increased amount leaf mold from all of the moldy wet leaves on the ground. Avoiding damp places, not raking leaves, and keeping the humidity below 50% may help in minimizing one’s exposure to molds. Dust mites are indoor allergens and are a problem for allergy sufferers year-round. Dust mites tend to live in bedding (i.e., mattresses, pillows, box springs), carpeting, and upholstered furniture. Covering one’s pillows, mattresses, and box springs with allergy-proof encasings and limiting stuffed animals and dust gathering objects has shown to help minimize one’s exposure to dust. Pets (e.g., cats, dogs, rabbits) can obviously cause allergy symptoms in pet-allergic individuals. Avoiding contact with pets, keeping a pet out of the bedroom, and washing the pet can all help reduce one’s exposure to pets. Cockroaches are potent allergens that cause perennial symptoms due to their ubiquitous nature. They are notable in the field of allergy and immunology for being a leading aggravating factor of childhood asthma in inner city populations. Extermination of cockroaches by professional exterminators can help reduce one’s exposure to cockroaches.

The board certified allergy specialists at Black & Kletz Allergy have been diagnosing and treating allergies, asthma, sinus conditions, and immunological disorders for more than 5 decades. Black & Kletz Allergy has 3 convenient locations in the Washington, DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location and the Washington, DC and McLean 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 us today to make an appointment at the office of your choice. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy pride themselves in delivering the highest quality allergy care in the Washington, DC metropolitan area in conjunction with providing an excellent patient experience in a friendly and pleasant environment.

There are different mechanisms that play a role in the causation of adverse and undesirable effects triggered by the consumption of food. In the world of food allergies, It is important to distinguish between these mechanisms in order to arrive at an accurate diagnosis. Allergy, intolerance, and sensitivity to foods require different diagnostic approaches including a careful history and skin or blood testing in order to diagnose the condition. The management of these conditions also varies based on the underlying mechanisms.

An allergy to a food traditionally means that there is an immunologic reaction to proteins in that food. This reaction is usually mediated by specific antibodies (IgE antibodies or immunoglobulin E antibodies) to these proteins. These antibodies react with the protein antigens in the food. These reactions result in a release of chemical mediators such as histamine and tryptase from mast cells and basophils into the tissues and bloodstream.

These chemical mediators (e.g., histamine, tryptase) also have adverse effects on the blood vessels, heart, lungs, and other vital organs. The result of this release of chemical mediators could vary in severity from mild itching of the skin to a severe life threatening reaction such as anaphylaxis. Ingestion of even small amounts of food can trigger such reactions, which usually begin within minutes of exposure.

The most important element in diagnosing food allergies is taking a careful and comprehensive history from the patient. It is important for the board certified allergist to focus on the specific food ingested (including the list of ingredients in prepackaged foods) as well as the timeline of the onset and progression of the symptoms. The history is complemented by the detection of specific IgE antibodies to the food(s) in question by way of skin testing and/or blood testing. These specific IgE allergy tests should be limited to only the foods that could have triggered the reaction suggested by the history.

Treatment of food allergies traditionally has been focused on the identification and subsequent strict avoidance of the offending food(s). Patients are also prescribed an epinephrine auto-injector (e.g., EpiPen, Auvi-Q, Adrenaclick) to be used in case of a systemic reaction following an inadvertent exposure to the food. However, more recently, a desensitization procedure to foods such as peanuts by way of oral immunotherapy has become available.

As opposed to an allergy, an intolerance to a food is not mediated by an immunologic process. Instead, the process primarily involves the gastrointestinal system rather than the immune system. An insufficiency of certain enzymes usually found in the gastrointestinal system may hinder the proper digestive process and result primarily in gastrointestinal symptoms. A common example is lactose intolerance, where an enzyme called lactase is deficient. Lactose is a sugar found in dairy products. The enzyme lactase breaks down the lactose in normal individuals. In patients with lactose deficiency (i.e., lactose intolerance) the undigested lactose becomes fermented in the intestines which causes uncomfortable gastrointestinal symptoms such as nausea, abdominal discomfort, abdominal bloating, flatulence, and/or diarrhea after the consumption of dairy products. The symptoms are usually dose-dependent, meaning that the symptoms are usually worse the more you eat/drink.

Breath hydrogen tests are sometimes helpful in confirming the diagnosis of lactose intolerance. The treatment involves either avoidance of the foods one is intolerant to or supplementation with the oral enzymes (e.g., lactase enzyme) along with these foods in order to help in their digestion.

A sensitivity to a food is a poorly understood phenomenon and may involve non-specific inflammation of the gut. The symptoms are widely variable and may include abdominal pain, nausea, diarrhea, fatigue, joint pain, brain fog, and/or vague constitutional symptoms. The symptoms can begin hours or days after the food exposure and can be chronic in nature. The symptoms may be mediated by an immunologic processes but IgE antibodies are not usually involved. Some researchers speculate that IgG antibodies specific to foods may be involved, although it has not been scientifically proven. Interestingly, some IgG antibodies to certain foods can protect an individual from sensitivity and in fact, their levels are shown to rise after desensitization to those foods.

As the value of IgG antibodies in diagnosing food sensitivities has never been conclusively established, tests to measure IgG levels in blood against foods should not be ordered or obtained.

Of note, some physicians will lump food intolerance and food sensitivity into the same category.

Another caveat in the diagnosis of food allergies is that even elevated IgE antibody levels against specific foods do not always correlate with reactions after the consumption of these foods. False positives and false negatives can and do occur. Hence, the results should always be interpreted in the context of clinical reactions after exposure.

In view of the above mentioned nuances, ordering “broad panels” of specific IgE to various foods without correlating it to the patient’s history is not helpful in the diagnosis of food allergies. IgE levels should be obtained only to those specific foods that the patient could have reacted to, which should be based on the patient’s history. It is important to correlate the timeline of symptom onset as well as the progression of the symptoms after the exposure to the food.

The board certified allergists at Black & Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area and are very experienced in the diagnosis and treatment of food allergy, food intolerance, and food sensitivity. Black & Kletz Allergy diagnose and treat both children and adults and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call our office to make an appointment or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been serving the Washington, DC metropolitan area for more than 5 decades and we pride ourselves in providing exceptional allergy, asthma, and immunological care in a professional and pleasant environment.

So, you have a runny nose, nasal congestion, sneezing, post-nasal drip, sore throat and coughing and it is the Summertime. Are you confused? You thought allergies occur in the Spring and Fall. You thought that “colds” occur in the Fall and Winter. Well, both “colds” and allergies can occur anytime and Summer is no exception.

“Colds” are caused by more than 200 different types of viruses. Some common viruses responsible for colds may include rhinovirus, other enteroviruses, coronavirus, influenza virus, parainfluenza virus, adenovirus, human respiratory syncytial virus (RSV), and metapneumovirus. Rhinovirus, an enterovirus, is by far the most common cause of the common cold than any other virus. Typically, the symptoms of a “cold” are similar to those of allergic rhinitis (i.e., hay fever). In addition to the classic sneezing, runny nose, nasal congestion, and post-nasal drip of allergic rhinitis, individuals with “colds” may also have other symptoms that may include sore throat, coughing, headaches, fatigue, achiness, fevers, chills, and/or discolored nasal discharge. It should be noted that discolored nasal discharge, fevers, and chills do not occur in most individuals with a common cold. In patients who have the influenza virus (i.e., flu), achiness, headaches, and fever are much more common than in individuals who only have the common cold.

In contrast to “colds” which are caused by viruses, Summer allergies are caused by common environmental allergens. The most common allergens found in the Summer include grass pollen, weed pollen, molds, dust mites, cockroaches, and pets (e.g., cat, dog, birds). Occasionally some tree pollen may cause some Summertime allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area, but in general, trees pollinate in the Spring and are not much of a nuisance by the time Summer rolls around. Grass pollen tends to become a problem in May and it may continue to be irritating to allergy sufferers until August. Ragweed usually begins to pollinate in mid-August and is generally done pollinating by the first frost in October. Molds, dust mites, cockroaches, and pets are perennial allergens and can bother allergic individuals throughout the year, including the Summer. Molds are found both indoors and outdoors and tend to be worse in damp places in the house such as kitchens, bathrooms, and basements, although mold can be anywhere in the house. Dust mites, cockroaches, and pets are indoor allergens, although pets can transfer outdoor allergens (i.e., pollens) to the inside of a house by means of their coats, as pollen may stick to the pet’s hair or fur.

The diagnosis of whether the “allergy” symptoms are a result of allergies or of a “cold” depends on many factors. The length of time one has had symptoms, auxiliary symptoms (i.e., sore throat, coughing, headaches, fatigue, achiness, fevers, chills, and/or discolored nasal discharge), other effected individuals, and response to treatment all play a role in diagnosing the cause of the symptoms. Typically, a “cold” lasts about 1 week in duration unlike allergic rhinitis which generally last at least a season and sometimes is perennial in nature. If other individuals that live in the same household have similar symptoms, a “cold” should be thought of as the cause before allergies. Supplementary symptoms to the classic allergic rhinitis symptoms such as sore throat, coughing, headaches, fatigue, achiness, fevers, chills, and/or discolored nasal discharge should trigger the allergist to think of a “cold” or flu before allergies as a cause. Lastly, the response to the treatment that an individual tries may also help the allergist determine the cause of the symptoms, be it an allergy or a “cold.”

The treatment of the symptoms may be similar regardless of whether the symptoms are a result of allergies or a “cold.” Symptomatic treatment typically may include oral antihistamines, nasal antihistamines, nasal corticosteroids, decongestants, and/or analgesics. Ongoing treatment may be needed in individuals with allergic rhinitis, whereas symptoms typically abate on their own within 1 week in individuals who have a “cold.”

Regardless of whether you have allergies or a “cold,” it should be emphasized that the classic symptoms of allergic rhinitis (i.e., sneezing, runny nose, nasal congestion, post-nasal drip) may occur at any time of the year. Yes, even Summer. Whether or not the symptoms are due to allergies or are a result of a “cold” however is another story. Either way, seeking the advice of a board certified allergist is an important step in determining the ultimate cause as well as finding the solution to reduce and hopefully eliminate those unwanted and annoying symptoms.

The board certified allergists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC metropolitan area. Our office locations are in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Each office has on-site parking and the Washington, DC and McLean 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. Our allergists see both adult and pediatric patients. To make an appointment, please call our office location that is most convenient for you or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy strive to provide our patients with the highest quality allergy, asthma, and immunology care in the Washington, DC, Northern Virginia, and Maryland metropolitan area.

Allergic reactions can sometimes be life-threatening. Anaphylaxis is a severe allergic reaction that is characterized by a sudden onset of symptoms with rapid progression. The manifestations may include generalized itching (i.e., pruritus), hives (i.e., urticaria), swelling (i.e., angioedema) of soft body parts, rapid pulse rate, a precipitous drop in blood pressure, dizziness, nausea, vomiting, abdominal pain, wheezing, shortness of breath, and/or loss of consciousness. Anaphylactic reactions are usually triggered by allergies to foods (e.g., peanuts, tree nuts, fish, shellfish), insect venoms (e.g., bee, wasp, yellow jacket, hornet, fire ant), and/or medications.

Administration of epinephrine immediately after the onset of an anaphylactic reaction usually stops the reaction from progressing and can be lifesaving. Occasionally, more than one dose of epinephrine is needed to reverse the untoward effects of anaphylaxis. Until now, the only approved route of the administration of epinephrine into the body has been through an injection with a syringe and needle. Epinephrine auto-injector devices such as EpiPen, Auvi-Q, and Adrenaclick have been available for several years. These self-injectable epinephrine devices are easy to use and allows the patient to administer epinephrine as soon as early anaphylactic allergic symptoms develop.

On May 11, 2023, an expert panel of advisers recommended to the Food and Drug Administration’s (FDA) that they approve an epinephrine nasal spray product, clearing a key hurdle for what could soon be the first needle-free option for treating severe allergic reactions.

The device which is designed to deposit epinephrine into the nostril is called Neffy. The same device was previously approved to administer a medication called naloxone into the nose to reverse the effects of a narcotic overdose.

Neffy delivers 2 mg. of epinephrine which is suitable for patients weighing above 30 kilograms (66 lbs.). The FDA is likely to decide on the final approval process in the next few months. If approved, the device will be available for use before the end of the 2023 year.

During clinical trials, the epinephrine nasal spray administration was compared with the previously approved injectable epinephrine products (i.e., EpiPen, Auvi-Q, Adrenaclick) in more than 600 individuals. The nasal spray has demonstrated comparable efficacy and rapidity of action, in most cases within a minute of administration. The effects on blood pressure and pulse rate, which were surrogate markers for the reversal of reaction, were non-inferior to injectable epinephrine. When a second dose is needed, the nasal spray showed a slightly better response than with injections. The epinephrine concentrations in the bloodstream also did not differ substantially with either route of administration.

Neffy’s safety profile was comparable with an injection of epinephrine with mild reactions that did not include any meaningful nasal irritation or pain. Intranasal delivery and pharmaco-dynamic response also were effective even with nasal congestion or a runny nose, such as when patients are experiencing allergic rhinitis (i.e. hay fever) or an upper respiratory tract infection (URI).

During clinical studies, the researchers also found that patients are more likely to use the nasal spray much earlier than the injection, which is advantageous in reversing the anaphylactic reaction. The other benefits of the nasal spray are that the nasal spray is more convenient to carry and there obviously was no needle- related injuries since no needle is needed.

If approved by FDA, the intranasal epinephrine could offer a preferred alternative to injectable epinephrine devices and meet an unmet need. Many individuals fail to use self-injectable epinephrine devices when anaphylaxis arises. Some find the pen-style devices inconvenient to carry. Some are reluctant to use them because they are fearful of needles, while others panic when an anaphylactic reaction occurs. Having an epinephrine nasal spray available is a welcome addition to the arsenal of medications used to combat and treat severe allergic reactions.

The board certified allergy specialists at Black & Kletz Allergy has 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. The allergists of Black & Kletz Allergy diagnose and treat both adult and pediatric patients. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy have been helping patients with anaphylaxis, hives, insect sting allergies, food allergies, medication allergies, hay fever, asthma, sinus disease, eczema, and immunological disorders for more than 5 decades. If you suffer from allergies, it is our mission to improve your quality of life by reducing or preventing your undesirable and irritating allergy symptoms.

Mold allergies are very common, particularly in the Washington, DC, Northern Virginia, and Maryland metropolitan area. The reason why there appears to be a high prevalence of mold-allergic individuals in the Washington, DC metro area may be tied to the fact that Washington, DC was built on a swamp. The climate in this mid-Atlantic region is conducive to mold growth due to its relative humidity. In the Spring there is a lot of rain. The Summers are very humid. In the Fall, the leaves from trees fall to the ground and subsequently develop “leaf mold” on the leaves due to the decomposition of the leaves by molds. Although decomposition of leaves is an important step in the mineralization of organic nutrients and the recycling of nutrients to plants, it is often met with dismay to allergy sufferers who are allergic to molds.

Molds are fungi that grow in the form of multicellular strands called hyphae. Fungi that circulate in a single celled environment are called yeasts. Molds are a common cause of hay fever (allergic rhinitis) and/or eye allergies (allergic conjunctivitis). Individuals that are allergic to molds may experience sneezing, nasal congestion, runny nose, post-nasal drip, itchy nose, sinus headaches, itchy eyes, watery eyes, and/or redness of the eyes. In some people, molds may cause asthma-like symptoms which may include wheezing, chest tightness, coughing, and/or shortness of breath. In asthmatics, molds may be a triggering factor which can cause a worsening of their asthma symptoms. The treatment of allergic rhinitis, allergic conjunctivitis, or asthma due to mold allergies usually involves reducing the exposure to molds, if possible. Common medications that are used may include antihistamines, decongestants, mast cell stabilizers, topical corticosteroids, anticholinergics, inhaled beta-agonists, leukotriene antagonists, and occasionally biological medications. Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization) is very effective in the treatment of mold allergies as it helps in 80-85% of patients on the injections. The average length of time on allergy immunotherapy is typically 3-5 years.

Not only can molds not cause allergy symptoms, but molds can in fact affect individuals in 3 other major ways: 1. Act as an irritant; 2. Cause infection; or 3. Act as a toxin.

Molds can cause an irritant reaction which is similar to an allergic reaction but this type of reaction is not technically allergic since there is not an immune reaction to the molds. Irritant reactions are also called nonallergic rhinitis. Individuals that have an irritant response to molds typically experience symptoms such as irritated eyes, nose, throats and/or lungs. Examples of irritant reactions include a runny nose after eating horseradish or burning and watery eyes from freshly cut onions. The best treatment of irritant reactions to molds is to avoid exposure to molds. If one cannot avoid exposure, medications may be used to help minimize the symptoms of the irritant reaction. Such medications may include oral antihistamines, oral decongestants, nasal antihistamines, nasal decongestants, nasal corticosteroids, nasal anticholinergics, and/or ocular medications.

Fungi and molds can cause infections in certain individuals, particularly those who are immunocompromised or have a “low” immunity. Individuals can be immunocompromised for a variety of reasons which may include medications (e.g., corticosteroids, tacrolimus, cyclosporine, biological monoclonal antibodies, azathioprine), immunodeficiencies (e.g., hypogammaglobulinemia, Bruton’s agammaglobulinemia, IgG subclass deficiency, common variable immunodeficiency), HIV/AIDS, elderly individuals, radiation, cancer, malnutrition, and stress after surgery, to name a few. Fungi tend to infect the sinuses, brain, eyes, lungs, nails, esophagus, tongue, and/or bloodstream. The fungal infection can be either systemic or superficial. Systemic fungal infections tend to occur more in immunosuppressed individuals and may be life-threatening. It is important to note that superficial fungal infections of the nails, tongue, and skin are common in normal individuals without compromised immune systems. Fungal infections of the lungs, brain, bloodstream, esophagus, sinuses, and eyes that are more problematic and tend to occur more often in patients with compromised immune systems. The treatment of fungal infections varies depending on the severity and location of the fungus. It should be noted that antifungal medications are used to treat fungal infections and may be given orally, topically or intravenously.

Molds may also act as a toxin in a condition called toxic mold syndrome. This syndrome is caused by mycotoxins (i.e., toxins produced by molds) and is sometimes referred to as sick building syndrome. Individuals with this disorder generally complain of a variety of non-specific symptoms as the symptoms may vary greatly from one individual to another. The symptoms may include watery eyes, itchy eyes, red eyes, runny nose, sore throat, rashes, headaches, nosebleeds, nausea, vomiting, dizziness, anxiety, fatigue, lack of concentration, mood swings, poor appetite, insomnia, weight loss, memory loss, hair loss, rashes, chest tightness, coughing, wheezing, and/or shortness of breath. Toxic molds grow most commonly on damp walls and ceilings. Toxic molds tend to manifest as black, brown, or green patches along with an associated musty odor.

The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating mold allergies, as well as all types of other allergic conditions and asthma. We are board certified to treat both pediatric and adult patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from mold allergies, we are here to help alleviate or hopefully end these undesirable symptoms so that you can enjoy a better quality of life. Black & Kletz Allergy is devoted to providing the highest quality allergy care in a caring, relaxed, and professional environment.

Mammalian meat allergy which is also known as alpha-gal syndrome causes an immediate hypersensitivity reaction hours after eating beef, pork, lamb, venison, or any other mammalian meat product. Although the allergy was first described in patients with hives (i.e., urticaria) and severe life-threatening reactions such as anaphylaxis, there is now a new phenotype of mammalian meat allergy that has different presenting symptoms. The new and increasingly recognized phenotype is called gastrointestinal (GI) alpha-gal. Gastrointestinal alpha-gal presents with GI symptoms such as abdominal pain, diarrhea, nausea, and vomiting without the predominant skin, respiratory, or circulatory symptoms.

Individuals with mammalian meat allergy or alpha-gal syndrome have an allergy to the galactose alpha-1,3-galactose, a sugar molecule on the cells of all non-primate mammals which is not present in humans. Lone star ticks can transfer this molecule to humans, by first feeding the mammals, and subsequently biting the humans. Since the galactose alpha-1,3-galactose molecule is foreign to humans, antibodies are formed in order to fight the foreign sugar molecule. When this occurs, the individual becomes sensitized to the molecule. The antibodies produced are called IgE antibodies that are specific towards the galactose alpha-1,3-galactose sugar molecule.

After the sensitization to the galactose alpha-1,3-galactose sugar molecule occurs, if the individual eats mammalian meat which naturally contains the galactose alpha-1,3-galactose (i.e., alpha-gal antigen), the alpha-gal antigen binds to the IgE antibodies present on the mast cells that richly populate the GI tract. As a result of the binding, these mast cells degranulate and release large quantities of histamine and other chemical mediators into the bloodstream. These chemical mediators in turn can act on sensory nerve endings to cause pain, intestinal smooth muscles to cause contractions, and/or mucous glands to cause the secretion of mucous.

When patients seek care for frequent abdominal pain, bloating, cramping, and/or diarrhea, they are often diagnosed as having irritable bowel syndrome (IBS), if no organic cause for these symptoms is identified. Some of these patients could have been previously sensitized to alpha-gal and their symptoms could be an indicator of an allergic reaction. The onset of symptoms could be several hours after the ingestion of the mammalian meat, as opposed to other common immediate type of hypersensitivity reaction (e.g., egg allergy, peanut allergy, seafood allergy), where symptoms usually begin within minutes of the exposure to the food.

A history of awakening up at night from sleep with gastrointestinal distress may suggest alpha-gal given the typical hours delay that occurs in this condition from alpha-gal ingestion to the subsequent reaction. Patients who have a history of tick bites or enjoy outdoor pursuits are at a higher risk for this allergy.

Diagnosis:

Alpha-gal syndrome or mammalian meat allergy is a clinical diagnosis with supporting laboratory findings (i.e., a positive alpha-gal antibody level in the blood). A diagnosis of alpha-gal syndrome may be made in patients with consistent symptoms and an increased alpha-gal IgE titer whose symptoms resolve or improve after adhering to an alpha-gal–avoidance diet, where mammalian meat is avoided.

The clinical presentation of this syndrome can be highly variable and unpredictable. Many patients who have been are previously sensitized, may not have symptoms every time they consume mammalian meat. At other times however, they can have a severe reaction after consuming even a small quantity of mammalian meat.

It should be noted that the gold standard for diagnosing food allergies typically is by an oral food challenge. In individuals with mammalian meat allergy however, there is usually at least a couple or more hours-long delay time until the allergic reaction occurs. Since the allergic reaction is delayed and may also be inconsistent, an oral food challenge is not reliable and thus not used to diagnose mammalian meat allergy.

Management:

The cornerstone of managing alpha-gal syndrome is to eliminate alpha-gal from the diet. Individuals diagnosed with this condition should not eat pork, beef, lamb, venison, rabbit, whale, or any other mammalian meat. In essence, any animal with hair as well as products made from these mammals (e.g., lard, butter, milk) should be avoided. Dairy does contain smaller amounts of alpha-gal, particularly ice cream, cream, and cream cheese, which have a high fat content.

Gelatin is derived from the collagen in pig or cow bones. As such, foods that contain gelatin (e.g., marshmallows, gummy bears, gelatin candies) also may trigger allergic reactions. In addition, processed foods can have small amounts of animal-derived products. Restaurants may cross-contaminate foods with alpha-gal which may be a problem for patients with high levels of sensitivity to alpha-gal.

Fish, shellfish, turkey, chicken, and other fowl are acceptable for patients with alpha-gal.

Prevention:

Alpha-gal–allergic individuals should take measures to avoid further tick bites because additional tick bites may worsen the allergy. Performing regular tick checks, showering soon after activities in grassy and woody areas, creating a barrier at the ankles by pulling up tight mesh socks over the pant cuffs on hikes, and treating clothes and boots with permethrin may all help reduce the likelihood of tick bites.

Certain medications such as cetuximab (i.e., Erbitux) and pancreatic enzymes are derived from pigs and may cause problems in mammalian meat-allergic individuals. A company in Blacksburg, VA developed alpha-gal-free pork, which is FDA-approved but not yet widely available. Another option for alpha-gal allergic individuals is to consume plant-based alternatives to meat commonly found in companies like Beyond Meat or Impossible (e.g., Impossible burger).

All patients diagnosed with alpha-gal allergy should carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) for use in case of a systemic reaction following an inadvertent exposure to mammalian meat. If a self-injectable epinephrine device is used, the patient should go immediately to the closest emergency room.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating food allergies and intolerances as well as mammalian meat allergy (i.e., alpha-gal) for many years. If you or your child suffers from food allergies, food intolerances, eosinophilic esophagitis, hives (i.e., urticaria), swelling episodes (i.e., angioedema) please call us to make an appointment. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas with on-site parking all 3 locations. Our Washington, DC and McLean, VA locations are Metro accessible and we offer a free shuttle between our McLean, VA office and the Spring Hill metro station on the silver line. We look forward to helping you with all your allergy, asthma, and immunology needs as we have been doing in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than a half century.

It is the Spring now and people will be spending a lot more time outdoors. Activities such as hiking, gardening, landscaping, golf, and picnicking tend to pick up in the Spring when the temperatures are warmer and these activities are generally enjoyed until the late Fall in the Washington, DC, Northern Virginia, and Maryland metropolitan area, when the temperatures become cooler. These outdoor activities as well as other outside happenings may predispose an individual to coming in contact with poison ivy, poison oak, and/or poison sumac. These plants are well known for causing an itchy rash when the plants come in contact with a sensitive individual. The itchy rash can occur from touching any part of the plant including the leaves, berries, flowers, stems, and/or roots, whether the plant is living or dead.  In some individuals, coming in close contact with anything that has touched the plants, (e.g., shoes, sneakers, clothing, garden tools, lawn mowers, fur from animals) can also spread the agent that is responsible for causing the itchy rash.

The agent responsible for causing the itchy rash is a chemical called urushiol. It is important to note that all parts of these 3 plants contain the same oily pale-yellow liquid resin called urushiol.  As stated above, it is this contact with the urushiol that is responsible for causing the rash.  When an urushiol-sensitive individual comes in contact with the urushiol, an allergic reaction takes place. This allergic reaction occurs on the skin which results in an itchy rash. The rash that is caused by poison ivy, poison oak, and/or poison sumac is classified as “contact dermatitis.”

The itching and rash can vary in severity from individual to individual and range from a mild rash to a severe rash. The symptoms of the cutaneous allergic reaction may include itching, linear red streaks (which characteristically follows a straight line pattern where the plant brushed up against the skin), red bumps of varying sizes, and/or blisters filled with fluid. Occasionally, the rash can become secondarily infected, which is usually due to scratching.  Rarely, an individual may be so highly sensitive that angioedema (i.e., swelling) of the throat, face, lips, eyes, and/or neck may occur. If this type of swelling occurs, it can manifest itself as difficulty swallowing and/or difficulty breathing which can be very serious as it may lead to unconsciousness.  Individuals who develop such severe reactions should go immediately to the closest emergency room for treatment.

Usually, the symptoms of poison ivy, poison oak, and/or poison sumac begin between 24-48 hours after contact with the plants.  Occasionally, it may take a longer period of time to develop symptoms, particularly if it is the first time that the individual has a reaction.  The rash typically lasts about 2-3 weeks in duration, but can persist much longer in some sensitive individuals.

A few common fallacies should be pointed out about poison ivy, poison oak, and poison sumac. First of all, this type of contact dermatitis does not actually spread by itself. In order to develop a rash, contact with the urushiol liquid is necessary. Thus, the only way the rash is transported to other areas of the skin would be from spreading the oily urushiol from one area to another by way of one’s fingers. It is actually the urushiol being transported from one area to another that causes the contact dermatitis to be visible in another location. It is not the leakage of the blister fluid that causes other areas of the skin to be involved because there is no urushiol in the blister fluid. One should also keep in mind that there are other skin diseases that may cause blistering. It is advised to see a board certified allergist or dermatologist if you have blistering of any kind.

Identifying the differences between poison ivy, poison oak, and poison sumac is not always that easy and clinically not that important. Poison ivy and poison oak look similar and consist of compound leaves (i.e., multiple leaflets that make up 1 leaf). In the case of poison ivy and poison oak, there a 3 leaflets on each leaf. Poison ivy has 3 glossy almond-shaped leaflets with jagged edges per leaf. In the Spring, the leaves can be red or a mixture of red and green. In the Summer, the leaves are green. In the Fall, the leaves can be bright orange, yellow, or red. Poison oak has 3 fuzzy leaflets per leaf that have uneven and scalloped edges. In the different seasons, the leaves can vary from green to red. Poison oak tends to blend in around the surrounding shrubs which often makes it difficult to spot. Poison sumac has between 7 and 13 leaflets on a reddish stem and resembles a fern. The green leaflets of poison sumac are oval-shaped with a pointy top. These leaflets tend to run in pairs up the stem. It should be noted that all 3 plants may also contain berries.

Prevention of contact with poison ivy, poison oak, and poison sumac is ideally the best way to avoid the contact dermatitis that occurs with these plants. It is advisable to wear long pants, long-sleeved shirts, sleeves, gloves, and closed shoes in order to decrease the probability of contracting the rash. It is also desirable to wash one’s clothes immediately in order to remove any urushiol that may have gotten on one’s clothing from the plants.

The treatment of poison ivy, poison oak, and/or poison sumac is to wash the affected skin with a mild soap and cool water in order to try to remove the oily urushiol. Calamine lotion, zinc oxide ointment, and oral antihistamines are used often to help relieve the annoying symptoms. Occasionally oral corticosteroids and antibiotics may be necessary in more severe and recalcitrant cases and in cases of secondary infections respectively. If the rash persists and or gets worse, it is important to see a board certified allergist or dermatologist.

The board certified allergy specialists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan region and have been providing allergy and asthma care to this area for more than 50 years. We diagnose and treat both adults and children. Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices offer on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. In addition, our McLean, VA office location offers a complementary shuttle that runs between this office and the Spring Hill metro station on the silver line. For an appointment, please call one of our offices. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from poison ivy, poison oak, poison sumac, contact dermatitis, hives (i.e., urticaria) hay fever (i.e., allergic rhinitis), sinus problems, asthma, or immune issues, please contact our office as it is our mission to help alleviate your undesirable symptoms, so that you can enjoy a better quality of life.