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As Winter begins and the temperatures plummet, the cold air can cause havoc on individuals with certain allergic and immunologic conditions that are caused or made worse with cold weather.  Some of the allergic and immunologic conditions that are exacerbated by cold weather include cold-induced pruritus (itching), cold-induced urticaria (hives), cold-induced angioedema, (swelling), cold-induced anaphylaxis, Raynaud’s disease, Raynaud’s phenomenon, cryoglobulinemia, cold agglutinin disease, and cold-induced asthma.

Cold-induced Pruritus, Urticaria, Angioedema, and Anaphylaxis

Cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, and cold-induced anaphylaxis are all very similar conditions.  The major difference between them is the severity of the reaction to the cold.  Exposure to cold temperatures can result in itching, hives, swelling, and/or anaphylaxis to the cold-exposed part of the body.  Cold-induced pruritus, cold-induced urticaria, and cold-induced angioedema are conditions with increasing severity respectively.  Cold-induced urticaria can usually be diagnosed by an allergist in the office by an “ice cube test,” where an ice cube is placed on the forearm of the patient for 10 to 15 minutes and then removed.  When the skin re-warms in a few minutes, an elevated red wheal or hive in the shape of the ice cube confirms this disorder.  Cold-induced angioedema can be very serious if swelling develops in the tongue and/or throat which can potentially block the flow of air into the lungs.  In such circumstances, these patients should be taught how to use a self-injectable epinephrine devices (i.e., EpiPen, Auvi-Q) and they should carry them at all times.  If used, they should go to the nearest emergency room, even after using the epinephrine.  Cold-induced anaphylaxis is a life-threatening condition where the cold causes a systemic reaction which involves several body systems such as the skin, respiratory, and circulatory systems.  Again, these individuals should be taught how to use a self-injectable epinephrine devices and they should carry them at all times.  If used, they should go to the nearest emergency room, even after using the epinephrine.  Individuals that have severe reactions to the cold need to be educated on how to help prevent these reactions as well as how to treat them.  Treatment begins with avoiding the cold whenever possible.  In addition, various medications can be used to help prevent the itching, hives, swelling and/or anaphylaxis that may occur in people with these conditions.

Rarely, the above conditions can be associated with some systemic diseases and blood tests for cryoglobulins and cold agglutinins may be appropriate.  A brief summary of these 2 rarer diseases are discussed below.

Cryoglobulinemia

Cryoglobulinemia is a disease in which patients have high levels of immunoglobulins (antibodies) that bind together and “clump up” to form a “precipitate” in the bloodstream when the body’s temperature drops below the normal 98.6°F.  The majority of the immunoglobulins are Immunoglobulin M (IgM), but Immunoglobulin G (IgG), and Immunoglobulin A (IgA) also cause this disease.  These antibodies are thus called cryoglobulins since the prefix “cryo” means “cold” in Greek.  When these cryoglobulins form a precipitate, it causes an obstruction in the blood vessels and blocks the flow of blood to the periphery.  As a result, it may cause gangrene in the fingers and toes since less or no blood reaches these areas.  Damage can also occur in the skin, joints, nerves, muscles, kidney, and liver.  Interestingly, when the body temperature reaches 98.6°F again, usually by warming methods used in therapy, the cryoglobulins go back into solution causing the precipitate to “dissolve” and the flow of blood is re-instated through the blood vessels again.  The disease is most common in individuals 50 years of age and above and there are 3 types of cryoglobulinemia.  The causes of cryoglobulinemia may include several underlying diseases or conditions.  Some of the more common underlying disorders include multiple myeloma, Waldenström’s macroglobulinemia, autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus (lupus), certain leukemias, and infections such as Mycoplasma pneumonia, hepatitis C, hepatitis B, post-streptococcal glomerulonephritis, and HIV.  The treatment of cryoglobulinemia begins with treating the underlying disorder.  Keeping the individual warm with protective clothing, avoiding cold liquids, and avoiding exercise in the cold, can all help prevent the body temperature from getting too low.

Cold Agglutinin Disease

In cold agglutinin disease, patients have high levels of Immunoglobulin M (IgM) antibodies in their bloodstream which attack their own red blood cells when their body temperature is below 88°F.  Occasionally, the antibody Immunoglobulin G (IgG) or even rarer, the antibody IgA (IgA) can cause this disorder.  When the red blood cells are attacked, they are destroyed, leading to a type of anemia (low red blood cell count).  As with cryoglobulinemia, there may be an underlying illness or condition causing cold agglutinin disease.  Some of these underlying causes may be due to chronic lymphocytic leukemia, lymphoma, Waldenström’s macroglobulinemia, and infections such as mononucleosis, HIV, and Mycoplasma pneumonia.  Treating the underlying disorder, as well as keeping the patient warm by using protective clothing, avoidance of drinking cold liquids, eating good sources of folic acid in fruits and vegetables, and avoidance of strenuous exercise, particularly in the cold air all are effective in the management of this disease.

Raynaud’s Disease and Raynaud’s Phenomenon

Raynaud’s disease and/or Raynaud’s phenomenon occurs when there is decreased blood flow to the fingers, toes, nose, and/or earlobes when someone is exposed to the cold.  It is thought to occur as a result of vasospasm (spasm of the blood vessel) causing the decrease in blood flow.  These vasospastic events are generally episodic in nature.  Initially the skin of these regions turns a whitish-pale color.  At this point, the skin feels cold and can feel numb.  The oxygen supply is thus reduced causing a bluish tint to the skin.  When the episode is finished and/or the body part gets re-warmed, blood flow to the skin areas is resumed and the skin turns reddish in color and then finally the color becomes normal.  This phase is generally accompanied by local swelling with an associated tingling pin and needle sensation like when someone’s fingers or toes “fall asleep.”  It is often referred to the disease that is red, white, and blue.  Raynaud’s disease and Raynaud’s phenomenon are more common in females.  The term Raynaud’s Disease is used when there is no reason identified as an underlying reason for the vasospasm.  On the other hand, Raynaud’s phenomenon is used to describe the same situation only when there is an identifiable underlying condition that is believed to cause the decreased blood flow.  Some of the underlying secondary diseases may include autoimmune or connective tissue disorders such as systemic lupus erythematosus (lupus), systemic sclerosis (scleroderma), polymyositis, dermatomyositis, Sjögren’s syndrome, mixed connective tissue disease, rheumatoid arthritis, and Takayasu’s arteritis.  Other underlying conditions known to cause Raynaud’s phenomenon include atherosclerosis, malignancy, hypothyroidism, multiple sclerosis, Lyme disease, carpal tunnel syndrome, and certain medications (e.g., beta blockers, sulfasalazine, ergotamine, bromocriptine, bleomycin, pseudoephedrine, methylphenidate, dexmethylphenidate).  The treatment of Raynaud’s phenomenon is primarily to treat the underlying condition.  In addition, with both Raynaud’s disease and Raynaud’s phenomenon, it is important to keep warm by wearing gloves, mittens, socks, scarves, ear muffs, and hats.  There are several medications that can also be given such as alpha blockers, calcium channel blockers, and vasodilators.

Cold-induced Asthma

Cold dry air is a known irritant to the respiratory passages and can trigger an increase in the frequency and severity of asthma.  The symptoms that asthmatics experience may include wheezing, chest tightness, coughing, and/or shortness of breath.  Exercising in the cold is even worse in many patients with asthma.  It is important for individuals with asthma to understand their triggers and to pre-medicate, with some of their asthma medications, before venturing out into the cold.  The patient should also understand when to call their allergist, before their asthma symptoms get out of control.

The board certified allergists at Black & Kletz Allergy have been treating cold-induced allergic and immunologic conditions in adults and children.  We have been providing quality allergy care to those located in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years.  Black & Kletz Allergy provides on-site parking at all of their convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA locations are Metro accessible and there is a complementary shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  Please call any one of our offices for a consultation for your allergy, asthma, or sinus needs or alternatively, please click Request an Appointment and we will respond within 24 hours on the next business day.

Serving as Vienna, Centreville, and Arlington allergists, we have noticed that we are experiencing a relatively mild Winter so far.  Some reports indicate that this is the third balmiest winter in several decades.  The grass is still green in many of our yards and the air is warmer and moister than usual.

Every year, a hard freeze kills several types of weeds and keeps many molds in a dormant state for a few months. Higher than normal temperatures can not only prolong the pollen season, but it also can result in the proliferation of molds.

Molds are fungal organisms that release tiny spores into the atmosphere.  These microscopic spores are inhaled by us and can reach the deeper parts of our lungs.  In sensitive individuals, these can adversely affect the eyes, nose, sinuses, and lungs.  We are in fact noticing higher numbers of mold-related allergy sufferers this season than in the previous years.

Some typical symptoms seen in people with mold allergies may include sneezing, itchy eyes, redness of the eyes, watery eyes, nasal congestion, runny nose, post-nasal drip, itchy throat, sore throat, itchy ears, fatigue, sinus pressure and/or sinus headaches.  The congestion in the nose or sinuses can block the drainage pathways from the sinuses which can predispose one to sinus infections.  These sinus infections may cause facial pressure and/or pain, discolored secretions, and headaches.  In individuals with a history of asthma, an exacerbation can be triggered by the mold resulting in an increase in the frequency and severity of coughing, wheezing, and difficulty in breathing.

Exposure to outdoor molds can be reduced by avoiding raking wet leaves and damp mulch.  Molds need moisture to grow and indoor mold spores can be kept at low levels by closing the windows and keeping the humidity below 55%.  High efficiency particulate air filters (i.e., HEPA filters) are helpful in trapping the dust mites and mold spores and recirculating fresher air.  It is also interesting to note that dust mites flourish when the humidity is high.  Dust mites (the main culprits of “dust” allergies) also are more prevalent during the Winter when people use their heat in their homes.  Many “dust allergic” individuals also suffer from mold allergies as well, so this unseasonably warm Winter is causing even more havoc to these people.

Several over the counter and prescription medications like non-sedating antihistamines, topical ocular preparations, and intranasal sprays can effectively mitigate the symptoms when preventive measures are less than adequate.  It is especially important for asthmatic individuals to take their controller medications on a daily basis to protect their lungs from allergic inflammation and thus prevent a flare-up of breathing difficulties.

The board certified allergists at Black & Kletz Allergy are always ready to answer your questions and address your concerns.  Black & Kletz Allergy has 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA with on-site parking at each location.  The Washington, DC and McLean offices are Metro accessible and there is a free shuttle between the McLean office and the Spring Hill metro station on the silver line.  The allergy specialists of Black & Kletz Allergy treat both children and adults and have been serving the greater Washington, DC area for over 50 years.  If you or someone you know suffers from allergies or asthma, please call us for an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours of the next business day.

People who have allergies are more prone to developing acute, chronic, and recurrent sinus infections (i.e., acute sinusitis, chronic sinusitis, recurrent sinusitis).  Allergic rhinitis (hay fever) is a condition in which allergens such as dust mites, molds, pollens, cats, dogs, and/or cockroaches will cause classic allergy symptoms in individuals that are sensitized to these allergens.  Some of the typical symptoms may include:  runny nose, nasal congestion, post-nasal drip, sneezing, itchy nose, itchy throat, snoring, sinus pressure, and/or sinus headaches.  The allergens cause inflammation and swelling in the nasal passages and sinus cavities.  These allergies can also lead to the development of nasal polys which further aggravate nasal congestion.  In the month of February, in the areas surrounding our Washington, DC, Manassas and McLean allergist offices, like Arlington, Centreville and Vienna, the allergens primarily responsible for causing allergic rhinitis symptoms include:  dust mites, molds, cats, dogs, cockroaches, and tree pollens.  The trees in the Washington, DC area usually begin to pollinate in mid to late February.  If the month is on the warmer side, the trees pollinate earlier.

When an allergic individual is exposed to an allergen to which they are sensitized, they exhibit the symptoms as mentioned above.  This predisposes the allergic person to develop sinus infections.  When someone develops nasal congestion or has nasal polyps due to allergies, the capability for the sinuses to drain properly diminishes.  As a result, the mucus becomes stagnant in the nasal passages and accumulates in the sinuses.  When the mucus “sits” in the sinuses, it is more likely to become infected with bacteria.  The dark, moist, stagnant environment in the sinuses is a perfect breeding ground for bacteria; much like a stagnant pond is much more likely to develop algae than a free flowing river.  Hence, if allergies are treated or prevented, then one is less likely to develop a sinus infection.

Allergic rhinitis can be treated with a multitude of medications which may include antihistamines, decongestants, expectorants, nasal sprays, saline irrigation of the nose, and/or leukotriene antagonists.  Allergic rhinitis symptoms can be prevented by avoiding the offending allergen, although this is difficult to accomplish in many cases.  Allergy shots (i.e., allergy immunotherapy, allergy desensitization, allergy injections) are another way to minimize or prevent allergic rhinitis symptoms from occurring.  They are 80 – 85% effective and have been used in the U.S. for over 100 years.  Patients on allergy shots often realize a decrease in both the number and the severity of sinus infections.

Note that in addition to allergies, February is a time of the year that has other nonallergic factors which increase the likelihood of developing sinus infections.  In the Winter, there tends to be more “colds,” (which are due to viruses), as well as other viruses in circulation that cause upper respiratory tract infections.  Notwithstanding, people tend to stay indoors more often during the Winter, resulting in individuals being in closer contact with each other than at other times of the year.  This further increases the chance of spreading these viral upper respiratory tract infections.  In addition, the flu season occurs during the Winter which affects the nose and sinuses in most individuals.  The flu, which is caused by the influenza virus, also predisposes individuals to sinus infections.

Sinus infections can also exacerbate both allergy-induced and nonallergy-induced asthma.  When an asthmatic develops an upper respiratory tract infection such as a sinus infection, it also commonly aggravates their asthma symptoms which generally include wheezing, shortness of breath, coughing, and/or chest tightness.  This can be very serious and the asthmatic should see their allergist so their sinus infection can be treated effectively and without delay.  In addition to the asthma symptoms, acute sinus infections typically present with sinus headaches, nasal congestion, post-nasal drip, purulent discolored nasal discharge, and possibly a low grade fever.  Recurrent sinus infections may indicate an additional immunological defect and an immune system evaluation should be performed by the allergist.  Chronic sinus infections usually indicate that antibiotic therapy needs to be given to the patient for a much longer course than the typical 10-14 days given with acute sinus infections.  Another interesting fact about chronic sinus infections is that they can cause exacerbations of someone’s asthma without any sinus-related symptoms present.  Patients with chronic sinusitis may not have any symptoms at all.

If you suffer from allergies and/or sinus infections, please call Black & Kletz Allergy to schedule an appointment with one of our board certified allergists.  We treat both adults and children, and have 3 offices in the Washington, DC, Northern VA, and Maryland metro area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each location and the Washington, DC and McLean, VA offices are Metro accessible, with a free shuttle between the McLean office and the Spring Hill metro station on the silver line.  Black & Kletz Allergy has been providing high quality allergy, asthma, and immunology care to the DC metro area for over 50 years.  Please call us for an appointment today or alternatively, you can click Request an Appointment and we will respond within 24 hours on the next business day.

Dr. Kletz & Dr. Gondi, Trusted Gainesville Allergists, Discuss Dental Problems and Allergies As allergists that Gainesville, VA calls upon, we know that when one thinks about allergies and allergy symptoms, dental problems usually do not come to mind.  In fact, most people tend to separate dental and medical problems into two distinct categories.  Medical diseases can and do influence your dental health.  Most people know that certain heart defects and murmurs may require premedication with antibiotics in order to prevent subacute bacterial endocarditis.  Patients with GERD (gastroesophageal reflux disease), Sjögren’s syndrome, anorexia, and bulimia are more prone to cavities of the teeth.  There are many more medical conditions which can have profound implications on the health of one’s teeth which will not be discussed.

What about allergies?  Can they cause dental problems?  The simple answer to this question is:  Yes

Many children with hay fever (allergic rhinitis) have nasal congestion as a major feature of their disease.  The nasal congestion frequently causes these children to become “mouth breathers,” since they are unable to breathe through their noses.  As the children grow, they develop a narrow high upper arched palate in their mouths which results in malocclusion (i.e., poor bite) of their teeth.  The teeth grow in crooked usually resulting in the need for costly braces by an Orthodontist.  Seeing a board certified allergist like the ones at Black & Kletz Allergy in the Gainesville, VA, Falls Church, VA , and Tysons Corner, VA areas can prevent this type of dental problem in children if addressed early on.  The allergists at Black & Kletz Allergy would perform a comprehensive history and physical examination and likely do allergy testing to find out if and what the child is allergic to in the environment.  Allergies to dust mites, molds, pollens (e.g., trees, grasses, weeds), pets, and cockroaches are very common allergens that can cause chronic nasal congestion.  There are other nasal conditions, such as nasal polyps, which are usually due to an underlying allergy that can also cause chronic nasal congestion.  After fully evaluating the child, a treatment plan would be discussed with the parent(s) which may include measures to avoid the offending allergen, use medications in the forms of syrups, powders, tablets, capsules, nasal sprays, eye drops, and/or begin a course of allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization).  Allergy immunotherapy or allergy shots are very effective as they work in 80-85% of the individuals taking them.  They are given to people ranging in age from young children through the elderly.  They have been given in the U.S. for over 100 years.  Treating the hay fever early in its course is very effective in preventing the dental malocclusion that occurs too often in untreated individuals with this condition.

Another problem that people face when it comes to allergies and dentistry is the common “I am allergic to Novocain” response that dentists hear over and over again from patients.  We, as allergists near Gainesville, VA, also hear this common complaint.  Dentists frequently have to use a “numbing medicine” before they can do certain dental procedures such as root canals, pulling teeth, dental implants, putting in crowns, etc. in order to prevent pain from occurring in their patients.  Many times the “allergy” symptoms described are really a side effect of the Epinephrine (adrenaline) that is frequently mixed in with the “numbing medicine” rather than a true allergy to the “numbing medicine” itself.  Epinephrine is usually mixed in with the “numbing medicine” as a way to constrict the small blood vessels in the mouth which helps prevent excessive bleeding.  The most common “numbing medicines” or local anesthetics used are categorized as “Caine drugs.”  (See “Medication Allergies”).  Some examples of “Caine drugs” include Novacain (procaine), Xylocaine (lidocaine), Carbocaine (mepivacaine), Marcaine (bupivacaine), and Pontocaine (tetracaine).  Some individuals are truly allergic to the local anesthetic and some are even allergic to the preservatives found in the local anesthetic.  It turns out, however, that most individuals who think they are allergic to a “Caine drug” usually are not when skin tested by an allergist.  It is important, however, to see a board certified allergist and have skin testing performed to rule out a “Caine drug” allergy, as such an allergy can be very serious and potentially life-threatening.  The allergy doctors in the Gainesville, VA, Falls Church, VA, and Tysons Corner, VA areas at Black & Kletz Allergy routinely see patients with this potential allergy and skin test them to a specific local anesthetic in the “Caine drug” class at one of our 3 office locations in theWashington, DC, Northern Virginia, and Maryland metropolitan area.  If the skin testing to a specific “Caine drug” is negative, then the allergist will let your dentist know that is fine to use that particular medication.  Note that it is possible to be allergic to one specific “Caine drug” but not another specific “Caine drug.” (Example: One can be allergic to Novacain but not Xylocaine).

The board certified allergists at Black & Kletz Allergy treat both adults and children and will answer any questions you have concerning local anesthetic allergy testing as well as other medication allergy testing such as penicillin testing.  Black & Kletz Allergy has locations 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 also Metro accessible.  There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  If you would like to make an appointment with an allergist, please call us 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 providing quality allergy care to the DC metro area for more than a half century.

The Washington, DC, Northern, Virginia, and Maryland metropolitan area has its share of pollutants in its air as well as the many allergens that are known to be prevalent. The allergens that are common in the DC metro area include tree and grass pollens in the Spring, ragweed pollen in the Fall, and mold spores which are perennial in nature. The molds are year-round due to the history of Washington, DC being a swamp many years ago. The humidity also tends to be high in the area, which favors the growth of molds. Regarding pollutants, there are many different types of pollutants in the Washington, DC metropolitan area including such cities as Gainesville, VA, Falls Church, VA, and Tysons Corner, VA.. Some of these pollutants include carbon monoxide, ozone, organic dusts and other fine particulate matter, nitrogen dioxide, sulfur dioxide, and lead emissions.

It is not news to anyone that the traffic in the Washington, DC metro area is sometimes horrific. Not only does it play havoc with people’s temperament, but so many motor vehicles produce emissions which contribute greatly to the air pollution and thus the air quality of the area. In the summers, this pollution tends to be worse. The sunny days will produce increased levels of ozone which has been determined to be hazardous to one’s health, particularly people with lung disease such as people with asthma and chronic obstructive pulmonary disease (COPD). Chronic bronchitis and emphysema are the two most common conditions that contribute to COPD.

Almost all patients with allergic rhinitis (i.e., hay fever) and/or asthma know a lot about the pollen count and what it means. The pollen count is the number of pollen grains in one cubic meter of air. For example, if the pollen count for tree pollen is 250, it means that there are 250 grains of tree pollen in a sample of air that is 1 meter X 1 meter X 1 meter. Keep in mind that 1 meter is 39.37 inches. Different locations throughout the U.S. have different guidelines depending on the types of pollens they have and the quantity of the pollen released into the air. As a general rule, the pollen count levels can be interpreted by the following values: Trees – 1-14 is Low; 15-89 is Moderate; 90-1,499 is High; 1,500 and above is Very High. Grasses – 1-4 is Low; 5-19 is Moderate; 20-199 is High; 200 and above is Very High. Weeds – 1-9 is Low; 10-49 is Moderate; 50-499 is High; 500 and above is Very High. Molds – 1-6,499 is Low; 6,500-12,999 is Moderate; 13,000-49,999 is High; 50,000 and above is Very High. In fact, you can always click Today’s Pollen Count at the top of our website to see the latest pollen count for the Washington, DC, Northern Virginia, and Maryland metropolitan area. Many individuals use this knowledge to help them guide when they should avoid certain outdoor activities. Generally, the pollen counts are the highest in the mornings through midday. Planning to do outdoor activities, such as exercising or doing yard work, in the evening is usually recommended to minimize pollen exposure.

In addition to being aware of the pollen count, it is also important to be aware of the Air Quality Index (AQI). The AQI indicates how polluted the air is in your area. The AQI is calculated based on 5 major pollutants which include carbon monoxide, nitrogen dioxide, sulfur dioxide, fine particulate matter, and ground-level ozone. The last two pollutants (fine particulate matter and ground-level ozone) pose the greatest threat to an individual’s health. The AQI is divided into 6 different zones of increasing amounts of pollution and thus health risk. The zones are color-coded and in order from less pollution to more pollution are as follows: Green, Yellow, Orange, Red, Purple, and Maroon. In the Washington, DC area, it is not uncommon to have a few “Code Red” days during the summer, particularly when it is hot, humid, and sunny. “Code Green” is the best air quality and poses little or no risk of any health concern. “Code Yellow” signifies acceptable air quality and may pose a moderate health concern for a very small number of people who are very sensitive to air pollution. “Code Orange” indicates an unhealthy quality of air for some sensitive groups of people. “Code Red” means that the air quality is generally unhealthy for the general public, although usually only sensitive groups will experience more serious health effects. “Code Purple” notifies the general public that the air is very unhealthy and tends to occur in emergency conditions, such as when there is a chemical spill. “Code Maroon” indicates hazardous conditions where everyone will most likely experience untoward health issues. Generally, it is recommended to stay indoors when the level is “Code Red” and above.

The board certified allergists of Black & Kletz Allergy treat patients of all ages including children and the elderly in the Falls Church, VA, Tysons Corner, VA, and Gainesville, VA areas. Children and elderly persons tend to be more sensitive to poor air quality, as well as individuals with lung conditions such as asthma and COPD. Black & Kletz Allergy has 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean offices 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. If you would like to make an appointment, please call us or you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors of Black & Kletz Allergy have been serving the greater Washington, DC metro area for more than 50 years and we pride ourselves in excellent quality allergy, asthma, and immunology care in a friendly, caring, and professional environment.

Explained By Allergists McLean VA Patients Trust There has been an increase in the incidence of allergic diseases over the past 20-30 years and this phenomenon is more pronounced in industrialized countries compared to developing countries.  Many researchers believe that environmental and dietary changes play major roles in the development of allergies.  This is true in areas such as Falls Church, VA, Gainesville, VA, and Tysons Corner, VA as well as the rest of the Washington, DC metro area.

The primary role of our immune system is to defend and protect us from infections caused by germs like viruses, bacteria, and parasites.  Exposure of the immune system to infections with germs in early life stimulates the maturation of the immune system in a normal balanced way.  The absence of this stimulation can trigger the immune system to mistake innocuous substances such as dust mites, molds, pollens, and certain foods as potentially harmful and mount a defensive attack on them causing allergic disease.  This “hygiene hypothesis” aims to explain why more people suffer from allergic disorders in the developed, overly hygienic Western world.  An alternative interpretation of the evidence supporting the hygiene hypothesis forms the basis for the “microflora hypothesis,” which says that rather than specifically limiting infection, even the decreased exposure to microbes changes the colonization of bacteria of the infant gut, which has a negative effect in the development of the normal immune system which ultimately leads to allergic disease.

An adult human harbors about 100 billion bacteria in the intestines alone.  These gut bacteria account for 90% of the cells in the human body!  Human cells contain about 21,000 different genes, but the microbes living in the human comprise about 3 million genes.  The composition and function of the bacteria in the gut varies from person to person (i.e., biodiversity) and evolve during the first years of life and stabilize within the first 3 years of life.

The development of the gut microbiome (i.e., all the microorganisms that live in the gut) is influenced by interactions between diet, environment, and host-associated factors.  There is increasing evidence that these bacteria play many helpful roles in the modulation of our immune responses, especially in maintaining a balance between 2 different types of white blood cells called Th1 lymphocytes and Th2 lymphocytes.  The Th1 lymphocytes help protect us from infections, whereas the Th2 lymphocytes help mediate allergic disease.

The emerging hypothesis infers that environment or lifestyle-driven aberrancies in the early-life gut microbial composition and function represent a key mediator of childhood allergies and asthma.  Significant perturbations in the gut bacterial composition, especially reduced diversity, in the Western societies due to frequent antibiotic usage, environmental and lifestyle changes, etc. have disrupted the mechanisms of mucosal tolerance leading to more allergic disease.

Epidemiologic and clinical data supporting this interpretation include:

A recent meta-analysis of 25 studies revealed that the administration of probiotics reduces allergy-causing IgE antibody levels and the risk of atopic sensitization.  An example of dietary factors influencing allergies is the landmark LEAP study which demonstrated that early introduction of peanut products to high risk infants significantly decreased the subsequent development of peanut allergy.

There are a number of ongoing studies which will improve our understanding of the mechanisms underlying allergic disorders and hopefully offer new and exciting options in the management of these conditions in near future.

The board certified allergists of Black & Kletz Allergy always strive to keep abreast of new developments in the field of Allergy, Asthma, and Immunology in order to offer new and emerging diagnostic and therapeutic modalities, as soon as they are available.  Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and offer on-site parking at each location.  In addition, the Washington, DC and McLean offices are Metro accessible.  There is a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line.  The allergy specialists of Black & Kletz Allergy see both adults and children in the Tysons Corner, VA, Falls Church, VA, and Gainesville, VA areas and we have been serving the greater Washington metro area for over 50 years.  Please call one of our convenient offices to make an appointment or alternatively, you can click Request an Appointment and we will reply within 24 hours by the next business day.

From Allergy Doctors Vienna VA Patients Trust Now that the weather in Tysons Corner, VA, Gainesville, VA, and Falls Church, VA and the rest of the Washington, DC metropolitan area has warmed up, as it is now Summer, the risk of an insect sting has increased.  The most common stinging insects in the Washington, DC metro area are honey bees, yellow jackets, white-faced hornets, yellow-faced hornets, and wasps.  They all introduce their venom into their subjects when they sting their prey.  In some cases, people have toxic (i.e., non-allergic) reactions to the insect stings, particularly if stung by several insects at the same time.  The body, in this case, generally reacts to the venom as if it was a poison.  This can occur because the victim is exposed to an over-abundance of venom at one time.  A toxic reaction can cause symptoms similar to those of an allergic reaction, but also may include symptoms such as nausea, fever, and seizures.  This can be life-threatening and depends on the amount of venom injected into the individual.  On the other hand, about 3% of individuals experience true allergic reactions, which is usually not dependent on the amount of venom, but to the allergic response to the venom by the individual.  These allergic reactions can also be life-threatening.

When stung, most individuals have no reaction or a small local reaction.  People with this type of response are at no increased risk for a systemic (anaphylactic) reaction than that of the general population.  Other people will develop a large local reaction, where the area that was stung gets red and very swollen.  This large local reaction can reach the size of a baseball in some cases.  Still, however, there is no increased risk in these individuals of a systemic or anaphylactic reaction from the insect sting.  On the other hand, a small percentage of individuals will develop a systemic reaction to an insect sting which may include some or all of the following:  generalized itching (i.e., pruritus), hives (i.e., urticaria), swelling (i.e., angioedema) of another area of the body where the sting did not take place, abdominal cramping and pain, wheezing, shortness of breath, chest tightness, coughing, feeling faint, and drop in blood pressure.

If a person has had a large local reaction or a systemic reaction to an insect sting, they should definitely seek a consultation with a board certified allergist like the allergy specialists of Black & Kletz Allergy.  The allergists that Tysons Corner, VA, Falls Church, VA, Gainesville, VA, and Washington, DC residents have trusted for years have had over 50 years’ experience diagnosing and treating insect sting allergies.  A comprehensive history and physical examination is taken and then a decision is made whether to test that individual for allergies to honey bees, yellow jackets, white-faced hornets, yellow-faced hornets, and wasps.  Allergy testing can be done via blood or by skin tests.  The allergist will then decide the preferred method of testing for each specific individual, depending on the history of the reaction that is ascertained at the visit.

Measures in order to help prevent insect stings are discussed with patients, as well as what things should be done, if a future sting occurs.  For example, if stung by a honey bee, a stinger is left in the skin of the victim.  One should never pull out the stinger, as this actually increases the amount of venom that is introduced into the individual by causing contractions of the venom sac which is hidden under the skin of the person.  Instead, one should scrape off the stinger with a finger nail, credit card, etc. in order to prevent the introduction of more venom into the body of the individual.

If a patient has a positive allergy test to any of the stinging insect venoms, it is imperative that he/she go on a course of venom allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization) as it is extremely successful in preventing further anaphylactic reactions from insect stings.  The procedure entails giving progressively larger doses and volumes of insect venom to the individual weekly over a period of 10 weeks, then every 2 weeks for 1 dose, then every 3 weeks for 1 dose, then a maintenance dose every 4 weeks for 1 year, and then the maintenance dose can be decreased to every 6 weeks for several years.  The maintenance dose is roughly equivalent to the amount of venom in an actual sting.  Therefore, if someone gets stung while they are on a maintenance dose of venom immunotherapy, they are essentially getting the same dose of venom as they normally get every 6 weeks.  For this reason, they usually do not have a systemic reaction to the stinging insect, because they are protected due to the allergy shots.

All patients with allergic reactions to stinging insects are prescribed a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick).  At Black & Kletz Allergy, individuals are taught the correct method on how to use, when to use, and what to do, after using these devices.  We have training devices that we use to show patients the proper way to use them.  As a general rule, if someone is stung by a stinging insect and experiences any systemic sign or symptom, they should use the self-injectable epinephrine device and go immediately to the closest emergency room.

Reach Out To The Allergy Doctors Vienna VA Patients Call For Relief Insect sting allergies in cities such as Tysons Corner, VA, Falls Church, VA, and Gainesville, VA as well as others in the Washington, DC, Northern Virginia, and Maryland metropolitan area are not uncommon.  During the Summer and early Fall, there are more insect stings taking place and it is very important to take precautions to reduce the likelihood of getting stung.  The allergy doctors of Black & Kletz Allergy see both adults and children with insect sting allergies, in addition to other allergic disorders such as allergic rhinitis (i.e., hay fever), asthma, hives, swelling episodes, eczema, sinus disease, food allergies, medication allergies, and immune disorders.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA, all of which offer on-site parking.  The Washington, DC and McLean offices are Metro accessible and the McLean office offers a free shuttle that runs between the office and the Spring Hill metro station on the silver line.  Please call one of our offices to make an appointment or you can click Request an Appointment and we will respond to you within 24 hours by the next business day. Black & Kletz Allergy takes pride in providing excellent quality allergy, asthma, and immunology care to the Washington, DC metro area community in a friendly, convenient, and professional setting.

The Allergists Tysons Corner VA Trust Explain the Effects of Climate Change on Your Allergies The climate in places like Tysons Corner, VA, Falls Church, VA, and Gainesville, VA, as well as the rest of the Washington, DC metropolitan area, plays a significant role in producing allergens that annoy sensitized individuals.  The DC metro area was built on a swamp and there tends to be high counts of mold spores throughout the year, particularly from the Spring through the Fall.  Our humid Summers also account for excessive mold growth.  Pollen production is also a major problem in the Washington, DC metro area, mostly in the Spring and Fall.

Though there are still some unresolved controversies, the preponderance of evidence indicates that our climate has steadily changed over the past several decades and it is likely to continue to change in the near future.  This climate change has the potential to alter the incidence and severity of allergic and respiratory diseases in humans in the following ways:

More energy efficient and tighter homes will lead to an increase in indoor air pollution.  Accumulation of volatile organic compounds, radon gas, smoke, particulates, and protein allergens will increase the risk of respiratory illnesses.  In addition, higher water vapor and moisture levels will increase dust mite populations and cause an escalation of mold growth.

“Green practices” like composting facilities may cause increased respiratory diseases through the increased fungal burden that they put into the air.  Burning wood produces harmful chemicals including carbon dioxide, carbon monoxide, unburned hydrocarbons, and formaldehyde.  Inhaling particles coated with these chemicals contribute to asthma and chronic obstructive pulmonary disease (i.e., bronchitis, emphysema).

Ragweed flowers earlier and produces more pollen in urban locations where carbon dioxide concentrations and temperatures are higher.  The same effect can be seen with other allergenic species including poison ivy.

Whatever the coming changes may bring, a few proven environmental control measures such as keeping the indoor humidity lower to limit dust mite and mold growth, as well as decreasing outdoor activities on high pollen days, can help minimize allergic symptoms and reduce the need for medications. Contact a Top Allergist Tysons Corner VA Relies On The board certified allergists Tysons Corner VA trusts at Black & Kletz Allergy see patients from Tysons Corner, VA, Falls Church, VA, and Gainesville, VA as well as many other cities and towns in the Washington, DC, Northern Virginia, and Maryland metropolitan area. They are ready to work with you in teaching you how to improve your environment which subsequently will help relieve your allergic and asthmatic symptoms.  The allergy doctors at Black & Kletz Allergy treat both adults and children.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking and the Washington, DC and McLean, VA locations are Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Springhill metro station on the silver line.  Please call one of our convenient offices to make an appointment or if you prefer, you can click Request an Appointment and we will respond within 24 hours.  Black & Kletz Allergy has been providing excellent allergy and asthma care to the general population of the greater DC area for more than 50 years in a caring and professional setting.