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Though there are still some unresolved controversies, the preponderance of evidence indicates that our climate is steadily changing over the past several decades and is likely to continue into near future. This climate change also has the potential to alter the incidence and severity of allergic and respiratory diseases in humans. Although each individual is different, a general trend towards more allergens and more severe allergic disease seems likely if climate change continues in the direction it is going. While it is already known that the prevalence of both allergic rhinitis (i.e., hay fever) and asthma have increased in the last few decades, it seems likely that these numbers will continue to increase in the near future, at least partially as a result of climate change.

Below are a few ways that climate change may impact allergies:

• The warming of the climate and higher carbon dioxide levels will likely lead to longer pollen seasons.
• More hot summer days will generate more ozone which will probably trigger more flare-ups of breathing difficulties for people with chronic respiratory conditions such as asthma.
• Rising sea levels and changes in rainfall patterns are likely to increase the incidence and severity of mold allergies.
• The warming conditions caused by global warming may lead to the increased prevalence of biting and stinging insects in new areas.
• The effect of fewer cold winter days on respiratory infections from viruses and bacteria is still unpredictable.

We know that having more energy efficient and tighter homes leads to an increase in indoor air pollution. The accumulation of volatile organic compounds (VOC’s), radon gas, smoke particulates, and allergenic proteins will increase the risk of respiratory illnesses. In addition, higher water vapor and moisture levels will increase dust mite and mold growth, leading to an increase in the number of allergy sufferers as well as the severity of allergy symptoms.

“Green” practices such as composting facilities may cause an increase in respiratory diseases through the increased fungal load put into the air by these facilities. Burning wood produces harmful chemicals including carbon dioxide, carbon monoxide, unburned hydrocarbons, and formaldehyde. Inhaling particles coated with these chemicals contribute to bronchitis, asthma, and emphysema.

With an increase in temperatures and other features of climate change, ragweed will flower earlier in the season and produce more pollen in urban locations where carbon dioxide concentrations and temperatures are higher. The same effect can be seen on other allergenic species including poison ivy.

Whatever the coming changes may bring, a few proven environmental control measures should be noted as a means to help prevent allergy symptoms. Keeping the indoor humidity lower in order to limit dust mite and mold growth is a good thing to do particularly if one is allergic to dust and/or molds. It is also important to use a HEPA filter in one’s house and to change them regularly. Minimizing outdoor activities on high pollen days can also diminish allergic symptoms and reduce the need for allergy medications. One can also take a shower after spending time outdoors so that the pollen is washed off one’s body. Another environmental control measure that helps allergy sufferers is to wash off one’s pet after they spend time outdoors since pet hair attracts pollen.

The allergy doctors at Black & Kletz Allergy are board certified and treat both adult and pediatric patients. We have 3 convenient 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 which all offer on-site parking. The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment and we will reply within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy are eager to help you with any of your allergy or immunology needs. We diagnose and treat a multitude of allergy and immunological conditions including allergic rhinitis (i.e., hay fever), asthma, sinus problems, hives (i.e., urticaria), swelling episodes (i.e., angioedema), generalized itching (i.e., pruritus), food allergies, medication allergies, eczema (i.e., atopic dermatitis), insect sting allergies, poison ivy, poison oak, poison sumac, contact dermatitis, eosinophilic esophagitis, mast cell diseases, and immune disorders. The allergists at Black & Kletz Allergy are knowledgeable about how climate change may affect allergy symptoms and are here to help guide you through these changes. We are dedicated to providing excellent care to you as we have been doing in the Washington, DC metropolitan area for more than 5 decades.

The swimming season is in full swing and most public and private swimming pools are attracting swimmers of all ages and of all skill levels. For most individuals, swimming is one of the most pleasurable recreational avenues offered in the summer. For others, swimming offers an effective workout option without putting undue pressure on one’s joints.

Despite the popularity of swimming, a small percentage of individuals may experience adverse reactions while in a pool or after coming out of the pool. Some individuals experience itchy skin and rashes while others notice an increase in upper and lower respiratory symptoms. The question is: Is the chlorine in the water the culprit?

Chlorine is a chemical added to water in swimming pools in order to kill the bacteria that can grow in such water. Chlorine also oxidizes suntan oils, other body oils, cosmetics, leaf mold, bugs, urine, sweat, and other human bodily waste. Chlorine is not an allergen because it does not stimulate the immune system to produce proteins which then cause allergic symptoms. Chlorine is instead considered an irritant. As an irritant, chlorine may cause undesirable side effects on the skin and respiratory system. It is similar to other irritants such as perfumes, colognes, strong scents, pollution, and organic dusts. These irritants may also cause skin and respiratory symptoms that may be confused for allergy symptoms, but when it comes down to it, the symptoms are due to the irritating effect of the chemicals, dusts, or particulates, and not an allergic reaction to them.

In sensitive individuals, chlorine can result in a type of irritant contact dermatitis (ICD), especially if the concentration of chlorine in the pool is high.

Symptoms of irritant contact dermatitis may include:

• Excessive dryness of the skin
• Redness of the skin
• Itching of the skin
• Flakiness, fissuring, and/or scaling of the skin
• Hives (i.e., urticaria) – Raised blotches or “welts” with clear margins

Treatments of irritant contact dermatitis include:

• Washing with fresh water as soon as coming out of the pool
• Liberal application of emollients (i.e., moisturizing lotions)
• Mild topical corticosteroid creams or ointments
• Antihistamines to relieve itching of the skin

Patients with a history of respiratory disorders may experience more of a flare-up of both the upper and lower respiratory symptoms listed below when exposed to chlorine in a pool.

Upper Respiratory Symptoms:

• Sneezing
• Itchy nose
• Runny nose
• Nasal congestion
• Post-nasal drip
• Itchy throat
• Itchy eyes
• Watery eyes
• Redness of the eyes
• Sinus congestion
• Sinus headaches
• Coughing

Lower Respiratory Symptoms:

• Chest tightness
• Coughing
• Shortness of breath
• Wheezing

Even though the above upper and lower respiratory symptoms may be seen in anyone exposed to chlorine, these symptoms are more common and more prominent in patients with inadequately controlled allergic rhinitis (i.e., hay fever) and/or asthma.

Treatment of Upper Respiratory Symptoms: The treatment of the upper respiratory symptoms caused by chlorine exposure may include oral antihistamines, oral decongestants, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular antihistamines, ocular decongestants, and/or ocular mast cell stabilizers.

Treatment of Lower Respiratory Symptoms: The treatment of the lower respiratory symptoms caused by chlorine exposure may include an inhaled bronchodilator and/or an inhaled corticosteroid. The inhaled corticosteroid is used to prevent and control airway inflammation.

Prevention of Chlorine-Induced Symptoms: Choosing a swimming pool with less of a concentration of chlorine may help prevent or mitigate the severity of symptoms that occur in individuals who are sensitive to the effects of chlorine.

The board certified allergy specialists at Black & Kletz Allergy have expertise in diagnosing and treating chlorine sensitivity as well as all types of irritant reactions. In addition, we also treat all types of allergic, asthmatic, and immunologic conditions. The allergists at Black & Kletz Allergy treat both pediatric and adult allergy and immunology patients and have been practicing 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 irritant reactions to chlorine or any other irritant, or have allergies or asthma, we are here to help alleviate or hopefully end these unwanted symptoms that have been so bothersome, so that you can enjoy a better quality of life. Black & Kletz Allergy is dedicated to providing the highest quality allergy, asthma, and immunology care in a compassionate, relaxed, and professional environment.

We love our pets. Pets are very important to humans. They fulfill all types of psychological and social needs that people desire including happiness, self-worth, and companionship. Unfortunately, some individuals cannot experience the joy of owning a pet because they have allergy or asthma symptoms when they are exposed to the pet. Any pet can cause allergy symptoms, but the most common pet allergies in the U.S are due to cats and dogs. Approximately 70% of homes in the U.S. have at least one pet.  It is estimated that about 45% of U.S. households own a dog and about 35% own a cat. Despite this inequity, there are still more cats in the U.S. than dogs (i.e., 86 million cats and 78 million dogs). The U.S. is the number one pet-owning country in the world!

In addition to cats and dogs, there are numerous other pets that can be found in the U.S. These may include fish, birds (e.g., parrots, parakeets), rabbits, pigs, amphibians (e.g., frogs, toads, salamanders), reptiles (e.g., lizards, snakes, turtles, geckos), rodents (e.g., hamsters, guinea pigs, mice, gerbils, rats, chinchillas), ferrets, hedgehogs, hermit crabs, horses, insects, and spiders. Still yet, there are exotic animals that are kept as pets. Some of these animals may include, monkeys, chameleons, raccoons, foxes, bearded dragons, and tigers.

The classic symptoms of a pet allergy are those of either allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), asthma, and/or skin manifestations. The allergic rhinitis symptoms may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, fatigue, sinus congestion, and/or headaches. Eye symptoms typically may include itchy eyes, watery eyes, redness of the eyes, and/or puffy eyes. Some individuals with pet allergies may experience asthma symptoms such as chest tightness, wheezing, coughing, and/or shortness of breath. Known asthmatics may experience a worsening of their asthma when exposed to certain pets. Still others may develop skin manifestations which may include itchiness, redness, and/or hives (i.e., urticaria).

One myth that is widely held as fact by so many is that there are “hypoallergenic” cats and dogs to bring home if one is allergic to such a pet.  There are many pet-allergic individuals who feel that they have reduced allergic symptoms around short-haired cats and/or dogs that do not shed (e.g., poodles, Maltese, Portuguese Water Dog). It should be noted that there are no dogs that are 100% shed-free. Even though many people feel they are better around these non-shedding or short-haired animals, most scientific studies do not support this phenomenon. In addition, it is not the hair that causes the allergies, but rather the dander, saliva, and urine that is responsible for containing the allergens in cats and dogs that cause allergies.

The diagnosis of pet allergies begins with a comprehensive history and physical examination performed by a board certified allergist such as the ones at Black & Kletz Allergy. Next, allergy testing is usually done. The tests can be done either by allergy skin testing or by blood tests, depending on the individual and situation. Once a pet allergy is confirmed, it is important to discuss ways to prevent and/or treat such an allergy.

Prevention is the best option but most people are not willing to get rid of their pets which is very understandable, since they become part of the family. If prevention is not an alternative, there are still ways to minimize one’s exposure to a pet in the confines of one’s home. Despite one’s efforts to minimize their exposure to pets, it is often necessary to treat an individual for pet allergies.

Treatment of pet allergies may include antihistamines, decongestants, leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular antihistamines, asthma inhalers, and other allergy and asthma medications. Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a very efficacious treatment option in the management of pet allergies. Allergy immunotherapy has been used in the U.S for more than 100 years. Both children and adults respond nicely to this treatment. It is effective 80-85% of the time. Most patients are on allergy immunotherapy for 3-5 years.

The board certified allergy specialists at Black & Kletz Allergy see both pediatric and adult patients and have over 50 years of experience in the field of allergy, asthma, and immunology. 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. 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 servicing the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years and we look forward to providing you with the highest state-of-the-art allergy, asthma, and immunology care in a friendly and relaxed environment.

Allergy immunotherapy (AIT) (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a time-tested efficacious treatment option for disorders caused by the sensitization to environmental allergens such as dust mites, molds, pollens, pets, and/or cockroaches. It is 80-85% effective in reducing symptoms from allergic rhinitis (i.e., hay fever), asthma, and/or allergic conjunctivitis (i.e., eye allergies). Venom immunotherapy (VIT) on the other hand is 97% effective in preventing serious life-threatening reactions after stinging insect venom allergen exposures to honey bees, wasps, yellow jackets, white-faced hornets, yellow-faced hornets, and/or fire ants). Venom immunotherapy has been the standard of care for individuals allergic to stinging insect venoms for the past several decades.  The term immunotherapy may be used to denote the general concept of both allergy immunotherapy and venom immunotherapy. The process of immunotherapy entails injections with proteins extracted from allergens at regular intervals with increasing incremental doses. The treatment begins with very small doses in order to minimize the risk of adverse reactions. As the treatment continues, the doses are gradually escalated until a maintenance dose is attained.

This process helps allergic individuals develop a tolerance to the allergens they have been previously sensitized to. This procedure is especially useful when dealing with allergens which are usually difficult to avoid such as dust mites, molds, pollens, and/or stinging insects. Patients on maintenance doses of both allergy immunotherapy and venom immunotherapy should be able to resist allergic reactions. The reduction of the severity of symptoms should lead to a reduction of the need for medications. Medications may be effective but only offer temporary relief from allergy symptoms. Unlike immunotherapy, medications do not alter the underlying sensitizations of an individual.

In essence, immunotherapy is a desensitization process that helps the allergic individual develop tolerance to the substance(s) that he or she has been previously sensitized to.  Whereas most allergy medicines mask the symptoms of allergies, allergy injections treat the underlying cause and modulate the immune response.  This results in an increased resistance to the offending allergens.  This process is comparable to vaccinations with bacterial and viral products which help individuals resist infections with those microorganisms.

Allergy shots can cause 2 types of adverse reactions. The more common “local’ reactions generally manifest themselves as redness, itching, and/or swelling at the site of injection. “Systemic” or “generalized” reactions are not common but if they occur, they can result in hives, a drop in blood pressure, wheezing, shortness of breath, swelling of lips, tongue, etc. It is rare however to have life-threatening reactions such as anaphylaxis after allergy injections. Occasionally reactions begin as a local reaction and then progress to systemic reaction. Allergy immunotherapy is currently being researched as a possible treatment option for numerous food allergies.  The preliminary results of studies regarding immunotherapy with peanuts are very promising.  Although there is currently no FDA-approved protocol for immunotherapy for food allergies, it is hoped that we can offer this treatment to individuals with food allergies in the near future. For now, the most effective treatment for food allergies is to avoid the food and any cross-reacting foods. Note that despite there not being any immunotherapy given by injection for the treatment of peanut allergies, there is now a method to undergo peanut desensitization to peanuts by way of an oral route. Palforzia is a peanut allergen powder prescribed by board certified allergists that is used to desensitize patients from ages 4-17 who have a confirmed allergy to peanuts.

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 environmental allergies (i.e., allergic rhinitis, hay fever), eye allergies (i.e., allergic conjunctivitis), insect sting allergies, asthma, food allergies, eczema (atopic dermatitis), hives (i.e., urticaria), generalized itching (i.e., pruritus), swelling episodes (i.e., angioedema), contact dermatitis, eosinophilic esophagitis, medication allergies, 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 servicing the greater Washington, DC metropolitan area for many years and we look forward to providing you with excellent state-of-the-art allergy care in a welcoming and professional environment.

Is it possible to be allergic to exercise? Well, not really, however, exercise can cause the body to exhibit the signs and symptoms of allergies! We are also not talking about an excuse not to exercise! The mechanism by which exercise causes “allergy” symptoms is not completely understood but it seems to be related to an exaggerated cholinergic response to the warming that occurs with exercise and not due to an allergy at all. There is an increased level of histamine during and or following exercise in many of the conditions associated with this phenomenon. The severity of the “allergic” symptoms can range from mild to severe and in some cases they may be life-threatening. As a general rule, patients should stop exercising at the first sign of an “allergic” or asthmatic reaction. It may be recommended by a board certified allergist that individuals with any of the following conditions carry an epinephrine self-injectable device (i.e., EpiPen,Auvi-Q, Adrenaclick). It should also be noted that if one uses such as device, he or she should go immediately to the closest emergency room. Below are some examples of conditions where exercise causes symptoms that mimic allergies:

Exercise-induced asthma: Many individuals with asthma have external factors which exacerbate their asthma. Some of these triggers may include allergies to environmental allergens such as dust mites, molds, pollens, pets, and cockroaches. Others may include non-allergic triggers such as pollution, organic dusts, strong scents, increased humidity, changes in temperature, cold air, and certain chemicals. Still other asthmatics will complain of increased asthma symptoms when exercising. When an individual develops asthma symptoms (i.e., wheezing, shortness of breath, chest tightness, coughing) with exercise only, that person is said to have exercise-induced asthma. These patients have no other triggers for their asthma other than exercise. To an outsider, this person looks as though they are “allergic” to exercise since they have asthma symptoms whenever they exercise. Most individuals with exercise-induced asthma are given an inhaler that can both be used to treat the asthma as well as be used prophylactically to prevent the asthma symptoms prior to exercise. Leukotriene antagonists may also be utilized to help prevent the symptoms from occurring.

Exercise-induced urticaria (i.e., hives): In this condition, individuals develop hives whenever exercising or immediately following exercise. This is very confusing to the patients that are plagued with this disease. Individuals with this disorder often complain that they are “allergic” to exercise or that they are “allergic” to their own sweat. In reality, it is not an allergy at all. The hives are best controlled by avoiding exercise, but in individuals who want to exercise, there are medications (i.e., antihistamines, leukotrienes antagonists, H2-blockers) that can be given to both treat and prevent such reactions.

Exercise-induced pruritus (i.e., itching): Individuals who have generalized itching without the accompaniment of a rash after exercising have a condition called exercise-induced pruritus. It is very similar to exercise-induced urticaria except that the person gets itching without the hives. These individuals also feel that they are “allergic” to either exercise or their own sweat. In fact, it is not an allergy but rather an exaggerated cholinergic response to the warming of exercise. Avoiding exercise is an option but it does not prevent itching from occurring in exercise that occurs in emergency circumstances where exercise is a must and not an option. Medications used to prevent and treat this malady is the same as with exercise-induced urticaria.

Exercise-induced angioedema (i.e., swelling): In some individuals, exercise may trigger random swelling episodes that can occur anywhere on the body. The swelling can be on the skin or it can be internal. The most common locations for swelling to occur are the face, eyes, lips, throat, tongue, hands, and/or feet. Needless to say, that swelling of the throat can be life-threatening, so it is important to recognize the early signs and symptoms of this type of swelling. There are various medications that can be used to prevent and treat swelling episodes. Again, avoiding exercise is an option but it does not prevent swelling from occurring in exercise that occurs in emergent situations where exercise is a must. The medicines are similar to the ones used for the prevention and treatment of exercise-induced urticaria and pruritus.

Exercise-induced anaphylaxis: Occasionally, exercise can trigger a more serious and exaggerated response whereby an individual may experience life-threatening anaphylaxis. Again, it is very important for the affected individual to understand the signs and symptoms of early anaphylaxis so they are able to treat it appropriately in its early phase. Medications used to prevent and treat exercise-induced urticaria, pruritis, and angioedema are also used to manage exercise-induced anaphylaxis. Avoiding exercise completely is the best option in these individuals. As with all of the above conditions, carrying an epinephrine self-injectable device is very important. Once again, if the epinephrine self-injectable device is used, it is important that the individual go immediately to the closest emergency room.

Food-dependent exercise-induced anaphylaxis: This condition is an off-shoot of exercise-induced anaphylaxis. It is very similar to exercise-induced anaphylaxis except that in these individuals, exercise by itself does not cause anaphylaxis. Approximately 30-50% of patients with exercise-induced anaphylaxis have food-dependent exercise-induced anaphylaxis. Likewise, food itself does not cause anaphylaxis. However, if a person with this condition eats a certain food and then exercises within usually 2 hours after consumption, anaphylaxis will develop. Interestingly, these patients generally are not allergic to that specific food and as mentioned above, do not have anaphylaxis after eating that food. The anaphylaxis only occurs if that person exercises within 2 hours after eating that food. The most common foods that cause this type of reaction include wheat, shellfish, fruit, milk, celery, fish, alcohol, tomato, strawberries, and peach. Avoiding the combination of the trigger food with exercise is the key to preventing the anaphylaxis. As stated above, carrying an epinephrine self-injectable device is very important. If the epinephrine self-injectable device is used, it is important that the individual go immediately to the closest emergency room.

The board certified allergy doctors at Black & Kletz Allergy located in the Washington, DC, Northern Virginia, and Maryland metropolitan area will readily answer any questions you have regarding your exercise-induced asthma and other exercise-induced allergic disorders. We also diagnose and treat allergic rhinitis (i.e., hay fever), asthma, sinus disease, eosinophilic esophagitis, hives (urticaria), swelling (angioedema), generalized itching (i.e., pruritus), eczema (i.e., atopic dermatitis), medication allergies, food allergies, insect sting allergies, and immune disorders. We have 3 offices with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices offer on-site parking. In addition, our Washington, DC and McLean, VA offices are accessible by Metro. There is also a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please make an appointment by calling any one of our 3 offices, or alternatively, you can click Request an Appointment and we will answer you within 24 hours by the next business day. Black & Kletz Allergy diagnoses and treats both adults and children and we are proud to serve the Washington, DC metro area residents for which we have done for more than 5 decades.

The esophagus is a tubal structure that propels food from the throat into the stomach through rhythmic contractions of the smooth muscles in its walls. A thin mucus membrane lines the insides of its lumen. Eosinophils are type of white blood cells that have some role in combating certain parasitic infections. Eosinophils can also cause damage to tissues when they are accumulated in excess, due to a chronic inflammatory process.

Eosinophilic esophagitis (EoE) is an allergic/immunologic disorder in which eosinophils cause dysfunction of the esophagus which then leads to a difficulty in swallowing and occasionally an impaction of foods. The exact cause of the eosinophilic esophagitis is not clearly established but genetic factors predispose to the disease process. More recent evidence points to an allergic sensitization to certain foods, and possibly to environmental allergens, playing a role in the pathogenesis of the disorder.

Eosinophilic esophagitis is a rare disease, as it is estimated that there are approximately 160,000 people suffering from it in the United States. Eosinophilic esophagitis can occur in all age groups; however, it is most common in men during their 20’s and 30’s. A history of various atopic conditions such as asthma, atopic dermatitis (i.e., eczema), seasonal allergies (i.e., allergic rhinitis, hay fever), and food allergies may also be present in these individuals.

The symptoms of eosinophilic esophagitis usually include difficulty in swallowing, heartburn, abdominal pain or discomfort, and/or a bloating sensation. Many patients are diagnosed after an emergency department visit for the management of food getting “stuck” in the esophagus. The condition has a chronic remitting and relapsing course and many patients suffer from symptoms for many years before getting properly diagnosed.

The diagnosis of eosinophilic esophagitis is suspected by detecting ridges, furrows, rings, and strictures within the esophagus when observed via an upper endoscopic procedure. These sequelae are a result of the chronic inflammatory damage to the esophagus. The demonstration of an excessive accumulation of eosinophils (i.e., greater than or equal to 15 eosinophils per high power field) in the lining of the esophagus by microscopic examination of a biopsy specimen is required for the confirmation of the diagnosis.

Until recently, there have been no specific treatment options for the management of eosinophilic esophagitis. Some patients respond to empiric treatment with proton pump inhibitor (PPI) medications which reduce the acid secretion in the stomach and minimize reflux into esophagus.

An empiric 6 food elimination diet with milk, wheat, peanut/tree nut, egg, soy, and seafood/shellfish may be helpful in some individuals. The avoidance of specific foods based on a skin testing procedure to detect allergic sensitization may also be beneficial in minimizing symptoms in some patients. Others may require a more elemental amino-acid based diet to help control their unwanted symptoms.

The next step in the management of eosinophilic esophagitis is to utilize topical corticosteroids in order to control the inflammation inside the esophagus. Corticosteroid medications such as fluticasone and budesonide which were originally indicated for asthma are used in an ingested form in order to coat the interior mucosal surface of the esophagus. In this approach, the asthma inhaler is swallowed instead of inhaled in order to apply the anti-inflammatory corticosteroid medication directly to the desired tissue (i.e., esophagus). Despite this approach, however, many patients can continue to be symptomatic.

Recent advances in the understanding of the underlying pathologic process now focuses on the role of cytokines (i.e., molecules that mediate and drive the inflammatory process) such as interleukin-13 (IL-13). Clinical trials have shown that blocking these molecules by therapeutic agents may result in the improvement in the structural appearance of the esophagus, reduce the numbers of eosinophils in the esophagus, and thus bring about resolution of many of the symptoms of eosinophilic esophagitis.

Recently (on 5/20/2022), the U.S. Food and Drug Administration (FDA) approved Dupixent (i.e., dupilumab) as a treatment for eosinophilic esophagitis in adults and pediatric patients 12 years and older weighing at least 40 kilograms (i.e., 88 pounds). Dupixent is a monoclonal antibody and “biological” medication that acts to inhibit part of the inflammatory pathway.

Dupixent was originally approved in 2017 for anther condition. It is currently approved for the treatment of moderate to severe atopic dermatitis (i.e., eczema) in adult and pediatric patients aged 6 and older whose disease is not adequately controlled by topical prescription therapies or when those therapies are not advisable. Dupixent is also approved as an add-on maintenance treatment for adults and pediatric patients aged 6 and older with certain types of moderate to severe asthma, as well as an add-on maintenance treatment in adults with inadequately controlled chronic rhinosinusitis with nasal polyposis.

The dose of Dupixent for eosinophilic esophagitis is a 300 mg. injection under the skin once every week. Most patients can self-inject with a pre-filled syringe either over the abdomen or thighs. The most common side effects associated with Dupixent include injection site reactions, upper respiratory tract infections, joint pain, and herpes viral infections.

Undoubtedly there will be other treatments for eosinophilic esophagitis in the future. Until these remedies become available, we currently do have good therapeutic options that should curtail or prevent the symptoms of eosinophilic esophagitis.

The board certified allergists/immunologists at Black & Kletz Allergy can answer your questions and address your concerns you have regarding eosinophilic esophagitis or any other type of eosinophilic disorder. In addition, we treat a variety of allergic diseases including allergic rhinitis (i.e., hay fever), asthma, sinus conditions, hives, (i.e., urticaria), food allergies, medication allergies, insect sting allergies, and immunological disorders. We have been serving the Washington, DC, Northern Virginia, Maryland metropolitan area for over 50 years. Our office locations are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer parking at each office location and we are Metro accessible at our Washington, DC and McLean, VA locations. We also offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please call us at one of our locations to schedule an appointment or you can click Request an Appointment on our website and we will respond to you within 24 hours by the next business day.

Generalized pruritus (i.e., generalized itching) is not an uncommon condition and can be quite maddening to the individual suffering from it. It may be associated with hives (i.e., urticaria) and/or angioedema (swelling). The itching is usually described as either intermittent or chronic itching in various parts of the body or it can be intermittent or chronic itching of the entire body. In some individuals, the itching only lasts for a couple of days. In other individuals however, the itching can last much longer. It is not atypical for the itching to lasts weeks, months, or in some cases, years. The severity of the itching can be anywhere from mild to very severe. Many pruritus sufferers complain that the itching is so bothersome that it affects their quality of life. Regardless of how severe the itching is, one should seek medical care from a board certified allergist, like the ones at Black & Kletz Allergy, if the itching has occurred for more than 6 weeks so that the cause of the itching can be explored and hopefully identified. Pruritus is also generally easier to treat if the cause of the itching has been identified.

The diagnosis of pruritus is based solely on what the individual tells the allergist during a comprehensive history and physical examination. It is however important for the allergist to try to identify a cause of the itching as there are many known causes of pruritus. If the itching has been present for less than 6 weeks, the pruritus is said to be “acute.” Most of the time with acute pruritus, no testing is needed and the patient is treated with medications to alleviate the itching. In instances of “chronic” pruritus, where the itching has been present for more than 6 weeks, allergy tests and/or blood tests may be indicated in order to try to find the cause of the itching.

Some of the more common causes of pruritus may include food allergies, medication allergies, iron deficiency anemia, hepatitis B, hepatitis C, thyroid disease, chronic lymphocytic leukemia (CLL), diabetes mellitus, lung cancer, uremia (i.e., kidney damage), xerosis (i.e., dry skin), and pregnancy. It is important that a cause be identified so that either the allergen is avoided or treatment can be directed at the underlying systemic condition responsible for the itching.

The treatment of pruritus is always aimed at treating the underlying condition responsible for the itching. For example, if an individual is found to have hypothyroidism as the cause for the itching, it is prudent to treat the thyroid disease and the itching should go away. If no identifiable cause can be detected; the treatment then is aimed at alleviating the itching itself. There are a variety of medications that can be utilized in order to treat the itching. Some of these medications may include antihistamines , H2 blockers , and leukotriene antagonists . Rarely, oral corticosteroids may be used for refractory cases. Topical ointments and/or creams have also been used with some success in certain patients.  The length of time that a patient needs to be treated varies greatly from individual to individual.  In the majority of cases, medications may only be needed for 1 or 2 weeks, but can be necessary is some patients for several years.  Other treatments such as UV light treatments have been used with varying degrees of success.

The board certified allergy specialists at Black & Kletz Allergy have 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 allergy doctors at Black & Kletz Allergy are extremely knowledgeable regarding generalized pruritus as well as other skin disorders such as hives, eczema (i.e., atopic dermatitis), and swelling episodes. We diagnose and treat both pediatric and adult patients. In addition, we treat patients with environmental allergies, medication allergies, insect sting allergies, asthma, sinus disease, eosinophilic conditions, and immunological 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 servicing the greater Washington, DC area for more than 5 decades and we look forward to providing you with first-rate state-of-the-art allergy care in a welcoming and professional environment.

There are disease states where medications taken by mouth do not offer enough benefit in either relieving symptoms, stopping the progression of a condition, or preventing complications of a disease. In these instances, medications may need to be administered by means of the parenteral route, such as using a needle or catheter to infuse the medication.

The 2 ways that the administration of medications via the parenteral route can be accomplished include:

1. Intravenous route: A needle or catheter is inserted into a vein and the medication is infused. A peripheral vein in the arms or legs is most commonly used. Rarely a “central” deeply situated vein may need to be catheterized for long-term medication administration.

2. Subcutaneous route: A needle or catheter is inserted just under the skin and the medication is infused. The liquid medication is gradually absorbed into the blood stream from the surrounding “subcutaneous” space.

One of the most common medications used by allergists/immunologists like the one’s at Black & Kletz Allergy are immunoglobulins (i.e., antibodies) which are given by infusion therapy to treat diseases where one’s own immune system is unable to manufacture antibodies to fight infections. These diseases are called primary immunodeficiency diseases (PIDD). Untreated, the patient experiences frequent, severe, and sometimes life-threatening infections. These infections can be prevented by replenishing the body with “outside” antibodies (i.e., antibodies collected from healthy donors) through either intravenous or subcutaneous infusions. In some instances, the therapy is begun as intravenous therapy and then it may be transitioned to the subcutaneous route.

SOURCE:

The immunoglobulins that are used to treat these conditions are extracted from the plasma of healthy blood donors. They are usually pooled from thousands of donors, concentrated, and purified. They are treated to prevent transmission of blood borne diseases and then packaged in sterile conditions.

DURATION:

Intravenous infusions generally take approximately 3 to 4 hours each time to infuse. Subcutaneous infusions, on the other hand, can take up to 6 hours to get to the desired place because the solution is gradually absorbed from the site.

FREQUENCY:

Intravenous infusions are usually given once every 4 weeks, whereas the interval between subcutaneous infusions can vary between 1 and 4 weeks depending on the specific product.

Intravenous infusions usually involve 1 needle stick in order to insert a catheter into the vein, whereas subcutaneous infusions may need 2 to 4 different sites (over the abdomen, thighs, etc.) depending on the volume of the solution that needs to be injected.

LOCATIONS:

Patients can be trained to infuse the medications at home by using electric infusion pumps. The infusions are not usually painful. In complex situations, the treatments are given either in doctor’s offices or in infusion centers located in hospitals or free-standing infusion centers.

SIDE EFFECTS:

Intravenous infusions rarely cause systemic side effects. Headache is a commonly reported side effect. Some patients also experience chills and sweating during infusions. These side effects can often be mitigated by slowing down the rate of infusions. After the infusion is completed, some patients may experience fatigue and achiness for a day or two. These side effects can sometimes be prevented or minimized by being premedicated prior to the infusions.

Subcutaneous infusions usually cause fewer systemic side effects than intravenous infusions but they still may cause local reactions such as redness, swelling, and/or pain at the site of administration.

MONITORING:

The doses of immunoglobulin infusions are adjusted based on the “trough” or lowest levels (i.e., immediately before the next dose) for IgG antibodies. The goal is to constantly maintain these IgG levels in the normal range.

The frequency and severity of the infections are also closely monitored to assess the effectiveness of the antibody replacement therapy.

OTHER MEDICATIONS AND CONDITIONS:

In addition to immunoglobulins, other therapeutic agents such as antibiotics, corticosteroids, and biologicals can also be administered either intravenously or subcutaneously for conditions treated by allergists/immunologists. There are a multitude of biologicals on the market and more are becoming available to treat a slew of allergic or immunological conditions such as asthma, eczema (i.e., atopic dermatitis), chronic hives (i.e., urticaria), and chronic rhinitis with nasal polyps. The treatment of food allergies may be another allergic condition in which biologicals may be used in the future depending on the results from ongoing research.

The board certified allergists at Black & Kletz Allergy have treated numerous patients with conditions requiring treatment by the intravenous and subcutaneous routes in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. We treat both children and adults and we have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 offices of Black & Kletz Allergy have 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 would like to be seen for any allergy or immunology condition, please call us to make an appointment or alternatively, you can click Request an Appointment and we will respond to you within 24 hours of the next business day. Black & Kletz Allergy is proud to continue to provide high quality allergy, asthma, and immunology care to the Washington, DC metropolitan area.

Hay fever is the common name for allergic rhinitis. The classic symptoms of hay fever or allergic rhinitis may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, sinus pressure, sinus headaches, itchy throat, itchy eyes, watery eyes, and/or redness of the eyes. In some individuals, respiratory symptoms such as wheezing, chest tightness, coughing, and/or shortness of breath can develop. These individuals are then said to have allergic asthma. The cause of hay fever and/or asthma in allergic individuals is due to an allergic response to a foreign allergen such as pollens, molds, dust mites, pets, cockroaches, etc. Our immune system mistakes these allergens as potentially detrimental, and as a result mounts a defensive attack on these allergens when it encounters them.  Biologically, there is a release of chemical substances (e.g., histamine, leukotrienes, prostaglandins) into the tissues inside the nose, eyes and lungs which is responsible for the allergy symptoms.

The diagnosis of hay fever relies on a comprehensive history and physical examination by a board certified allergist in conjunction with allergy testing by either allergy skin testing or allergy blood testing. This is done in order to identify allergies to specific allergens for each individual.

The treatment of hay fever involves avoiding the offending allergens if at all possible. Most of the time however, it is impossible to avoid the exposure to things like dust mites, molds, and pollens. When avoidance is either impossible or unhelpful, allergy medications are usually utilized in order to alleviate the annoying allergy symptoms. Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are often implemented as a very effective way to combat allergies and asthma. Allergy shots are 80-85% effective and are generally taken for 3-5 years.

Not all individuals with allergy symptoms however are actually “allergic.” These individuals will have negative allergy skin tests or blood tests. If this occurs, the person is said to have non-allergic rhinitis or vasomotor rhinitis. They typically can have the same symptoms as someone with hay fever except they usually do not have itching of the nose, throat, or eyes.

The symptoms in individuals with non-allergic rhinitis may have intermittent symptoms or they can be perennial in nature. The physiology of non-allergic rhinitis is enlargement of the blood vessels inside the nostrils and subsequent leakage of fluids into the surrounding tissues resulting in excessive mucus and swelling of the mucus membrane linings and nasal turbinates. The cause of non-allergic rhinitis is unknown.

The triggers of non-allergic rhinitis may include: environmental irritants (e.g., pollution, dust, smoke, strong odors, fumes, chemical sprays, colognes, perfumes, potpourri, temperature changes, changes in humidity, viral infections (e.g., common cold, influenza), hormonal changes (e.g., thyroid disease, pregnancy, menstruation, emotional or physical stress, sleep apnea, gastrointestinal esophageal reflux disease (GERD), alcohol, rhinitis medicamentosa (i.e., prolonged or overuse of over-the-counter decongestant nasal sprays such as Afrin or Neosynephrine), gustatory rhinitis (i.e., food-related runny nose caused by an overstimulation of the vagal nerve. It is triggered by eating any type of food, but most often by hot or spicy foods), and various medications .

The diagnosis of vasomotor or non-allergic rhinitis is established when an individual has the classic symptoms of hay fever but has negative allergy skin tests or blood tests and there is no evidence of infection. It is a diagnosis of exclusion since there are no specific tests to diagnose non-allergic rhinitis. It is rather the lack of positive allergy tests that are needed to diagnose the condition.

The treatment of non-allergic rhinitis begins with avoiding any triggers that cause symptoms. If one cannot avoid the triggers, an over-the-counter or homemade saline solution may be helpful in alleviating symptoms. Corticosteroid nasal sprays may also be helpful in decreasing nasal congestion due to their anti-inflammatory actions. Anticholinergic and antihistamine nasal sprays are also helpful in diminishing nasal symptoms. Oral decongestants can be taken in order to decrease nasal congestion in individuals who do not have a contraindication to using them such as individuals with hypertension, pregnancy, etc.

Note: If left untreated treated, complications may arise in individuals with non-allergic rhinitis which may include nasal polyps, middle ear infections, sinus infections (i.e., sinusitis), lack of concentration, poor school performance, and/or decreased productivity at work.

The board certified allergy doctors at Black & Kletz Allergy see both pediatric and adult patients and have over 5 decades of experience in the field of allergy, asthma, and immunology. 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. 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 providing first-rate allergy and asthma care in the greater Washington, DC metropolitan area for over 50 years and we look forward to continuing to provide you with the highest state-of-the-art allergy care in a friendly and relaxed environment

Environmental allergies affect about 50 million Americans in varying degrees of severity. For a majority of these individuals, the symptoms are aggravated seasonally and triggered by exposure to outdoor allergens.

Most of these allergens are pollens, which are tiny microscopic grains that help in the fertilization of plants. These pollens are produced by trees, grasses, and weeds. Trees produce most of the pollen in the early Spring and grasses pollinate in the late Spring and early Summer in the Washington, DC, Northern Virginia, and Maryland geographical area. There is also a period in March and April when both trees and grasses release pollen. Ragweed is the most common weed and its pollen causes seasonal allergy symptoms in the Fall. Ragweed pollen usually begins to pollinate in mid-August in our region, peak in September and taper off after the first frost.

Types of Grasses: The most common grasses that release pollen triggering allergy symptoms are as follows:

• Orchard
• Timothy
• Sweet Vernal
• Perennial Rye
• Bermuda

There are also other less common types of grasses that can cause seasonal allergies.

Symptoms:

• Itchy, runny, stuffy nose
• Itchy, watery, red, puffy eyes
• Itchy throat
• Itchy ears
• Sneezing
• Post-nasal drip
• Cough

Pollen can also affect the sinuses causing facial pressure and headaches. Some individuals also experience itching and skin rashes after exposure to the grass.

Many asthmatics are also sensitive to the grasses and can experience a flare-up of their symptoms which may include chest tightness, wheezing, coughing, and/or shortness of breath during the grass pollen season.

Diagnosis:

The diagnosis of grass allergies begins with a comprehensive history and physical examination. Skin tests and blood tests are 2 types of allergy tests that are used in order to confirm the diagnosis of grass allergy. Skin tests necessitate pricking of the intact skin with a sharp plastic lancet which has been dipped in a fluid containing the chemical extracts from different pollens with positive and negative controls. An individual sensitized to one or more grass pollens will show a raised itchy bump at the site of the skin test site of the corresponding pollen extract after 15 to 20 minutes. The other test is a laboratory test which analyzes the blood sample for the presence of specific antibodies. If someone exhibits the typical nasal and eye symptoms of grass allergies and tests positive for grass allergy, the condition is called allergic rhinitis (i.e., hay fever) and allergic conjunctivitis respectively. As mentioned previously, allergies to grass can also trigger asthma in certain individuals.

Treatment:

Avoidance:

After the diagnosis of grass allergy is confirmed, the first step in the management is to avoid exposure to the offending grass pollen to the best of one’s ability. Below are some recommended ways on how to avoid the pollen exposure:

• Stay indoors on high pollen days with the doors and windows closed
• Change clothes after outdoor activities
• Before going to bed, take a bath or shower and wash one’s hair to remove the pollen
• Lawns should be cut short, reducing the ability of the grasses to release pollen
• Wash bedding in hot water at least once a week

Medications:

• Oral antihistamines – To reduce sneezing, itching, and runny nose
• Nasal sprays – To help relieve nasal congestion and post-nasal drip
• Eye drops – To minimize itching, watering, and redness of the eyes

Desensitization:

Allergen immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a procedure offered by our allergy and immunology practice in order to build up tolerance to the pollens that an individual is sensitized to. This process is effective in minimizing the need for medications and preventing the allergy symptoms even after exposure to the pollen.

Allergen immunotherapy is over 100 years old in the U.S. and it is considered the standard of care when environmental controls and medications do not give adequate relief from symptoms or when medications cause undesirable side effects. This treatment modality is instrumental in improving the quality of life of allergy sufferers. It is effective in 80-85% of the individuals who take allergy shots and is usually a 3-5 year process.

The board certified allergy doctors 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 grass allergies as well as other pollen and environmental allergies such as dust mites, molds, pets, and cockroaches. In addition, we also treat asthma, eczema, skin disorders (e.g., hives, generalized itching, swelling episodes, poison ivy, poison oak, poison sumac), food allergies, medication allergies, insect sting allergies, eosinophilic esophagitis, mast cell disorders, and immunologic disorders. Black & Kletz Allergy treat both adults and children 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 one of our offices 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 50 years and we pride ourselves in providing exceptional allergy and asthma care in a professional and pleasant setting.

Now that Spring has sprung, one is more likely to be stung by a flying insect, although the summer months are when insect stings occur the most. In the Washington, DC, Northern Virginia, and Maryland metropolitan area, the most common flying insects that cause stings include the honey bee, wasp, yellow jacket, white faced hornet, and yellow faced hornet. Honey bees live in colonies or “honeycombs” that are found in cavities of buildings or in hollow trees. Yellow jackets usually nest underground and unlike their fellow honey bees, they are rarely seen in cracks in masonry or woodpiles. Hornets produce grey or brown football shaped nests above the ground which are typically located in shrubbery or in branches of trees. Wasps make nests that are made up of a paper-like material which may be found behind shutters, in shrubs, or under eaves. Approximately 3% of individuals in the U.S. experience allergic reactions to the venom resulting from flying insect stings. Roughly 500,000 individuals in the U.S. seek emergency room care every year for insect sting reactions. Unfortunately, there are about 50 deaths reported each year from these reactions.  Though they can occur at any time of the year, they are most common in the summer months in our greater Washington, DC metropolitan area.

It should be noted that there is another type of stinging insect that individuals should be aware of, although it does not fly, nor is it common in the Washington, DC metro area. Fire ants will bite and sting. They inject their venom while stinging which can lead to anaphylactic reactions (i.e., anaphylaxis) in some allergic individuals. Although anaphylaxis can occur, the more typical reaction to a fire ant is that of a local burning pain with an accompanying red bump that can turn into a white fluid-filled pustule within a day or two. As mentioned above, they are not common in the Washington, DC metropolitan area however, the first documented infestation of fire ants in the state of Virginia was in 1989. Fire ants have also been found in Maryland.

When stung by a flying insect, most people have either no reaction at all or they have a small local reaction at the site of the sting. Individuals with this type of response are at no increased risk for an anaphylactic reaction than that of the general population. Some individuals will develop a large swollen red area where they were stung. This large local reaction can reach the size of a baseball in some instances. Even though there is a large local reaction, there is no increased risk of an anaphylactic reaction from the insect sting. On the other hand, approximately 3% of individuals will develop a systemic reaction to an insect sting which may include hives (i.e., urticaria), generalized itching (i.e., pruritus), swelling (i.e., angioedema), chest tightness, shortness of breath, wheezing, abdominal cramping, and/or drop in blood pressure.

The diagnosis of an insect sting allergy is done by board certified allergists like the ones at Black & Kletz Allergy. The allergist will perform a comprehensive history and physical examination. Depending on the history taken from the patient, allergy testing to flying insects is usually the next step. Allergy testing is usually done by the preferred method of skin testing, although blood testing is occasionally performed depending on the situation.

If an individual has a positive allergy test to any of the stinging insect venoms, it is highly recommended that this individual go on a course of venom allergy immunotherapy (i.e., allergy desensitization, allergy shots, allergy injections) as it is tremendously efficacious in preventing further anaphylactic reactions from flying insect stings.  Venom allergy immunotherapy involves receiving progressively larger doses and volumes of insect venom to the patient 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 reduced to every 6 weeks for several more years.  This maintenance dose is essentially comparable to the amount of venom in an actual flying insect sting.

All patients with flying insect sting allergies are prescribed a self-injectable epinephrine device such as EpiPen, Auvi-Q, or Adrenaclick. If one uses a self-injectable epinephrine device, they should go immediately to the closest emergency room. It is also important to note that unlike other flying stinging insects, honey bees leave their stinger in the skin of their victims. If one sees a stinger at the site of a sting, one should not pull out the stinger. It should be scraped off with a finger nail, credit card, or other flat surface. Pulling out a stinger can cause more venom to be introduced into the person’s body which can obviously be more detrimental.

The board certified allergy doctors at Black & Kletz Allergy will promptly answer any questions you may have regarding insect stings or any related conditions. Our allergy doctors have been diagnosing and treating insect sting allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. We have 3 convenient locations in the DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. There is on-site parking at each location and both 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. To schedule an appointment, please call us at any one of our 3 locations. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy is dedicated in providing the most up-to-date diagnostic and treatment modalities in the field of allergy, asthma, and immunology.

Unpleasant symptoms occurring after ingestion of a food could be due to a food allergy or food intolerance.

What is the difference between a food allergy and a food intolerance? Is it necessary or important to distinguish between the two terms? How is the food allergy or intolerance diagnosis established? Are these conditions managed differently?

The term “allergy” traditionally refers to a phenomenon where the immune system considers a substance as “foreign” and subsequently mounts a defensive attack against it. The symptoms of these allergic reactions are caused by the release of a variety of chemical mediators of inflammation such as histamine, prostaglandins, and leukotrienes, to name a few.

These allergic reactions can be mediated by either the humoral (i.e. antibodies are involved) or the cellular (i.e., lymphocytes are involved) arms of the immune system. The IgE antibody-mediated (i.e., humoral-mediated) reactions usually produce symptoms within minutes of exposure to the offending agent. The typical symptoms may include itching, sneezing, hives, swelling of soft tissues (e.g., lips, tongue, throat), and/or difficulty in breathing. These reactions are usually more severe and can occasionally be life-threatening. The lymphocyte-mediated (i.e., cell-mediated reactions), on the other hand, are also called delayed hypersensitivity reactions, as the symptoms usually appear a few days after the exposure to the triggering agents. An example of a delayed hypersensitivity reaction is an allergic reaction that occurs due to contact with a chemical or metal. In most cases of this type of contact dermatitis, skin manifestations in the form of itching and/or a rash occur.

Food “intolerance” usually denotes a difficulty in processing the food by the gastrointestinal tract. Sometimes the term “food sensitivity” is used instead of food intolerance. Various enzymes are needed in order to break down the proteins, sugars and fats in the food we eat. When there is a deficiency of an enzyme needed to breakdown food, that food will not be properly digested. As a result, bothersome symptoms such as abdominal pain/discomfort, abdominal bloating, nausea, diarrhea, and/or constipation after eating may occur.

Lactose intolerance is a common example of a food intolerance. Lactose is the sugar found in dairy products and it requires the enzyme called lactase in order to digest it. Many adults do not have enough lactase to process the lactose, and as a result, the undigested sugars become fermented in the intestines which then in turn may cause increased gas production. Thus, the symptoms associated with lactose intolerance may include abdominal bloating, flatulence, abdominal pain, and/or diarrhea after the consumption of dairy products.

Gluten is a protein found in wheat, barley and rye. Gluten helps foods hold their shapes such as breads, pasta, and cereals. Many individuals have an intolerance to gluten because they cannot process it well in their digestive tracts. This intolerance to gluten may result in symptoms such as abdominal discomfort/pain, abdominal bloating, nausea, diarrhea, and/or constipation.

Celiac disease is an immunologically mediated disorder where antibodies cause damage to the lining of the small intestine leading to difficulty in digesting gluten. This condition causes a variety of symptoms and is suspected by elevated antibody levels in the blood and confirmed by a biopsy of intestinal mucosa.

The diagnosis of food allergy is established by the demonstration of specific antibodies to proteins in the food, either by skin prick tests with various food antigens or by laboratory evaluation of an individual’s blood sample. The food skin prick tests and the blood tests are typically negative in cases of food intolerance.

The management of food allergy involves the complete elimination of the offending food from the diet, particularly since there is a possibility of severe adverse reactions in food-allergic individuals. In addition to avoiding the offending food, a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) is usually prescribed depending on the severity of the allergic reaction described by the food allergy sufferer. If the self-injectable epinephrine device is ever used, one should go immediately to the closest emergency room.

It is important to note that there are desensitization protocols for certain foods which may enable the development of tolerance to allergic protein. This process is called oral immunotherapy or oral desensitization. Oral food desensitization helps reduce the risks of severe food reactions occurring after accidental exposures. Even if an individual is undergoing oral immunotherapy, a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) will be prescribed. If it is ever used then one should go immediately to the closest emergency room. The management of food intolerance also involves avoidance of the suspected foods to the extent possible while substituting with other foods which are better tolerated to ensure adequate nutrition.

Lactose intolerance can be managed by the substitution of lactose-free dairy products in the diet and/or supplementation of the lactase enzyme (available in powder and pill forms such as Lactaid) when lactose-containing foods are consumed.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating food allergies and food sensitivities for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Each office has on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please call for an appointment if you would like a consultation with one of our allergists, or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy prides itself in providing quality allergy, asthma, and immunology care to the Washington, DC, Northern Virginia, and Maryland metropolitan area community.

It is March again, and this marks the start of Spring. In the Washington, DC, Northern Virginia, and Maryland metropolitan area, trees are pollinating in the month of March. The pollination of trees is a major trigger for many allergy sufferers as it may cause either allergic rhinitis (i.e., hay fever) symptoms, allergic conjunctivitis (i.e., eye allergies) symptoms, or both to occur simultaneously. The classic symptoms of allergic rhinitis may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, sinus congestion, sinus headaches, and/or snoring. The typical symptoms of allergic conjunctivitis may include itchy eyes, watery eyes, redness of the eyes, thick sticky discharge of the eyes, puffy eyelids, and/or eyelids sticking together especially in the mornings when awakening. Even though the likely candidate for an increase in ocular or nasal allergy symptoms in the month of March is likely to be the tree pollen, one cannot rule out other allergies such as allergies to molds, dust mites, pets, and/or cockroaches.

Allergic conjunctivitis is often categorized into 2 types:

• Seasonal allergic conjunctivitis – Associated with seasonal allergies mostly common in the Spring or Fall. Tree and grass pollens are usually responsible for Spring symptoms whereas weeds are usually responsible for symptoms in the Fall.
• Perennial allergic conjunctivitis – Associated with year-round allergies such as allergies to dust mites, molds, pets, and/or cockroaches.

Most allergic individuals who have allergic conjunctivitis also have allergic rhinitis at least to some extent. Some allergic individuals who have allergic conjunctivitis and/or allergic rhinitis also have asthma and/or eczema (atopic dermatitis). Asthma triggered by environmental allergens such as dust mites, molds, pollens, pets, and cockroach is essentially a continuation of the allergies past the nose and throat into the lower respiratory system. Individuals with asthma may experience wheezing, shortness of breath, chest tightness, and/or coughing. Asthmatics and individuals with eczema may also have concomitant allergic rhinitis, allergic conjunctivitis, or both.

Allergic conjunctivitis is usually diagnosed by board certified allergists, such as the ones at Black & Kletz Allergy, by way of a comprehensive history and physical examination. The individual is usually allergy tested by skin testing or blood testing in order to determine the offending allergens that are causing the symptoms of allergic conjunctivitis (i.e., itchy eyes, watery eyes, redness of the eyes, puffy eyelids, eyelids sticking together). Once the allergens are identified, it is advisable to try to avoid them if at all possible. Below are several recommendations on measures to help avoid allergens that may contribute to allergic conjunctivitis:

• Close the windows of one’s cars and house.
• Follow the local pollen count at www.bkallergy.com by clicking Today’s Pollen Count.
• Change one’s clothes and shower after spending a long time outdoors.
• Leave one’s shoes outdoors after being outside.
• Wash hair/fur of one’s pet after it comes inside from outdoors.
• Go outside after it rains since the pollen count is “washed away” temporarily.
• Use antihistamines and/or nasal sprays early in the pollen season.
• Consider allergy shots (see below) if more persistent or severe symptoms to pollens or molds occur, since they are effective in 80-85% of individuals with allergic rhinitis and/or allergic conjunctivitis.

On many occasions it is difficult, if not impossible, to avoid the allergens, so medications are prescribed. These medications may include allergy eye drops and/or oral antihistamines. Since it is quite common for individuals with allergic conjunctivitis to also have associated nasal symptoms (i.e., allergic rhinitis), many will also receive prescriptions for nasal sprays, oral leukotriene antagonists, and/or oral decongestants. Allergy shots (i.e., allergy immunotherapy, allergy injections, allergy desensitization, allergy hyposensitization) are very effective in the treatment of allergic conjunctivitis, allergic rhinitis, and asthma as they work in 80-85% of the patients that take them. Allergy shots have been given to treat allergies for more than 100 years. They are given to individuals of all ages, from small children to the elderly. The average length of time that one undergoes allergy immunotherapy treatment is typically from 3-5 years.

It is also important for the allergist to rule out other causes of “pink” or red eyes when someone presents with redness of the eyes. Infections of the eyes (i.e., viral, bacterial, fungal, parasitic), chemical irritants, pollutants, foreign body, anterior uveitis, subconjunctival hemorrhage, and blood thinning medications can all cause “pink” or red eyes.

The board certified allergy specialists at Black & Kletz Allergy have been diagnosing and treating both adults and children with eye allergies. Black & Kletz Allergy has 3 convenient 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 which all offer on-site parking. The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment and we will reply within 24 hours by the next business day. The allergy doctors of Black & Kletz Allergy are eager to help you with your allergy, asthma, sinus, and immunology needs. We are dedicated to providing excellent care and service to you as we have been doing in the Washington, DC metro area for more than 50 years.

If you are suffering from allergy symptoms and you live in the Washington, DC, Northern Virginia, and Maryland metropolitan area, you are not alone. There may be many reasons why this is so. You should understand that there are a variety of allergens that could be affecting you, even in February. We will discuss some of them below.

It should be noted that dust allergy is an allergy that occurs throughout the year. Dust is always present no matter how clean you are. In fact, it is not typically the dust particles that you often see in the air near a well-lit window that is the culprit in someone with dust allergies. It is the dust mites that are primarily responsible for causing the annoying symptoms in a dust-allergic individual. Dust mites are arachnids like spiders and ticks. They are microscopic and live off of the dead skin that sloughs off all individuals. A dust-allergic individual is actually allergic to the dust mite’s feces as well as its exoskeleton. The 2 common species of dust mites in the U.S. are Dermatophagoides farinae (i.e., American house dust mite) and Dermatophagoides pteronyssinus (i.e., European house dust mite). Both species are responsible for causing or contributing to both allergic rhinitis (i.e., hay fever) and asthma. The classic symptoms of allergic rhinitis may include sneezing, nasal congestion, runny nose, post-nasal drip, itchy nose, itchy throat, sinus congestion, sinus pressure, sinus pain, headaches, snoring, itchy eyes, watery eyes, puffy eyes, and/or redness of the eyes. Asthma symptoms, on the other hand, may include wheezing, chest tightness, coughing, and/or shortness of breath. Even though dust is a perennial allergen, it can worse for some individuals in the Winter, when a house is generally more closed up compared with the other seasons.

Mold is another perennial allergen that is bothersome to many individuals with allergic rhinitis and/or asthma. Although molds tend to be present in every season, they tend to be more abundant in the Fall, when leaves fall off of the trees and sit on the wet ground. This setting is perfect for molds as the moisture is a catalyst for mold growth. It should be noted that Washington, DC was built on a swamp and is thus is a great environment for molds to grow. Many individuals who live in the Washington, DC metro area are bothered by this abundance of mold and as a result suffer more than they would have if located in a different part of the country. Mold, just like dust, can cause or aggravate both allergic rhinitis and/or asthma. Mold-sensitive individuals may complain of runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, sinus headaches, snoring, sinus pressure, sinus congestion, sinus pain, watery eyes, itchy eyes, redness of the eyes, swelling of the eyes, chest tightness, wheezing, coughing, and/or shortness of breath depending on whether they exhibit allergic rhinitis symptoms, asthma symptoms, or both. In addition, there are conditions like allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal sinusitis that occur because of an allergy to molds where an inflammatory reaction ensues. These 2 disorders are more involved than that of the standard allergic rhinitis situation, thus requiring more specialized tests and more complex treatments in the diagnosis and management of these conditions.

Lastly, when one thinks about allergies in the month of February, one must think of tree pollen. In the metro Washington, DC area, trees begin to pollinate earlier than they have done even 10 years ago. In the past, trees would typically begin to pollinate in late February. In the last few years however, we have seen pollination begin in early February! This early tree pollination is what accounts for the earlier symptoms of hay fever felt by allergy sufferers in the Washington, DC area. Tree pollen also causes or aggravates both asthma and/or allergic rhinitis. Again, tree-sensitive individuals may experience nasal congestion, post-nasal drip, runny nose, sneezing, itchy nose, itchy throat, itchy eyes, watery eyes, puffy eyes, redness of the eyes, snoring, sinus pain, headaches, sinus congestion, sinus pressure, coughing, chest tightness, wheezing, and/or shortness of breath depending on whether they have asthma symptoms, allergic rhinitis symptoms, or both.

It must be stated that many allergy sufferers are allergic to more than one of these allergens (i.e., allergic to dust, molds, and tree pollen), and thus may exhibit far worse symptoms than if they were allergic to only one or two of them. In these individuals with multiple allergen sensitivity, they will most likely have allergy symptoms for much longer than the month of February or even one season. They usually have allergic rhinitis and/or asthma symptoms throughout the year.

The board certified allergists at Black and Kletz Allergy have over 50 years of experience in diagnosing and treating allergic rhinitis, asthma, immunologic disorders, and all other types of allergies. We treat both adult and pediatric patients. 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. 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 servicing the greater Washington, DC metropolitan area for many decades and we look forward to providing you with state-of-the-art allergy and asthma care in a friendly and pleasant environment.

Many parents wonder at what age can children be skin tested for allergies?

Skin testing is a simple and common procedure used to detect what an individual is sensitized (i.e., allergic) to. It entails the application of a small amount of a chemical antigen, which is extracted from the natural allergy causing substance, on the skin and then interpreting the result after approximately 15 to 20 minutes. Allergic individuals carry proteins called specific antibodies. These antibodies, which are found in the bloodstream, react to various external allergenic triggers depending on the sensitivity of the child.

When the antigen or allergen is introduced into the top layers of the skin with a small plastic toothpick-like applicator, the corresponding antibodies react with the antigen and release chemicals, such as histamine, at the site of reaction. These chemicals cause stretching of the blood vessel walls as well as fluid leakiness into the surrounding tissues. A positive skin test reaction will appear as a small raised bleb or wheal with redness surrounding the raised bleb at the site of the skin test area. This reaction confirms the presence of specific antibodies against the antigen and thus proves that the child is allergic to the substance being tested since it triggered the production of these antibodies.

The ability of the skin to react to outside allergy-causing substances is present at birth. It is true that most children do not develop sensitivities to outdoor allergens such as tree, grass, and/or weed pollens until about the age of 2 or 3. However, they can be sensitized to indoor allergens (i.e., dust mites, pet dander, cockroach) much earlier than that. Many infants can be allergic to foods even during the first few weeks of life. Since this is true, it is appropriate to skin test young children as soon as they develop allergy-related symptoms.

The consideration of allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is not the only reason to skin test children. If we can detect which food a child is sensitized to, we can prevent food-induced reactions by eliminating the offending food and substituting it with suitable alternatives. The identification of specific indoor environmental allergy triggers in young children will also enable us to implement proper control measures in order to reduce their exposure to those allergens which will in turn reduce their symptoms and decrease the need for medications.

Allergy skin testing is mainly done in children when one is trying to assess if a child may have food allergies, allergic rhinitis (i.e., hay fever), insect sting (i.e., bees, wasps, hornets, yellow jackets) allergies, medication allergies, and/or asthma. Although skin testing is the preferred method, the allergist will determine which type of allergy testing is appropriate for each child depending on whether the child is taking a medicine that may prevent or reduce a reaction to a skin testing substance, has a skin disorder that makes it difficult to see the results of skin testing, or has had a previous allergic reaction to skin testing with severe symptoms, which is extremely uncommon. Skin prick testing in children causes very little discomfort and is well tolerated. It is also safe and as stated above, adverse effects from skin testing are extremely rare.

The board certified allergy specialists at Black & Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area will gladly answer any questions and concerns about allergy skin testing for both children and adults. Dr. Michael Kletz and Dr. Appaji Gondi at Black and Kletz Allergy, have been diagnosing and treating individuals with hay fever (i.e., allergic rhinitis), asthma, sinus problems, insect sting allergies, hives (i.e., urticaria), eczema (i.e., atopic dermatitis), swelling episodes (i.e., angioedema), food and medication allergies, and immunological problems for more than 60 years combined. We have an office in Washington, DC and 2 other offices in Northern Virginia with locations in McLean, VA (Tysons Corner, VA) and Manassas, VA. All 3 office locations offer on-site parking and the Washington, DC and McLean, VA locations 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. For an immediate appointment, please call us or you may 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 providing excellent state-of-the-art allergy and asthma care in a professional and compassionate environment.