Go to our "CLOSINGS" tab on our website to see our updated Coronavirus Policy

Blog

Influenza Vaccination and Treatment Recommendations for 2022-2023

Influenza Immunization:

A routine annual influenza (i.e., flu) vaccination is recommended for all individuals equal to and greater than months of age. The recommendations below should always be discussed and approved by an individual’s primary care provider before vaccination occurs.

Children:

  • Children from 6 months through 8 years of age who have previously received 2 or more total doses of trivalent or quadrivalent influenza vaccine 4 or more weeks apart before July 1, 2022 will need 1 dose of the 2022-2023 influenza vaccine.
  • Children from 6 months through 8 years of age who have not previously received 2 or more total doses of trivalent or quadrivalent influenza vaccine 4 or more weeks apart before July 1, 2022 will need 2 doses of the 2022-23 influenza vaccine. These 2 doses should be given at least 4 weeks apart.
  • Children who are 9 years old or older only need 1 dose.

Adults 65 Years of Age or Older:

  • Adults 65 years or older should receive any one of the following higher dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4).

Pregnancy:

  • Influenza vaccines, except the quadrivalent live attenuated (LAIV4), can be received in any trimester of pregnancy, if approved by one’s Ob/Gyn doctor.
  • The quadrivalent live attenuated vaccine (LAIV4) should not be used during pregnancy since it contains a live virus, but it can be used postpartum, if approved by one’s Ob/Gyn doctor.

Chronic Medical Conditions:

The quadrivalent live attenuated vaccine (LAIV4) should not be received in individuals with the following:

  • History of severe allergic reaction (i.e., anaphylaxis) to any component of the vaccine
  • Concomitant aspirin or salicylate-containing therapy in children and adolescents
  • Children between the ages of 2 – 4 years of age who have received a diagnosis of asthma or if a wheezing episode has occurred during the preceding 12 months
  • Children and adults who are immunocompromised due to any cause
  • Close contacts and caregivers of severely immunosuppressed individuals who require a protected environment

Egg Allergy:

  • Individuals who have experienced only hives after exposure to egg may receive any licensed recommended influenza vaccine appropriate for their age.
  • Individuals reporting symptoms other than hives after exposure to egg [i.e., angioedema (i.e., swelling), respiratory distress, lightheadedness, recurrent vomiting], or who required epinephrine or another emergency medical intervention, may also receive any influenza vaccine that is otherwise appropriate. If a vaccine other than a quadrivalent cell-based influenza vaccine (ccIIV4) such as Flucelvax® or a quadrivalent recombinant influenza vaccine (RIV4) such as Flublok® is selected, it should be administered in an inpatient or outpatient medical setting, supervised by a health care provider who can recognize and manage severe allergic reactions.

Previous Serious Allergic Reaction:

Influenza vaccines are contraindicated for those with a history of a severe allergic reaction to any component of that vaccine.

Travelers:

Travelers who wish to reduce the risk for influenza should consider vaccination, preferably at least 2 weeks before departure.

Vaccination and Influenza Antiviral Medications:

Individuals receiving influenza antiviral medications can take influenza vaccines other than a quadrivalent live attenuated influenza vaccine (LAIV4).

With Other Vaccines:

  • The quadrivalent inactivated influenza vaccine (IIV4) and the quadrivalent recombinant influenza vaccines (RIV4) may be administered concurrently or sequentially with other live or inactivated vaccines.
  • Injectable vaccines given simultaneously should be administered at separate anatomic sites.
  • The quadrivalent live attenuated vaccine (LAIV4) may be administered simultaneously with other inactivated or live vaccines. If not given simultaneously, then at least 4 weeks should pass between the administration of the quadrivalent live attenuated vaccine (LAIV4) and another live vaccine.

Administration of IIV4 and RIV4:

  • The quadrivalent inactivated influenza vaccines (IIV4) and quadrivalent recombinant influenza vaccines (RIV4) are administered intramuscularly (IM). For adults and older children, the deltoid muscle in the arm is the preferred site. For infants and younger children, the anterolateral thigh is the preferred site.
  • The quadrivalent recombinant influenza vaccine (RIV4) is licensed for individuals 18 years of age and older and should not be used for children and/or adolescents less than 18 years of age.

Administration of LAIV4:

  • The quadrivalent live attenuated influenza vaccine (LAIV4) is administered intranasally using the supplied prefilled, single-use sprayer containing 0.2 ml. of vaccine.
  • If the vaccine recipient sneezes immediately after administration, the dose should not be repeated.
  • If nasal congestion is present which may interfere with the delivery of the vaccine to the nasopharyngeal mucosa, a deferral should be considered, or another age-appropriate vaccine should be administered.

Treatment of Influenza:

The antiviral medications that are used to treat the flu (i.e., influenza) are more efficacious when they are begun within 2 days of the beginning of symptoms.
There are 4 FDA-approved antiviral drugs used in the treatment of influenza:

  • oseltamivir phosphate (Trade name: Tamiflu®)
  • zanamivir (Trade name: Relenza®)
  • peramivir (Trade name: Rapivab®)
  • baloxavir marboxil (Trade name: Xofluza®)

Oseltamivir (Tamiflu®) is available as a pill or liquid suspension and is FDA-approved for the early treatment of influenza in individuals 14 days of age and older. Zanamivir (Relenza®) is a powder that is inhaled and approved for the early treatment of influenza in individuals 7 years of age and older. Note that zanamivir is administered using an inhaler device and is not recommended for individuals with respiratory problems such as asthma or chronic obstructive pulmonary disease (COPD). Oseltamivir and zanamivir are given twice a day for 5 days. Peramivir (Rapivab®) is given once intravenously by a health care provider and is approved for the early treatment of influenza in individuals 6 months of age and older. Baloxavir (Xofluza®) is a pill given as a single dose by mouth and is approved for the early treatment of influenza in children 5 – 12 years of age who do not have any chronic medical conditions, and for all individuals 12 years of age and older.

The board certified allergists at Black & Kletz Allergy have been advising patients on the treatment and prevention of the flu (i.e., influenza) for many years in both children and adults. 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 specialists of Black & Kletz Allergy are eager to help you with your allergy, asthma, immunological, and vaccination needs. We are dedicated to providing first-rate care to you as we have been doing in the Washington, DC metropolitan area for more than 50 years.

Halloween and Food Allergies

To the average parent, there is generally no association between Halloween and allergies. For some parents however, Halloween can be a “scary” time, but not because of ghosts and goblins. These “frightened” parents are parents that have a child who has food allergies. To the parent of a food-allergic child, the association between Halloween and food allergies is not only real, but can be downright scary and concerning.

Some food allergy statistics are in order at this point in order to shed light on the seriousness of food allergies. Approximately 8% of children in the U.S have food allergies. Food allergies are increasing and have increased by more than 50% in the last few decades. About one-third of children have food allergies to more than one food. Approximately 4 in 10 food-allergic children have had a severe reaction to a food. Peanut, followed by milk are the number one and two causes of food allergies in children. Tree nuts, shellfish, fish, eggs, wheat, and soy make up the next most common food allergies in children. If you are an observant parent, you can see that 6 of the top 8 food allergies are commonly found in many Halloween candies, assuming fish tacos and crab cakes are not common on your neighborhood block. To make matters worse, it is fairly common for miniaturized Halloween candies not to contain the nutritional information and allergen labeling, which is often found on the larger full-sized versions. This makes it even more difficult for a parent to screen for food allergens that may be in each treat. It should be noted that in order to be extra safe, a parent or child should live by the motto: “when in doubt, throw it out.”

Parents of a food-allergic child who are concerned about their child trick-or-treating on Halloween can go to the website of the Food Allergy Research and Education (FARE) organization and look at their program called the “Teal Pumpkin Project.” The Teal Pumpkin Project has been around since 2014 and its main objective is to increase awareness of the severity of food allergies as well as provide support to families who have food-allergic children. In the world of food allergies, the color teal signifies food allergy awareness. People with and without food-allergic children are encouraged to paint their pumpkins teal and display them by their front doors as a sign that their house is aware of food allergies and that they have alternative non-food containing “treats” for food-allergic children. Some non-food treats may include non-food treats may include stickers, toys, money, crayons, necklaces, bracelets, rings, glow sticks, hair accessories, finger puppets, bookmarks, vampire fangs, spider rings, balls, whistles, balls, etc. The houses with the teal pumpkins may also distribute traditional candies, but they will have separate bowls for food items vs. non-food items. FARE’s website provides a detailed “Teal Pumpkin Project Participation Map” so that participating houses can be easily assessed by the parents of food-allergic children.

In addition to the above Teal Pumpkin Project, other precautions should be adhered to with food-allergic individuals. Food-allergic children should be taught to graciously refuse homemade foods such as cupcakes and cookies that may not be safe for them. Young children should not trick-or-treat without parental supervision. Candies and treats without proper nutritional and allergen labeling should not be eaten in order to prevent a life-threatening allergic reaction. It is advised that one should trick-or-treat with an epinephrine self-injectable device such as an EpiPen, Auvi-Q, or Adenaclick. If an epinephrine self-injectable device is ever used, one should go immediately to the closest emergency room.

The board certified allergists at Black & Kletz Allergy support the efforts of the Teal Pumpkin Project and hope that our patients join in their efforts in order to try to make Halloween a safer holiday. Black & Kletz Allergy has always had a link to FARE. You will find it in the upper portion of our website under the blue “Resources” tab. Please click “LINKS” and then click “Food Allergy Research and Education.” The allergy specialists 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 servicing the greater Washington, DC metropolitan area for over 50 years and we look forward to providing you with the highest state-of-the-art allergy care in a welcoming and relaxed environment.

Alpha-Gal Syndrome (Mammalian Meat Allergy)

Meat allergy is an increasing problem over the last decade. It is generally not that people have developed a typical food allergy to meat in the classic sense, but this increase has rather occurred because of an entity called alpha-gal syndrome. It is often referred to as mammalian meat allergy, red meat allergy, and tick bite meat allergy. More specifically, alpha-gal syndrome is a food allergy to red meat (i.e., mammalian meat) and any other products made from mammals such as gelatin or milk products. The condition was discovered by researchers at the University of Virginia a little more than a decade ago.

The mechanism of why and how the syndrome occurs is quite interesting. Alpha-gal, technically referred to as galactose-alpha-1,3-galactose, is a carbohydrate (i.e., sugar molecule) that is present in most mammals (e.g., cows, pigs, sheep, deer, rabbits, whales). It is not found in humans or non-mammals such as fish, birds, and reptiles. Alpha-gal syndrome is caused by a Lone Star tick bite. After an individual is bitten by a Lone Star tick, the carbohydrate alpha-gal which is present in the tick’s saliva, is transmitted into the person’s blood stream. As a result, the individual will produce IgE antibodies as a defense mechanism against this foreign sugar molecule (i.e., carbohydrate). Because the person now has alpha-gal IgE antibodies present in their blood stream, whenever that individual consumes future mammalian meat which contains alpha-gal, their alpha-gal IgE antibodies will react against the alpha-gal present in the mammalian meat (e.g., beef, pork, lamb, venison, rabbit, whale) causing allergic symptoms.

The symptoms of alpha-gal syndrome or mammalian meat allergy are typically delayed approximately 2-8 hours after the person eats the meat before manifesting. This is in contrast to a “normal” allergic reaction to a food which usually causes symptoms within 30 minutes after ingestion. The symptoms of alpha-gal syndrome can vary in severity from mild to severe and may consist of hives (i.e., urticaria), generalized itching (i.e., pruritus), swelling episodes (i.e., angioedema), runny nose, nasal congestion, wheezing, coughing, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, dizziness, drop in blood pressure, and/or anaphylaxis. Obviously, anaphylaxis is life-threatening and individuals who have a history of anaphylaxis should use an injectable epinephrine device such as an EpiPen, Auvi-Q, or Adrenaclick if anaphylactic symptoms occur. They should also go immediately to the closest emergency room if they use their injectable epinephrine device.

The diagnosis of alpha-gal syndrome is made by performing a comprehensive history and physical examination. A history of a recent tick bite makes the diagnosis more likely, but it is not crucial as not all patients may remember if they had a recent tick bite. Since there is a delay between the ingestion of meat and the onset of symptoms with alpha-gal syndrome, the condition is underdiagnosed. Physicians may not see the connection between the ingestion of the meat and the beginning of allergic symptoms because of this time delay which is not characteristic of a normal allergy. As a result, the syndrome is underdiagnosed. Note: It is therefore important to seek out a board certified allergist like the ones at Black & Kletz Allergy in order to make the correct diagnosis. It is also important to note that since the allergic symptoms of alpha-gal syndrome are very common allergy symptoms, an allergist is often needed to differentiate these symptoms from other allergic conditions that are not tick-induced. Blood tests and/or food prick testing is usually necessary to confirm the diagnosis.

The prevention of alpha-gal syndrome is the prevention of tick bites. One should avoid places where ticks live such as in grassy or wooded areas. Wear long-sleeved shirts and pants. Wear hats and gloves. Use insect repellants, especially containing DEET. Check yourself and your pets for ticks after being outdoors in the grass or woods. Taking a shower after you return from outside may remove unattached ticks. If bitten, remove the tick as soon as possible either by yourself or by a physician in an emergency room. Do not squeeze or squash the tick. Let your physician know if you have been bitten by a tick as there are other diseases that can be caused by tick bites. Some of these diseases may include Lyme disease, Rocky Mountain spotted fever, Tularemia, Babesiosis, Ehrlichiosis, Rickettsiosis, Tick-borne encephalitis, Relapsing fever, Q Fever, Anaplasmosis, and Powassan.

The treatment of alpha-gal syndrome is also simply prevention. It is important to avoid the ingestion of mammalian meat and any other products made from mammals such as gelatin or milk products. Furthermore, one should avoid getting bitten again by ticks as it is thought that subsequent Lone Star tick bites may cause more severe disease if exposure to mammalian meat occurs.

The board certified allergy specialists at Black & Kletz Allergy have been diagnosing and treating alpha-gal syndrome and food allergies in both adults and children for more many years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have 3 office locations, all of which offer on-site parking. Our offices are located 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, VA office and the Spring Hill metro station on the silver line. For an appointment, please call us at one of our locations or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy have the expertise in alpha-gal syndrome and food allergies. Our goal is to serve the greater Washington, DC metro community with first-rate allergy care with boundless commitment and great pride as we have done for over 50 years.

Climate Change and Allergic Disease

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.

Allergy to Chlorine?

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 [i.e., asthma, chronic obstructive pulmonary disease (COPD)] 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.

Allergies to Cats, Dogs, and Other Pets

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 (Allergy Shots)

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.

Allergies to Exercise

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 [i.e., Singulair (monteleukast)] 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.