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Asthma is a fairly common disease in the U.S. Asthma is a chronic disease that causes inflammation of the bronchial tubes (i.e., breathing tubes) resulting is symptoms that may include chest tightness, wheezing, shortness of breath, and/or coughing. According to the Centers for Disease Control and Prevention (CDC), approximately 25 million people in the U.S. have asthma which equates to 1 in every 13 individuals or 7.7% of the population. Note that 7.5% of children in the U.S. have asthma. Asthma is more common in adult women (9.1%) compared with adult men (6.2%), however, in children, boys are affected more than girls (8.3% vs. 6.7% respectively). Regarding race and ethnicity, asthma prevalence in the U.S. decreases in the following order: Native American (10.5%) > African American (9.6%) > White (8.2%) > Hispanic (6.0%) > Asian (4.7%). The fatality rate per million in individuals with asthma in the U.S. decreases in the following order: African American (21.8%) > Native American (11.3%) > White (9.5%) > Asian or Pacific Islander (8.5%) > Hispanic (6.3%). From the above statistics, one can see that the fatality rate is not based on the prevalence. It should also be noted that the asthma prevalence has been increasing over the last few decades even though there are more treatment modalities available now than ever before.

Asthma is characterized by the class it is designated. Asthma is categorized as follows: mild intermittent, mild persistent, moderate persistent, and severe persistent. The classification depends on how often one experiences symptoms, how often symptoms are causing nighttime awakenings, if the symptoms are disrupting normal activities, and how often one uses their rescue inhalers. In addition to these categories, asthma can also be classified as exercise-induced asthma, cough-variant asthma, nocturnal asthma, occupational asthma, asthma with associated COPD (i.e., chronic obstructive pulmonary disease), cardiac asthma (i.e., not actually asthma but congestive heart failure and other heart disease that masquerades as asthma since the symptoms are very similar to asthma), allergic asthma (i.e., an older classification which is not used anymore), nonallergic asthma (i.e., an older classification which is not used anymore).

In addition to asthma, there are several conditions that mimic asthma in its presentation and some of them are as follows: cardiac asthma (mentioned above), vocal cord dysfunction and/or paralysis, GERD (i.e., gastroesophageal reflux disease), sinusitis, upper respiratory tract infections (i.e., URI’s), COPD (e.g., chronic bronchitis, emphysema), bronchiectasis, cystic fibrosis, thyroid gland tumors, lung or chest tumors, pulmonary embolism, anxiety, pneumonia, and food aspiration.

The diagnosis of asthma requires a comprehensive history and physical examination in conjunction with a pulmonary function test. Additional measures may be needed depending on the history and physical examination and may include allergy skin or blood tests, chest X-ray, other types of bloodwork, sweat chloride test, CT scans, and others. The treatment of asthma is catered to each specific patient based on the frequency and severity of their symptoms. A host of medications may be utilized and range from just a rescue inhaler (i.e., short acting beta 2 inhalers) for intermittent asthma to biologicals (i.e., Xolair, Fasenra, Nucala) for more moderate-to-severe cases. Other therapeutics utilized to treat asthma may include inhaled corticosteroids, long acting beta 2 inhalers, combination inhalers of corticosteroids and long acting beta 2 inhalers, leukotriene antagonists (e.g., Singulair, Accolate, Zyflo), methylxanthines (e.g., theophylline), and oral corticosteroids. The prevention of asthma symptoms can usually be achieved through allergy immunotherapy (i.e., allergy shots, allergy injections, allergy hyposensitization, allergy desensitization) as well as to attempt to avoid triggers that can exacerbate one’s asthma.

The board certified allergists at Black & Kletz Allergy have had more than 50 years of experience in diagnosing and treating asthma in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We treat both children and adults and have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at all of our office locations. The Washington, DC and McLean, VA offices are also Metro accessible. We offer 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 one of our offices or alternatively 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 are happy to help you diagnose and treat your asthma as well as any other allergy-related or immunological condition that you might have.

Hives (i.e., urticaria) are a fairly common occurrence which is usually very annoying to the individual who suffers from them. They are often called “welts” by the general public and “wheals” by allergists. Hives are itchy, red blotches on the skin that are usually raised. Some affected individuals may experience a burning sensation while others notice a stinging sensation. Hives, in some instances, may be flat and not raised. The size of an individual hive may range from very small to rather large. They can also coalesce with other hives to create giant “plaques” of hives. Hives can be various shapes and are usually not symmetrical. They often look like mosquito bites but without the actual bite. They can occur anywhere externally on the body (e.g., face, neck, extremities, back, abdomen) or be located internally (e.g., throat, intestines). When they are internal, symptoms such as swelling of the throat, abdominal pain, or diarrhea may ensue. When hives occur on the lips, tongue, eyes, or ears, it is not uncommon for the individual to notice only swelling of these body parts. This swelling is termed angioedema. Angioedema is essentially a hive that is in the deeper tissue layers. As a result, the lesion appears as a swelling, opposed to a hive. Either way, both are bothersome to the person who is afflicted with either or both of them.

Hives are basically grouped into two main categories, although there are actually more than two. The first category is referred to as acute urticaria. Acute urticaria is a condition where the hives occur for 6 weeks or less. If hives linger on and persist for more than 6 weeks, they are called chronic urticaria. Some cases of hives may last for months and even years in a small percentage of patients. Approximately 25% of the general population in the U.S. develop hives at some point in their lives. Each episode of hives generally last less than 24 hours in duration but may last for days or weeks in certain circumstances.

The diagnosis of hives begins with a comprehensive history and physical examination by a board certified allergist such as the allergists at Black & Kletz Allergy. The workup for hives will vary depending on what was discovered in the history and physical examination in conjunction with how long the hives have been present. For many individuals, a medication allergy is to blame. For others, a food may be the culprit. For those who present with chronic urticarial (i.e., hives that have persisted for more than 6 weeks), bloodwork is generally needed in order to rule out a multitude of diseases and conditions that are known to cause hives. Despite all of the bloodwork done on a patient with chronic urticaria, approximately 95% of these individuals will have normal test results. If the workup is completely negative, the term idiopathic chronic urticaria is used as a diagnosis. This basically is a fancy way of saying that no identifiable cause was discovered to cause the hives of that individual. Some of the conditions that are known to be associated with chronic urticaria include thyroid disorders, autoimmune disorders (e.g., systemic lupus erythematosus, Sjögren’s syndrome, rheumatoid arthritis), hepatitis B, other infections, cancers, complement disorders, and physical elements (e.g., heat, cold, pressure, exercise, vibration), to name a few.

The treatment of hives can range from avoidance to using medications. Antihistamines are usually the first line of defense of most cases of hives. Beta-2 agonists such as Pepcid (famotidine) are often utilized to enhance the effect of the antihistamine when an antihistamine alone is not enough to prevent hives. Leukotriene antagonists are often added to the regimen is difficult-to-treat hives. In recalcitrant disease, oral corticosteroids may be used to bring the hives under control for a short time since the use of long-term steroids is not ideal because of the risks and many side effects that may develop. Xolair (omalizumab) injections are used for idiopathic chronic urticaria in patients where other therapy is unsuccessful. Xolair injections Xolair are very effective in the management of chronic hives.

The board certified allergists at Black & Kletz Allergy have had more than 50 years of experience in diagnosing and treating asthma in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We treat both children and adults and have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at all of our office locations. The Washington, DC and McLean, VA offices are also Metro accessible. We offer 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 one of our offices or alternatively 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 are happy to help you diagnose and treat your asthma as well as any other allergy-related or immunological condition that you might have.

Why do we cough? Coughing is a natural defense mechanism to expel excessive mucus, microbes, and irritant substances from our airways which acts to protect our lungs from the potential damage caused by them. Coughing, however, can also be a bothersome symptom and is one of the most common reasons why patients consult their doctors. The sound of a cough is produced after forcible expiration (i.e., breathing out) against a closed glottis (i.e., voice box) as the air flows out when the glottis suddenly opens. A cough is defined as “acute” when it persists for less than 3 weeks, subacute when the duration is between 3 and 8 weeks, and chronic if it continues to be present for longer than 8 weeks.

Approximately 12% of U.S. population experiences a chronic cough at some point in their lives. It is more common in women than in men and generally peaks between the 5th and 6th decades of life. A chronic cough can be very bothersome which may negatively impact one’s quality of life. A severe cough may lead to vomiting, broken ribs, bleeding, incontinence, sleep disturbance, social distress, and/or depression.

Common causes of a chronic cough:

• Asthma
• Medications such as ACE (angiotensin converting enzyme) inhibitors and some diabetes mellitus medications
• Upper airway cough syndrome (e.g., post-nasal drip)
• GERD (i.e., gastroesophageal reflux disease) – Also known as acid reflux.
• Environmental irritants
• Tobacco use
• Eosinophilic bronchitis
• Tumors

Initial evaluation begins with obtaining a comprehensive history, which includes:

• Duration of the condition
• Characteristics of the cough
• Triggers for the cough (e.g., environmental, dietary)
• Medications taken (e.g., over-the-counter, herbal, prescriptions)

“Red flags” in the history suggesting a serious illness may include:

• Coughing up blood (i.e., hemoptysis)
• Chronic smoking with a new cough
• Difficulty in breathing
• Persistent hoarseness
• Difficulty in swallowing
• Vomiting
• Fever
• Weight less
• Swollen hands and/or feet
• Abnormal examination
• Abnormal chest X-ray

Treatments:

• Upper airway cough syndrome: Post-nasal drip is usually a result of inflammation of the nose and throat either from allergens or irritants. This condition frequently responds to either antihistamines or nasal sprays or the combination of both antihistamines and nasal sprays.
• Asthma: Cough may be the only symptom of asthma (e.g., cough variant asthma) and can be controlled with inhaled corticosteroids and/or oral leukotriene modifiers (e.g., Singulair, Accolate, Zyflo)
• Non-asthmatic eosinophilic bronchitis: A trial of oral corticosteroids such as prednisone for 1 to 2 weeks is usually helpful in relieving the cough.
• GERD: Approximately 10% of the population report frequent “heartburn” from acid reflux. Lifestyle modifications and medications to reduce acid secretion (e.g., Prilosec, Nexium, Prevacid) for 4 to 8 weeks will usually result in a substantial improvement of the cough.
• Speech evaluation and speech therapy may be useful in certain situations.

If the cough does not respond to the above treatments at the correct dosage for a sufficiently long duration, it is termed a chronic refractory cough. New medications which target the neurological pathways and block the cough reflex are actively being investigated and are as follows:

• Sodium channel blockers: Similar to local anesthetics such as lidocaine.
• Neurokin-1 (NK-1) receptor antagonists (e.g., Orvepitant, Aprepitant)
• Purinergic receptor antagonists: Gefapixant is the name of one of the most promising drugs currently in development which exhibited significant efficacy in controlling a refractory cough. It is undergoing phase 3 clinical trials at this time. It is given by mouth twice a day. Side effects reported so far include taste disturbances.

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

Historically, March is the month that many trees begin pollinating in the Washington, DC metropolitan area. This year, trees have begun to pollinate in February, as the temperatures in the metro area have been higher than normal for a typical Winter. We will begin to see tree pollen marked by a yellowish coating on our automobiles soon. For many allergic individuals, this represents a tumultuous time for those who are sensitized to tree pollen. Birch, cedar, ash, oak, elm, cottonwood, hickory, and maple are the predominant trees producing pollen in our area during the Spring.  This time of the year is the reproductive season for the trees. As a result, the tree pollen grains are released into the atmosphere in order to fertilize the ovules of other trees.  This process is called pollination. Pollen is produced and then dispersed by the wind throughout the day, however, the tree pollen counts are highest during the morning hours.

Pollen grains are not harmful or noxious when inhaled, unless an individual’s immune system mistakes the pollen as potentially hazardous and subsequently mounts a defensive attack on them.  This process is called allergic sensitization and results in the release of certain chemical mediators such as histamine and leukotrienes, which are mediators of the annoying symptoms of allergic rhinitis (i.e., hay fever) and allergic conjunctivitis (i.e., eye allergies).

Over the past decade, several scientists have noticed a steady increase in the tree pollen counts across the country.  Many scientific researchers believe, although controversial, that climate change is contributing in part to this trend of increasing pollen counts.  Carbon dioxide is the primary gas needed for the growth and development of trees, (along with sunlight, water, and nutrients), and increasing levels of carbon dioxide are being documented every year.  These changes in the climate may impact the pollen season of not only trees, but in addition, may affect the pollination of both grasses and weeds. Climate change may cause an increase in the amount of pollen produced as well as cause an extension of the duration of the pollen seasons.

What are the symptoms of Spring allergies? The most common symptoms of Spring allergies may include sneezing, clear runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, itchy eyes, watery eyes, red eyes, puffy eyes, cough, itchy ears, clogged ears, sinus headaches, sinus congestion, sinus pressure, snoring, and/or fatigue.  In asthmatics, the pollen can also trigger chest tightness, coughing, wheezing, and/or shortness of breath.

How are Spring allergies diagnosed? Spring allergies are diagnosed by board certified allergists such as the allergy specialists at Black & Kletz Allergy who first take a comprehensive history and perform a detailed physical examination.  Allergy testing is often done either by skin testing or occasionally via blood testing in order to identify the offending allergen.  Once the allergens are known, preventive measures are recommended in order to reduce exposure to the allergens. Some preventive measures to reduce exposure to pollen and to minimize symptoms may include the following:

• Track the local pollen counts on the homepage on our website, www.bkallergy.com by clicking Today’s Pollen Count and avoid outdoor activities on days where the pollen count is high, especially in early morning hours.
• Go outdoors shortly after it rains, as the water keeps the pollen from blowing from place to place.
• Change and clothes after wearing them worn outside.
• Leave shoes outdoors in order to help prevent bringing pollen into the home.
• Wipe down a pet’s fur and/or wash the pet before he/she comes indoors.
• Shower off the pollen from skin and hair before going to bed.
• Close the windows in automobiles and at home to keep the pollen out.
• Run the air conditioner in automobiles and at home.

How are Spring allergies treated? Begin using antihistamines and nasal corticosteroid sprays early in the season. They are more effective if begun before the onset of symptoms and if taken daily throughout the season. Other common types of prescription medications may include decongestants, leukotriene antagonists, nasal antihistamines, nasal anticholinergic agents, eye drops, inhaled corticosteroids, and inhaled beta-agonists. In cases of persistent or severe symptoms, consider allergy desensitization (i.e. allergy shots, allergy immunotherapy, allergy injections, allergy hyposensitization) to the pollen, which usually provides a long-term benefit and reduces the need for medications. They are effective in 80-85% of patients. They are generally taken for 3-5 years.

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

Most everyone is aware of the classic and common allergies that many individuals suffer from routinely.  Allergies to dust mites, molds, pollens, pets, and/or cockroaches usually manifest themselves as symptoms of allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), and/or asthma.  Food allergies are not uncommon and it commonly known that the most common food allergens are milk, egg, soy, wheat, peanuts, tree nuts, fish, and shellfish.  When people think of allergies of the skin, they often think of atopic dermatitis (i.e., eczema), allergic contact dermatitis (i.e., poison ivy, poison oak, poison sumac, cosmetic allergy), and hives (i.e., urticaria).  All of these allergies are relatively common but there are a number of allergies that are uncommon and/or unusual that are very interesting.  It is some of these more unusual and uncommon allergies that we will explore in the following paragraphs.

Uncommon Food Allergies:

• Oral Allergy Syndrome (Pollen Fruit Syndrome; Pollen/Food-Associated Syndrome):  An allergic reaction in the mouth usually causing itching that occurs in certain allergic individuals that have certain pollen allergies. Classic examples include birch tree allergies and reactions to raw apples, kiwi, apricots, cherries, peaches, plums, pears, avocados, celery, and/or carrots.  Ragweed allergies and reactions to melons, cucumbers, zucchini and bananas.  In this disorder, the raw fruit or vegetable looks similar structurally to the pollen and the body “thinks” that the food is the pollen and an allergic reaction (e.g., itchy mouth) occurs.  Interestingly, if the food is cooked and or processed, the individual can usually tolerate the food without any symptoms.

• Mammalian Meat Allergy:  Some individuals that are bitten by a Lone Star tick may develop a meat allergy due to the development of an antibody to a carbohydrate called galactose-alpha-1,3-galactose (i.e., alpha-gal).  This carbohydrate is found on all mammalian meat (e.g., beef, pork, lamb, venison, whale). When an individual with the alpha-gal antibody eats any mammalian meat, the meat triggers the release of the chemical called histamine.  It is the histamine that causes the allergic symptoms which usually appear 4-8 hours after the consumption of the meat. Symptoms may include generalized itching (i.e., pruritus), hives, and/or swelling (i.e., angioedema).

• Chamomile Tea:  Chamomile is related to ragweed and some ragweed-sensitive individuals may also react to chamomile tea and chamomile lotions.  Symptoms can range from allergic rhinitis symptoms to anaphylactic shock, although it is rare to have such a violent reaction.

• Gelatin Allergy:  Some individuals are allergic to gelatin; however, this allergy is rare.  Gelatin is a protein formed when connective tissue from animals is boiled.  Some individuals are allergic to this protein and when exposed, they can have an allergic reaction that may also be quite severe.  Gelatin may be found in chewy candies, frosted cereals, and in some vaccinations such as the flu shot.

• Wine:  Certain individuals are hypersensitive to sulfating agents used in processing certain foods, beverages, and drugs.  Sulfur dioxide and several forms of inorganic sulfites that release sulfur dioxide when used as food ingredients are known collectively as sulfating agents.  The preservative sulfite is used in the production of wine and other foods. Some individuals, especially asthmatics, are sensitive to sulfites and should avoid certain foods that may contain sulfites such as sauces, gravies, soups, wine vinegar, processed meats, dried/frozen/canned fruits and vegetables, and occasionally salad bars.

• Hot Dogs and Deli Meats:  Hot dogs and various deli meats are highly processed foods that contain many additives.  An allergic reaction after eating these meats could be due to any of these added ingredients.  It is believed however that nitrate and nitrite additives are generally the cause in most instances.

• Water:  Yes, individuals can be allergic to water.  It is quite rare, however, there are some individuals who have a condition called aquagenic urticaria.  If one has this malady, the contact with water will cause itching and hives. There is no optimum treatment for this disorder at the present time

Uncommon Non-Food Allergies:

• Latex Allergy:  Latex or natural rubber allergies can range from a mild irritation of the skin to a severe anaphylactic reaction.  Common latex products include latex gloves, condoms, dental dams, adhesive bandages, balloons, waistbands, tires, and pacifiers, to name a few.  It is interesting to note that there are similar proteins in natural rubber latex and certain foods (e.g., avocados, chestnuts, papaya, bananas, kiwis), so cross-reactivity can occur.

• Sex:  There are individuals that have a disorder called seminal fluid hypersensitivity whereby they are allergic to the seminal fluid of a particular person.  It is generally an allergy to a specific man’s seminal fluid and not necessarily to all men. The symptoms can range from just a minor irritation on the skin, to hives, to anaphylaxis.  Symptoms can be avoided with the use of condoms. Many times, in vitro fertilization is needed in order for the couple to conceive without risk to the allergic individual.

• Sunlight:  A small percentage of the population have a sensitivity to sunlight where they may develop hives, itchy skin, rash, nausea, and/or headache.  Solar urticaria is a condition where hives form upon exposure to sunlight.

• Exercise:  Exercise may trigger a generalized itching, hives, swelling, asthma, and/or anaphylaxis, depending on the person.  These conditions are called, exercise-induced pruritus, exercise-induced urticaria, exercise-induced angioedema, exercise-induced asthma, and exercise-induced anaphylaxis respectively.  In some instances, an individual must exercise in the cold air for symptoms to occur. In others, a specific food must be eaten a few hours before exercise in order for there to be an allergic reaction.  This is called food-dependent-exercise-induced urticaria. An example of this is a person who can eat celery without problems and they can exercise without problems. However, if they eat celery within 2 hours before exercise, they will develop hives.  Patients with these conditions should never exercise alone and if they exercise, should always stop exercising at the first sign or symptom of their allergy.

• Cold:  Cold can be a trigger for some individuals to develop generalized itching, hives, swelling, asthma, and/or anaphylaxis.  The names of the corresponding conditions are cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, cold-induced asthma, and cold-induced anaphylaxis respectively.  Similar to exercise above, these patients should avoid the cold, if possible.

• Money:  Individual with nickel allergy may develop allergic contact dermatitis from handling coins.  Metal allergy is not that uncommon, but having reactions to holding coins is fairly uncommon.  Obviously, the condition is more prevalent in individuals who handle money more often such as bank tellers and cashiers.

• Scratches:  Some individuals have a disorder called dermatographism where a simple scratch or pressure on the skin will cause the affected area to develop hives in a linear pattern to match the scratch.  The name dermatographism means “skin writing” so it is possible to write a word on the individuals’ skin just by writing the word using a fingernail on the skin. Approximately 5 minutes later, the word is visible in a reddish and raised fashion.

There are more uncommon allergies than mentioned above, but the ones listed above give some indication of the diversity of unusual allergies.  Individuals can be allergic to almost anything. It is a combination of the patient’s awareness of their symptoms and situation in conjunction with the allergist’s knowledge that is needed in order to diagnose and then prevent and/or treat such unusual allergies.

The board certified allergists at Black & Kletz Allergy have 3 office locations in the Washington, Northern Virginia, and Maryland metropolitan area.  The allergy doctors at Black & Kletz Allergy treat both pediatric and adult patients.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.   For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy have been helping patients with hay fever, asthma, sinus disease, eczema, hives, insect sting allergies, immunological disorders, medication allergies, and food allergies for more than 50 years.  If you suffer from any allergy, whether unusual or not, it is our mission to improve your quality of life by reducing or preventing your undesirable and annoying allergy symptoms.

Keratoconjunctivitis is term used to describe inflammation of the cornea and conjunctiva.  Keratitis specifically is the inflammation of the cornea (i.e., the transparent dome that covers the pupil and the iris of the eye). Conjunctivitis, on the other hand, is the inflammation of the conjunctiva .  It is more commonly referred to as “pink eye.” Keratoconjunctivitis is one of the most common causes of red and irritated eyes as millions of individuals visit doctors for this condition every year.

Most of the cases of keratoconjunctivitis and conjunctivitis are due to allergies.  Conjunctivitis due to allergies is referred to as allergic conjunctivitis.  Infections are another common cause of keratoconjunctivitis and conjunctivitis with viruses accounting for most of the infections across all age groups.  Of note, conjunctivitis caused by bacteria is more common in children. Other infectious agents may include a parasite or a fungus. It should also be noted that an injury to the eye can inflame the cornea or conjunctiva without a secondary infection.

Types of Keratoconjunctivitis:

Keratoconjunctivitis sicca is also commonly known as dry eye syndrome.  Dry eye occurs when either the eye does not produce enough tears or when the tears evaporate too quickly.  It can also occur when there is an imbalance in the tear mixture.  Tears are comprised of water, fatty oils, and mucus. Individuals need the correct mixture of all three of these ingredients in order to properly nourish one’s eyes.  Some of the more common causes may include allergies, contact lens use, pregnancy, meibomian gland (i.e., glands in eyelids that excrete oil into the tears) dysfunction, and certain medications such as (e.g., antihistamines, some blood pressure medications, hormone replacement therapy, antidepressants).

Epidemic keratoconjunctivitis (EKC) is an eye infection caused by a specific virus called the human adenovirus.  It is also known as “adenoviral keratoconjunctivitis” or just “viral keratoconjunctivitis.”

The incubation period of EKC is long and it is very contagious.  It tends to spread quite easily especially when individuals are in close quarters (e.g., dormitories, hospitals, schools, arenas, movie theaters).

There’s no specific treatment for EKC.  Symptoms typically last a few weeks in duration before abating.  Adenoviruses may also target the digestive, respiratory, and genitourinary tracts.

Vernal keratoconjunctivitis (VKC) is a recurrent, chronic allergic inflammation of the eyes.  It generally results in small, round bumps known as giant papillae underneath the eyelid.  VKC generally affects the upper eyelids more than the lower eyelids. The symptoms are much more common in the Spring with the arrival of pollen, particularly tree and/or grass pollen.

The cause is thought to be an allergic disorder, but may also involve genetic and/or immune system disorders.  It is more common in tropical environments and is more common in boys than in girls.

Atopic keratoconjunctivitis (AKC) is a chronic inflammatory disease of the eye that usually affects patients with a history of atopic dermatitis (i.e., eczema).  Males are affected with AKC more often than females, and it is more likely to involve the lower eyelids more than the upper eyelids.

Symptoms characteristically worsen in the Winters.  Without treatment, AKC may lead to serious complications such as:

• Ulceration
• Keratoconus (i.e., thinning and bulging cornea)
• Corneal vascularization (i.e., growth of new blood vessels into the cornea

Herpetic keratoconjunctivitis is an infection caused by the herpes simplex virus, particularly Type 1.  Touching one’s eyes after touching a cold sore may transfer the virus to the eyes.

Allergic keratoconjunctivitis refers to any keratoconjunctivitis caused by an allergen.  Vernal keratoconjunctivitis and atopic keratoconjunctivitis, for example, are included in this group.  The allergies can be seasonal or perennial in nature.

Symptoms of Keratoconjunctivitis:

Symptoms range from mild to severe.  The symptoms may vary depending on the cause.  Some symptoms associated with keratoconjunctivitis may include:

• Redness
• Itchiness/Burning
• Puffy eyelids
• Discharge from the eyes (i.e., watery eyes)
• Stickiness of the eyes (i.e., eyes become “glued shut”)
• Light sensitivity (i.e., photophobia)
• Dryness
• “Foreign body” sensation in the eyes
• Blurry of vision (usually mild)

Diagnosis of Keratoconjunctivitis:

The diagnosis can be made based on the medical history, symptoms, and visual inspection of the eyes.  Depending on the initial findings, a physician may also want to examine:

• Visual acuity
• Under the eyelids
• Ocular pressure
• Pupillary reactions
• Discharge of the eyes
• Corneal sensation

In some cases, one may need to be tested for:

• Allergens
• Viruses
• Autoimmune disorders
• Genetic conditions

Treatment of Keratoconjunctivitis:

Treating the symptoms:

One may need a combination of therapies which may include:

• Topical antihistamines or mast cell stabilizers
• Preservative-free lubricating gels and ointments
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Topical corticosteroids

In cases of severe keratoconjunctivitis sicca, punctal plugs may be inserted to reduce the drainage of the tears into the nose. 

Treating the underlying condition(s):

Some viral infections, such as herpes, may require treatment with topical or oral antiviral medications.  Any underlying autoimmune or genetic conditions may also need specific treatments.

Black & Kletz Allergy has board certified allergists in 3 convenient locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area.  The allergists are trained and very familiar with allergic eye disorders such as mentioned above.  The allergy specialists at Black & Kletz Allergy diagnose and treat both adults and children.  We offer on-site parking in our Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA locations.  The Washington, DC and McLean, VA offices are Metro accessible and the McLean office has a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line.  If you are experiencing what appears to be allergy symptoms associated with your eyes, please call us to schedule an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been serving the needs of allergy and asthma sufferers in the Washington, DC metro area for more than 5 decades.

What are some of the causes?

As we enter into the season of colder days and nights in the Washington, DC metropolitan area, we are exposed to colder and drier air.  The cold and dry air in conjunction with lower humidity levels predispose individuals to flare-ups of eczematous skin conditions.

Layers of clothing during outdoor activities and returning to overheated homes can trigger a cycle of sweating, itching, scratching, and irritation.  Dry heat from our furnaces will evaporate the normal protective oils of one’s skin which may lead to cracking of the skin.

The smoke emitted by indoor fireplaces and wood burning stoves in combination with exposure to dust and dust mites may cause exacerbations of allergies, eczema, and asthma in individuals predisposed to these conditions.  Parched air can dry up the normal moisture in the mucus membranes leading to nose bleeds as well as a burning sensation in the eyes. 

The pile of wet leaves in people’s yards create a breeding ground for the molds to grow and their spores may trigger allergic rhinitis (i.e., hay fever), asthma, and eczema (i.e., atopic dermatitis) in sensitized individuals.  The wool in one’s sweaters can irritate sensitive skin and cause itching (i.e., pruritus) and rashes.

Other common triggers of eczema may include hot water, smoke, sweat, extreme temperatures, perfumes, colognes, cleaning solutions, scented laundry detergent, scented candles, scented soaps, scented shampoos, scented dryer sheets, fabric softeners, pets, molds, pollens, skin infections, stress, and certain foods in people with known food sensitivities.

What can be done in order to improve the situation?

Thorough and regular moisturizing of the skin with emollients (e.g., creams, ointments, lotions, gels) is the best protection against flare- ups of individuals with eczema.  Thick oil-based creams and/or ointments generally help protect the skin from excessive dryness better than water-based lotions. “Soak and seal” methods are efficacious in helping prevent the loss of moisture from the skin.

Direct exposures to sources of dry heat (e.g., radiant warmers) should be avoided.  If the HVAC system does not have a central humidifier, an ultrasonic water vaporizer in the bedrooms, especially during nights, will reduce excessive dryness of the mucus membranes and the skin.

Long, hot showers can strip the skin of its natural oils.  Shorter, lukewarm showers or baths are skin-friendly. Milder soaps, detergents, and shampoos without fragrances are kinder to the skin.

Woolen and synthetic clothes can irritate the skin and cause itching when they are in direct contact with skin.  Natural fabrics such as cotton and cashmere are less likely to cause flare-ups of itching and rashes while in direct contact with skin.

In spite of above measures, if eczema does flare-up, one may need to use medications in order to control eczema.  Below are a list of several medications used to treat eczema:

1.) In order to manage eczema, it is very common to use topical anti-inflammatory medications (e.g., topical corticosteroids) for a short period of time.

2.) The itching usually responds well to first generation antihistamine medications.

3.) Second generation antihistamines may also help and have the advantage of being generally non-sedating.

4.) Eucrisa (crisaborole) ointment 2% is a nonsteroidal cream that is quite efficacious in the treatment of eczema and has very few side effects.    The most common side effect is a mild burning or stinging sensation of the skin where the ointment is applied. Eucrisa ointment 2% is indicated in the treatment of eczema in children ages 2 years of age and older as well as in adults.

5.) Topical immunosuppresants are commonly used in both children and adults.  The two most common medications in this class include Protopic (tacrolimus) ointment and Elidel (pimecrolimus) ointment.  They are both fairly effective and are steroid-free. Protopic can be used in children 2 years of age and older as well as in adults.  Elidel is approved for children 3 months of age and older as well as for adults.

6.) Rarely, a short course of oral corticosteroids may be necessary during severe exacerbations of eczema, although the use of oral corticosteroids is generally avoided due to the potential side effects that corticosteroids can produce.

7.) If all else fails, there is a class of medications called “biologicals” that may be utilized and has been very effective in the treatment of eczema.  Dupixent (dupilumab) is currently the only biological that is FDA-approved to treat moderate-to severe-eczema. It is currently approved for adolescents (12 years of age and above) as well as for adults.  Of note, Dupixent also is approved for the treatment of asthma in patients 12 years of age and older, as well as in adults with chronic rhinosinusitis with nasal polyps (CRSwNP).

The board certified allergy specialists at Black & Kletz Allergy have expertise in diagnosing and treating eczema as well as other skin conditions .  We are board certified to treat both pediatric and adult patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than a half a century.  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 directly or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  If you suffer from eczema or other skin-related disorder, 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 care in a friendly and professional environment.

Twenty percent of the U.S population have cat allergies and 10% of the population have dog allergies.  In the U.S., the most common pet are dogs, which are followed by cats as the second most common pet. Approximately 70% of homes having at least one pet.  This is a higher percentage of homes with pets than in the past as more and more families are acquiring pets. In addition to cats and dogs, some other common pets include birds (e.g., parakeets, parrots), fish, rabbits, rodents (e.g., guinea pigs, hamsters, gerbils, chinchillas, rats, mice) reptiles (e.g., snakes, lizards, turtles, geckos), hermit crabs, ferrets, horses, and spiders.  Horses normally do not live in people’s homes, but they may be rather allergenic. In recent years, there is a fad of owning miniature horses which in some cases do live in their owner’s house. This is probably not a good idea in general, but for those who are allergic to horses, it is especially unwise.

Allergies to pets are in fact really an allergy to the specific proteins that are produced by a particular pet.  In dogs, the major protein responsible for allergies to dogs is called “Can f 1.” This protein produced by dogs is most commonly found in the dog’s dander, saliva, and urine.  In cats, the major proteins associated with allergies are known as “Fel d 1” and “Fel d 4.” These two proteins are responsible for most of the suffering in individuals with cat allergies.  Similarly, most of the proteins that cause allergies in cats are concentrated in the sebaceous glands in the skin (i.e., dander), the saliva, and the urine. Unlike dogs, cat dander tends to “stick” to things such as walls, carpeting, clothing, bedding, etc. and is commonly transported from the home to home or home to work environments.  If the Fel d 1 protein is measured on a cat owner’s clothing, bedding, or upholstered furniture at work, it is likely that the protein will be found. In addition, it may take months for these proteins to dissipate and become undetectable, despite a thorough cleaning of the home, due the stick-to-itiveness of cat dander. Note that since the protein is also found in urine, cat litter boxes are a rich source of these proteins and allergic individuals should avoid exposure to litter boxes.  In dogs, fortunately the protein Can f 1 is not as “sticky” as the cat proteins, but still can adhere to walls, clothing, carpeting, bedding, etc. Interestingly, there is an increased incidence of horse allergy in some individuals that have cat and/or dog allergies due to a common protein that is shared between all three animals. In rodents, in addition to the allergenic protein being present in the urine, dander, and saliva, certain rodents such as mice contain allergenic proteins in their mouse droppings.

In addition to pet allergies, there are additional potential medical hazards to consider when owning certain pets.  Mice and rats carry many diseases such as the bubonic plague, Hantavirus pulmonary syndrome (HPS), leptospirosis, tularemia, rat bite fever (RBF), lymphocytic choriomeningitis, salmonellosis, and Lassa fever.  Exposure to birds can cause infections and diseases such as psittacosis, salmonellosis, allergic alveolitis, campylobacteriosis, avian flu, avian tuberculosis, Newcastle disease, cryptosporidiosis, and giardiasis.  Reptiles can irritate one’s skin. Snakes can cause life-threatening allergic reactions from the venom that is introduced from a snake bite.

As a general rule, if an individual is allergic to a specific pet, it is advisable not to own that pet.  Even though this seems pretty obvious, a majority of individuals still choose to either acquire a pet or keep an existing pet that they own despite that the pet causes unwanted allergy symptoms.  This is understandable, although not advisable, since a pet becomes a member of the family and often causes great happiness.

One myth to debunk is that there are “hypoallergenic” cats and dogs to get if one is allergic to such a pet.  While some pet-allergic individuals feel that they have reduced allergic symptoms around short-haired cats and/or dogs that do not shed (e.g., poodles), most scientific studies do not support this phenomena.

Obviously, the best way to combat pet allergies is to completely avoid them as mentioned above.  If this is not an option, one can take some measures to reduce their exposure to the allergens that cause pet allergies.  Brushing your cat or dog frequently and bathing your cat or dog often will help reduce the levels of cat and proteins. It is also advisable to prevent the pet from entering your bedroom.

The symptoms of pet allergies are similar to any other type of environmental allergy.  The symptoms may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy eyes, watery eyes, redness of the eyes, puffy eyes, headaches, sinus congestion, itchy skin (i.e., pruritus), hives (i.e., urticaria), wheezing, chest tightness, coughing, and/or shortness of breath.

The treatment of pet allergies begins with avoidance of the offending pet as previously mentioned.  Medications used for the management of pet allergies may include antihistamines, decongestants, leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, and/or asthma inhalers.  Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are very effective in treating pet allergies as they are also very efficacious in the management of dust mite, mold, and pollen allergies.  They work in 80-85% of patients with allergies and have been used in the U.S. for more than 100 years.

The board certified allergists at Black & Kletz Allergy have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area and treat both adults and children with pet allergies.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Black & Kletz Allergy offers on-site parking at each of their 3 office locations and the Washington, DC and McLean, VA offices are also Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call our office or you can click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy has been serving the asthma and allergy needs of the DC metro area community for more than 50 years and we strive to offer high quality allergy and asthma care in a compassionate professional environment.

As we are in the Fall season and approaching Winter, many individuals may experience a clear runny nose, post-nasal drip, sneezing, sore throat, nasal congestion, sinus pressure, headache, coughing, and/or fatigue.  The question to many becomes, “Do I have a common cold or do I have Fall/Winter allergies? It is a common question to an even more common complaint. How does someone know if they are having allergies rather than the common cold?  Well, if someone does not have a history of allergic rhinitis (i.e., hay fever) and they develop the above-mentioned symptoms, they probably are not experiencing allergies, unless these symptoms persist for several weeks or more.  If the symptoms persist, one should consult a board certified allergist like the ones at Black & Kletz Allergy.  The allergy specialist can help identify if one has allergies vs. are the symptoms a result of a lingering cold or a secondary bacterial infection (e.g., sinus infection, upper respiratory infection, pneumonia)?

The common cold is caused by a variety of viruses (e.g., rhinovirus, human coronavirus, influenza viruses, parainfluenza virus, human respiratory syncytial virus (i.e., RSV), enteroviruses other than rhinovirus, and adenoviruses).  There are over 200 viruses associated with the common cold, although rhinovirus accounts for most of them. In addition, approximately 25% of colds are caused by unknown factors, which are presumed to be due to unidentifiable viruses.

Of particular importance to infants and young children is the human respiratory syncytial virus which can be fairly severe in these age groups and cause life-threatening illness in approximately 1-2% of infants and young children who get the virus.  RSV may also cause serious symptoms in individuals whose immune systems are compromised, as well as in individuals with chronic heart or lung disease. Most of the time, RSV has a mild self-limited course in children and adults resulting in a cold-like illness.  In fact, almost all children get RSV by the age of 2. It is only this 1-2% of infants and young children, some individuals whose immune systems are compromised, and some people with chronic heart or lung disease who go on to develop more serious symptoms which may include pneumonia (i.e., infection of the lungs), and/or bronchiolitis .  Infants and young children with this more severe course often require intravenous antibiotics and fluids, oxygen, and sometimes need to be placed on a ventilator for a short period of time in order to help them through the respiratory distress that can accompany this virus. In addition, infants and young children that develop complications from RSV may be more likely to develop asthma in the future.

While discussing the common cold, there is a common myth to debunk regarding the development of the common cold and environmental factors.  It is a myth that being out in the cold weather will cause a cold. The traditional theory is that a cold can be “caught” by the prolonged exposure to cold weather, which is probably how the disease got its name.   It is much more likely that in the Fall and Winter months, when it happens to be cold outside, some of the viruses that cause the common cold occur more frequently during this time period.  If these viruses are more prevalent during this time period, it stands to reason that we are exposed to more of these viruses at this time and therefore are more likely to “catch” a cold in these colder months.  One other factor to consider is that once a few individuals develop colds, since it is easily transmissible, more and more people who are in close contact will then develop colds. This process becomes exponentially larger and before you know it, “almost everybody” has a cold.

What about someone who does have a history of allergies?  If they develop the classic symptoms of a cold in the Fall or Winter as mentioned in the first paragraph, is it their allergies or a common cold?  The same basic formula applies to them. If the symptoms are present for a week or two, one is to assume it is a common cold. However, if the symptoms last several weeks or more, then one is to assume that their allergies are playing a role.  The allergens that typically cause allergic rhinitis symptoms in the Fall and Winter include dust mites, molds, pets, cockroaches, and other animals such as rodents. Allergy testing can be done via skin or blood testing. If an environmental allergy is identified, it is important to try to prevent exposure to the allergens.  If that does not relieve the symptoms, then there are host of medications that can be utilized in order to help mitigate one’s allergy symptoms.

If you are suffering from a prolonged “cold” and/or are not sure if your symptoms may be due to allergies and you would like to be seen at one of Black & Kletz Allergy’s 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), or Manassas, VA, please call us to make an appointment.  Alternatively, you can click Request an Appointment and we will get back to you within 24 hours by the next business day.  We 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.  Black & Kletz Allergy provides a friendly and caring environment for you to get the top quality allergy, asthma, and immunology treatment that we have been providing the community for more than 50 years.

A mast cell is a component of the immune system that is involved in the allergic response.  Mast cells contain histamine and other chemical mediators. These chemicals are released into the bloodstream and then into the surrounding tissues during an allergic reaction.

In a disorder called “mastocytosis,” individuals harbor excessive numbers of mast cells in the bone marrow and other organs.  It is important to note that this condition may occur both in children and adults. Individuals with mastocytosis frequently experience generalized itching, flushing, skin rashes, abdominal cramps, nausea, vomiting, diarrhea, shortness of breath, dizziness, and/or passing out (i.e., syncope). 

Children are more likely to have symptoms limited to the skin whereas the majority of adults have systemic symptoms which usually involve multiple organ systems.  These symptoms are similar to that of anaphylaxis. In addition, these individuals are more sensitive to various triggers such as temperature changes, certain medications, spicy foods, alcohol, bee stings, etc.  Occasionally they suffer anaphylaxis spontaneously without exposure to any obvious trigger(s).

The first step in the diagnosis of this condition is a comprehensive history taking note of the specific symptoms, as well as their onset, progression, and severity.  Physical examination sometimes reveals freckle-like skin lesions called “urticaria pigmentosa” which typically appear over one’s thighs, abdomen, etc. These spot-like skin lesions can lead to hives (i.e., urticaria) upon stroking the skin (also known as Darier’s sign), as well as after exposure to temperature changes (e.g., taking hot showers).  This occurs as a result of the compression of mast cells.

The most helpful diagnostic laboratory test is a serum tryptase level, which is usually elevated in systemic mastocytosis.  Urine examination also can be useful in detecting higher levels of metabolites of various chemical mediators of allergic reactions.  Confirmation of the diagnosis usually requires a skin biopsy, bone-marrow examination, evaluation of organ functions, and occasionally genetic studies.

The usual course of treatment of this condition is avoidance of exposure to the known triggers of mast cell activation in order to prevent acute symptoms. There are several medications that are utilized in order to treat this condition.  Antihistamines block the effects of histamine, which is one of the most common mediators of allergic reactions. As a result, antihistamines are the most commonly used medications to treat mast cell disorders.  A medication called cromolyn is helpful to alleviate the gastrointestinal symptoms (i.e., abdominal cramping, nausea, vomiting) that may occur with mast cell disorders including. Aspirin, ketotifen and leukotriene modifiers are also sometimes employed in the treatment of mast cell disease.

It is important to note that individuals with mast cell disorders are also at risk for fractures due to osteopenia and/or osteoporosis, and bone health needs special attention.  More aggressive forms of systemic mastocytosis may require interferon, immune modulators, and/or chemotherapeutic agents.

All patients with established mast cell disorders need to have ready access to epinephrine auto-injectors (e.g., EpiPen, Auvi-Q, Adrenaclick) at all times to be used at the onset of symptoms suggestive of anaphylaxis.  Once used, it is important for the individual to go to the closest emergency room. It is also important for patients with mast cell disorders to make surgeons and anesthesiologists aware of their mast cell disorder in case a surgical procedure is needed, as surgery can also be a trigger systemic symptoms.

The board certified allergists at Black & Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area and are very experienced in the diagnosis and treatment of mast cell 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 our office to make an appointment or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been serving the Washington, DC metropolitan area for more than 50 years and we pride ourselves in providing excellent allergy and asthma care in a professional and pleasant setting.

Dust is a very common allergen which can cause havoc among sensitized individuals.  Most people are not aware that the cause of dust allergies are dust mites. Dust mites are microscopic animals belonging to the class Arachnida.  Arachnids are arthropods which are invertebrate animals that have an exoskeleton (i.e., external skeleton), a segmented body, along with paired jointed appendages.  In addition to mites, some other examples of arachnids include spiders, ticks, and scorpions.  Dust mites, which are also known as house dust mites, are between 0.2 to 0.3 mm. in length and are translucent, making them almost invisible to the naked eye.

Dust mites survive by eating the dead skin of humans and pets as it flakes off their bodies.  They also eat some varieties of mold. They live throughout the world except at high altitudes (i.e., above 5,000 feet).  Dust mites are generally found in bedding (e.g., pillows, mattresses, box springs, blankets), upholstered furniture, carpeting, drapes, and curtains.  They tend to thrive in humid conditions where the relative humidity is above 50%. The allergenic components of dust mites are the exoskeleton and their fecal deposits.  Since the exoskeleton and fecal deposits are relatively heavy in nature, they are not suspended for long in the air. Thus, they are generally found on the floor and other surfaces.  The dust that you see in the air is not usually composed of dust mite allergens unless the floor or surface is disturbed. If this occurs, the dust mite allergens only remain in the air for a couple of hours or less.  The two major species of dust mites that are highly allergenic and tend to affect sensitized individuals in the U.S. are Dermatophagoides farinae (i.e., American house dust mite) and Dermatophagoides pteronyssinus (i.e., European house dust mite).  

Individuals who are allergic to dust mites may exhibit signs and symptoms of allergic rhinitis (i.e., hay fever), allergic conjunctivitis, and/or asthma.  These symptoms may include sneezing, runny nose, nasal congestion, postnasal drip, itchy nose, itchy eyes, watery eyes, redness of the eyes, puffy eyes, sore throat, snoring, fatigue, sinus headaches, wheezing, coughing, chest tightness, and/or shortness of breath.

The diagnosis of dust mite allergy requires a thorough history and physical examination by a board certified allergist like the ones at Black & Kletz Allergy.  Testing to dust mites can be done via skin or blood testing.  The severity of the dust mite allergy can also be assessed. Once diagnosed, the allergist will recommend several preventative measures that should be implemented by the allergy sufferer.

Some of these preventative measures may include:  

1.)  Covering the pillows, mattress, and box spring with allergy-proof encasings

2.)  Washing the bedroom sheets in hot water (greater than or equal to 130 °F) 

3.)  Vacuuming carpeting at least once a week

4.)  Keeping the relative humidity less than or equal to 45%

5.)  Reducing or eliminating stuffed animals and other dust-gathering toys

6.)  Replace bedroom wall-to-wall carpeting to hardwood or vinyl flooring

7.)  Use a HEPA filter in the HVAC system and replace the filter every 3 months

The treatment of dust mite allergies may include the use of oral antihistamines, decongestants, leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergic medications, allergy eye drops, inhaled corticosteroids, inhaled bronchodilators, allergy immunotherapy (i.e., allergy shots, allergy injections, allergy hyposensitization), and/or biologicals (e.g., for the treatment of moderate to severe asthma).

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating dust mite allergies for many decades in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our Washington, DC and McLean, VA offices 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.  The allergists at Black & Kletz Allergy are extremely knowledgeable about the most current treatment options for patients with allergic rhinitis, allergic conjunctivitis, and asthma and can promptly answer any of your questions.  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 50 years and we look forward to providing you with excellent state of the art allergy and asthma care in a friendly and pleasant environment.

Every year, several children are taken to emergency departments on Halloween day for the management of severe allergic reactions.  What is meant to be a fun-filled activity can turn out to be a harrowing experience for some families. A few general precautions made by families can prevent most allergic emergencies in children and are as follows: 

To help insure that a food allergic child can participate in Halloween and have as much fun as the next child, although nothing is guaranteed, there is a program run by the Food Allergy Research and Education (FARE) organization called the “Teal Pumpkin Project”.  This FARE-sponsored international program has been in place since 2014.  It began in Tennessee by the mother of a severely food allergic child.  The Teal Pumpkin Project’s purpose is to raise awareness of the severity of food allergies and show support to families who have food allergic children.  This is done by painting a pumpkin the color teal and then placing it on one’s front porch to signify that “non-food” treats are available at that location on Halloween night.  The color teal is used because it represents food allergy awareness.  Typically, “non-food” treats may include toys, crayons, stickers, rings, bracelets, necklaces, glow sticks, hair accessories, coins, finger puppets, balls, bookmarks, spider rings, vampire fangs, whistles, etc.

It important to point out that the Teal Pumpkin Project is not exclusionary and it still promotes the option of distributing normal trick-or-treat candy to children without food allergies.  It recommends that the “non-food” items be kept in a different bowl than the traditional candy bowl.  FARE provides a “Teal Pumpkin Project Participation Map” on its website so that participating houses can be easily assessed by the parents of food allergic children.

Being cognizant of the hidden dangers of trick-or-treating and proactive in preventing allergen exposures can greatly reduce parents’ anxiety as well as help children fully enjoy the Halloween experience.  The board certified allergists at Black & Kletz Allergy have had over 5 decades of experience in diagnosing and managing food and environmental allergies, asthma, and eczema in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Both food and environmental allergies can be diagnosed by a thorough history and physical examination along with prick skin testing and/or blood testing.  We would be happy to see you in one of our 3 convenient locations 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 our office or alternatively, you may click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy is proud to provide quality allergy, asthma, and immunology care in a relaxed compassionate environment.

Hives (i.e., urticaria) is a type of skin rash that usually presents with red, raised, and itchy bumps, usually similar in appearance to mosquito bites. Other colloquial terms for hives include welts or wheals. They may occur anywhere on the body and appear in various shapes and sizes. They usually blanch with pressure. In some instances, they may look like small red dots or even be flush with the skin. The borders of each hive may be sharply demarcated or they may blend in with the surrounding skin. If the hives are deep enough in the skin layer, the result may be swelling of that area commonly referred to as angioedema.

Hives are quite common as they affect 20% to 25% of the population at some point in their lives. Hives generally, as a rule, are intermittent and usually last less than 24 hours in duration. They may occur very frequently (i.e., multiple times per day) or they may occur very rarely (i.e., one isolated episode). If an episode of hives resolves within 6 weeks, it is known as “acute urticaria.” If the episode lasts more than 6 weeks in duration, it is known as “chronic urticaria.” You may be asking yourself, what are the causes of hives, since they are so common. Many times, the cause is fairly obvious in such cases where the hives develop shortly after eating a certain food, or immediately after a bee sting. They may occur during the course of or shortly after completing a course of antibiotics. Other medications may be the causative agent in others affected with hives. Aspirin and nonsteroidal anti-inflammatory drugs (NSAID’s) are the most common classes of medications that cause hives besides antibiotics. Some of the most commonly prescribed NSAID’s include ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn, Anaprox), salsalate (Disalcid), indomethacin (Indocin), etodolac (Lodine), diclofenac (Voltaren, Arthrotec, Cataflam), ketorolac (Toradol), piroxicam (Feldene), meloxicam (Mobic), Oxaprozin (Daypro), nabumetone (Relafen), tolmetin (Tolectin), fenoprofen (Asaid), sulindac (Clinoril), and celecoxib (Celebrex). It is important to note that any medication or food can cause hives in any individual, despite the fact that they may have ingested the food or medication in the past without reactions. An assortment of other conditions such as infections (viral, bacterial, fungal, or parasitic), inflammatory conditions, autoimmune disorders (when the immune system fights an individual’s own tissues and organs instead of defending them against outside intruders), and rarely even cancers can play a role in causing hives.  If the hives persist longer than 24 hours and/or they leave residual marks on the skin, it may indicate inflammation of the small blood vessels, a condition known as “vasculitis.” Other factors that may cause or exacerbate hives may include exercise, cold, heat, vibration, pressure, sun exposure, and/or water, to name a few.

If you suffer from hives, it is important to see a board certified allergist such as the allergists at Black & Kletz Allergy. Our allergy specialists see numerous cases of hives and/or swelling episodes each week. We have over 5 decades of experience in the Washington, DC, Northern Virginia, and Maryland metropolitan area in diagnosing and treating hives. We see patients of all ages ranging from newborns to the elderly. At your first consultation with our allergists, a comprehensive history and physical examination will be performed. Depending upon your history and examination, diagnostic tests may include bloodwork, allergy skin testing, urinalysis, X-rays, and/or a skin biopsy. Since histamine is the principal chemical that is responsible for the development of hives, most of the cases are responsive to medications that block the action of histamine on the skin. In some individuals, avoidance of a particular food or medication is all that is needed. For others, there are a variety of treatment options, some of which include antihistamines, leukotriene antagonists, histamine-2 blockers, corticosteroids, immune modulators, and “biologicals” or various combinations of the aforementioned medications.

Black &Kletz Allergy has 3 convenient locations in the Washington, DC metro 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 hives, swelling episodes, allergic rhinitis (i.e., hay fever), asthma, sinus conditions, and immunology needs.  We are dedicated to providing excellent care to you as we have been doing in the Washington, DC metro area for more than 50 years.

Proton pump inhibitors (PPIs) are a group of medications commonly used to treat symptoms caused by excessive stomach acid.  The most common PPIs available in the U.S. are Nexium (i.e., esomeprazole), Protonix (i.e., pantoprazole), Prilosec (i.e., omeprazole), Prevacid (i.e., lansoprazole), Aciphex (i.e., rabeprazole), and Dexilant (i.e., dexlansoprazole).  These medications act by reducing the amount of acid secretion produced by the parietal cells in the lining of the stomach. In addition to lifestyle and dietary modifications, they are usually the first line medications prescribed to treat common conditions such as gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), erosive esophagitis, Zollinger-Ellison syndrome, and peptic ulcers (duodenal or stomach ulcers).  GERD is commonly referred to as “heartburn” by the general public.  These PPIs are also used in combination with corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and/or some antibiotics to protect the stomach.

These medications are considered relatively safe and some are also available over the counter.  Even though they are available over the counter, there are side effects, particularly if used long-term.  Some of the more common side effects may include headaches, rashes, fever, abdominal pain, nausea, vomiting, diarrhea, constipation, lightheadedness, and change in or unpleasant taste.  Long-term use has been linked to osteoporosis (i.e., thinning of the bones) which may lead to bone fractures. Other more severe side effects may include acute interstitial nephritis (i.e., kidney failure), lupus, pneumonia, low magnesium levels, muscle spasms, heart palpitations, and clostridium difficile-associated diarrhea, to name a few.

In addition to the side effects of PPIs, there have been a few recent publications that have reported their association with possible allergic reactions.

In an article published in The Journal of Allergy and Clinical Immunology: In Practice, the authors reported serious allergic reactions in five patients receiving PPIs.  These patients developed allergic reactions within 30 to 60 minutes of taking the medications orally.  One patient developed a more rapid reaction after receiving the drug intravenously.

All patients were subsequently evaluated for sensitivity to PPIs using skin prick testing and intradermal skin testing techniques.  All patients showed positive reactions indicating an immediate allergic sensitivity that was mediated by the IgE antibody. 

When patients develop life-threatening anaphylactic reactions, foods and insect stings are usually thought to be the causative agents as medications other than penicillins cause anaphylaxis very rarely.  However, this report highlights the need for a high index of suspicion for medications such as PPIs being the culprits in causes of anaphylaxis.

A more recent publication in the journal Nature Communications, the authors reported an increase in allergic symptoms in patients receiving PPIs on a regular basis.  The data revealed that people taking PPIs for any reason had a two-to-three times higher chance of receiving prescriptions for medications used to treat allergies at a later date.

Stomach acid is needed for proper digestion of ingested food.  It contains various enzymes which help break down the complex proteins in the food before they are further processed.  It also protects the digestive system from infections caused by bacteria and other harmful substances. 

Reducing the acid production by PPIs can impede the proper digestion of proteins.  PPIs also alter the microbiome of the stomach. Consequently harmful proteins and other substances can get absorbed into the bloodstream unchallenged. This has the potential to weaken the natural defense mechanisms and can either cause or aggravate allergic sensitization to certain foods and environmental triggers.

The authors of this publication caution people not to use acid suppressor medications any longer than absolutely necessary.

The board certified allergists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan region and have been providing allergy and asthma care to this area for more than 5 decades.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices offer on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  In addition, our McLean, VA office location offers a complementary shuttle that runs between this office and the Spring Hill metro station on the silver line.  For an appointment, please call one of our offices.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  If you suffer from allergies or asthma, it is our mission to help alleviate your unwanted symptoms, so that you can enjoy a better quality of life.

Black & Kletz Allergy is dedicated to providing the highest quality allergy and asthma care in a compassionate, relaxed, and professional environment.