Newer Medications for Atopic Dermatitis

December 13, 2024 | Black & Kletz Allergy

Atopic dermatitis (i.e., eczema) is a chronic inflammatory disorder of the skin. The symptoms usually begin in infancy and early childhood, although less commonly, they may begin later in life.  Genetic predisposition is the underlying reason for most cases, however environmental factors and allergic sensitization to foods and aeroallergens may trigger and/or aggravate the condition. The face and extensor regions of the extremities are usually affected in infants and young children, whereas the flexural areas, especially in the bends of elbows and knees, are more commonly involved in older children and adults. The symptoms of atopic dermatitis may range from mild dryness and itching of the skin to moderate thickening and discoloration of the skin, excessive creasing and cracking of the skin, and oozing in severe cases.  It should be noted that inflamed skin is more susceptible to bacterial and fungal infections than skin that is not inflamed.  More and more body surface area is involved as the disease progresses and this can have a huge negative impact on one’s quality of life. Though there is no cure for the genetic abnormalities that are responsible for atopic dermatitis at this time, many treatments are available to help reduce the ongoing inflammation and minimize the aggravating symptoms.  Until 2015, the only FDA-approved treatments for atopic dermatitis were topical corticosteroids and topical calcineurin inhibitors [e.g., Protopic (tacrolimus) ointment, Elidel (pimecrolimus) ointment].  Since then, many newer medications have been made available for the treatment of atopic dermatitis.

1. Eucrisa (i.e., crisaborole) topical ointment 2% - Approved by the FDA in December 2016 for mild-to-moderate atopic dermatitis in adults and children aged 2 years and older.  In March 2020, the FDA expanded the indication to include infants and children aged 3 months and older.
2. Dupixent (i.e., dupilumab) - A monoclonal antibody approved in 2017 for adults with moderate-to-severe atopic dermatitis which is not adequately controlled with topical prescription therapies.  It is the first biologic medication for atopic dermatitis and it is administered as a bi-weekly injection subcutaneously (SQ) or under the skin.  In 2019, this indication was expanded to include adolescents aged 12 years and older.  In 2020, it was further expanded to include children as young as 6 years of age.
3. Adbry (i.e., tralokinumab) - A monoclonal antibody that inhibits interleukin 13 (IL-13).  It was FDA-approved for the treatment of moderate-to-severe atopic dermatitis for adults whose disease is inadequately controlled with topical therapies.  In December 2023, the approval was expanded to include children 12-17 years of age.  This biologic is also given as a subcutaneous (SQ) injection every other week.
4. Rinvoq (i.e., upadacitinib)  - This oral JAK1-selective inhibitor was approved for the treatment of refractory moderate-to-severe atopic dermatitis in patients aged 12 years and older whose disease is not adequately controlled with other systemic drug products, including biologics.  It is taken daily in either 15mg. or 30mg. doses.
5. Cibinqo (i.e., abrocitinib) -An oral JAK1 inhibitor that is taken once a day that is indicated for the treatment for patients aged 12 years and older with moderate-to-severe atopic dermatitis.  It is dosed at 100mg. per day.
6. Opzelura (i.e., ruxolitinib) cream 1.5% - The first topical JAK inhibitor, which gained FDA approval, for short-term and non-continuous long-term treatment of mild-to-moderate atopic dermatitis in non-immunocompromised adults and adolescents whose disease is not adequately controlled with other topical prescription therapies.  It is applied twice daily to the affected areas of the skin.
7. Zoryve (i.e., roflumilast) topical cream – It got FDA approval for mild-to-moderate atopic dermatitis in adults and children aged 6 years and older in July 2024.  It is applied once a day to the affected areas as a 0.15% cream.
8. Ebglyss (i.e., lebrikizumab) - A monoclonal antibody that binds to IL-13 and inhibits the release of proinflammatory cytokines, chemokines, and IgE.  In September 2024, it was approved by the FDA for moderate-to-severe atopic dermatitis in patients aged 12 years and older who weigh at least 40 kg. (88 lbs.) in cases when the disease is not adequately controlled with topical prescription therapies.  It can be used with or without a topical corticosteroid.

Additional treatments:

1. In January 2015, the World Allergy Organization recommend the use of probiotics in pregnant and lactating women and their breastfed infants to prevent the development of atopic dermatitis.
2. Acyclovir, an anti-viral medication is effective in treatment of atopic dermatitis complicated by herpes virus infections (i.e., eczema herpeticum).
3. Excessive colonization of the affected skin by bacteria such as Staphylococcus and clinical infection in patients with atopic dermatitis can usually be controlled by antibiotics.
4. Phototherapy can be very effective in certain clinical scenarios of atopic dermatitis.
5. Immunosuppressive medications such as azathioprine, cyclosporine, mycophenolate, and methotrexate are effective in very severe cases of atopic dermatitis, but systemic toxicity limits their regular usage.
6. Antihistamines such as hydroxyzine may offer relief in individuals with atopic dermatitis from intense itching, but sedation is a common side effect.
7. Hydration of the skin with regular use of emollients such as Vaseline petroleum jelly can improve excessive dryness and itching in patients with atopic dermatitis.
8. A cool mist humidifier may help in reducing dryness in individuals with atopic dermatitis.
9. Soaps and detergents should be mild and non-irritating in patients with atopic dermatitis.

The board certified allergy specialists at Black & Kletz Allergy have been diagnosing and treating atopic dermatitis for more than 50 years. We treat both adults and children.  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 atopic dermatitis, other skin allergies and/or any other allergy symptoms, we are here to help lessen 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 devoted to providing the highest quality allergy care in a comfortable, considerate, and professional environment.

Winter Allergies Are Almost Here

December 6, 2024 | Black & Kletz Allergy

If pollens are generally a problem in the Spring and Fall, why do so many people experience allergy symptoms in the Winter?  What allergens are causing individuals to feel so lousy during the coldest time of the year?  The answer is not a simple one.  There are many allergens that may wreak havoc on sensitive allergic individuals during the Winter.  The most common allergens responsible for Winter allergies may include dust mites, molds, pets, and/or cockroaches. As far a dust mites are concerned, in the Washington, DC metro area, the 2 common species of dust mites are Dermatophagoides fariniae (i.e., American dust mite) and Dermatophagoides pteronyssinus (i.e., European dust mite).  Both of these species are quite allergenic.  In fact, it is the fecal particles and exoskeleton that are the allergenic components of the dust mites.  Dust mites are usually found indoors in places such as in bedding (i.e., pillows, mattresses, box springs), carpeting, and upholstered furniture.  They are microscopic in nature and look similar to cockroaches except they cannot be seen with the naked eye.  They are approximately 0.25 mm. in length.  Dust mites survive by eating the dead skin that habitually sloughs off of humans each night, hence they are commonly found in bedding.  Dust mites flourish in high humidity, warm, moist climates.  They do not survive if the temperature is over 130° F or when the altitude is greater than 1 mile (5,280 feet).  Dust mites are known to be a common cause of allergic rhinitis, allergic conjunctivitis (i.e., eye allergies) and asthma in many sensitive individuals.  Dust mites can be killed with the application of miticide products, however these products have not been shown to be that efficacious.  Encasing one’s pillows, mattresses, and box springs in allergy-proof encasings are a fairly effective way to minimize one’s exposure to dust mites. In the Winter, many people close up their homes by keeping the windows closed and recirculating the air.  As a result, indoor allergens such as dust mites, molds, pet dander, and cockroach become trapped in the home causing an individual to breathe in more allergen than during other times of the year when the windows tend to be open more often. Cockroach allergy is common particularly in major cities such as Washington, DC and New York City.  They are potent allergens.  Many apartments, condos, homes, restaurants, and public buildings in inner cities are infested with cockroaches, even though they may not be visible during the day to most people.  It is important to make sure that traces of food are not left on countertops and floors, as this entices cockroaches.  There is also a strong association between cockroach allergy and childhood asthma in inner city populations.  Cockroach allergies may cause allergic rhinitis, allergic conjunctivitis, and/or asthma symptoms in sensitive allergic individuals. Pet allergens from the dander and saliva tend to be worse in the Winter due to the closed up nature of a typical house.  People who are allergic to pets but refuse to give them up should at least not allow the pet to venture into their bedroom, if at all possible.  This will give the individual a “pet-free” zone in the bedroom, where people tend to spend the most time. Mold allergy is also prevalent during the Winters in the Washington, DC metropolitan area.  Washington, DC was built on a swamp and as a result the abundance of mold is commonplace.  Similar to dust mite, cockroach, and pet allergies, mold is an indoor allergen, however, unlike dust mite, cockroach, and pet allergies, mold is also found outdoors.  This double whammy makes mold allergy a unique allergen in that it affects people both indoors and outdoors.  It is recommended that people keep the relative humidity in their homes to be below 33%. In a perfect world, avoidance of the offending allergen is obviously the best option to prevent environmental allergies.  In reality however, it is very difficult, if not impossible, to avoid contact with some of these ubiquitous allergens.  So if one is unable to avoid these allergens, there are numerous medications that can be used by allergy doctors to treat dust mite, mold, pet, and cockroach allergies.  In addition to various antihistamines, decongestants, nasal sprays, and allergy eye drops, allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization) are a very effective tool that board certified allergy specialists use to treat individuals with these allergies, as well as pollen allergies.  Allergy injections are effective in 80-85% of the patients.  Allergy shots have been used in the U.S. to treat allergies and asthma for over 100 years.  The average length of treatment is 3-5 years. The board certified allergy specialists of Black & Kletz Allergy have been treating pediatric and adult patients with allergies and asthma for over 5 decades.  Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have convenient offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our offices in Washington, DC and McLean, VA are Metro accessible with free shuttle service between the Spring Hill metro station and our McLean office.  All 3 locations offer on-site parking.  To make an appointment, please call us, or alternatively you can click Request an Appointment and we will respond within 24 hours on the next business day.  The allergists at Black & Kletz Allergy strive to manage your allergy and asthma to your utmost satisfaction in a professional caring atmosphere.

Prevention of Peanut Allergy

November 22, 2024 | Black & Kletz Allergy

Much of the information from the past decade regarding when to introduce peanuts into the diet of infants has been reviewed recently and subsequently revised.  Research over the past 9 years shows that early introduction and regular consumption of peanuts decreases the risk of developing a peanut allergy.  It is no longer recommended that parents delay the introduction of peanuts in most children, as delay beyond 12 months may actually increase the risk of peanut allergy. A landmark clinical trial published in 2015, called the Learning Early About Peanut Allergy (LEAP), showed that the introduction of peanut products into the diets of infants at high risk of developing peanut allergy was safe.  This led to an 81% reduction in the subsequent development of the peanut allergy.  Prior to 2008, clinical practice guidelines recommended avoidance of potentially allergenic foods in the diets of young children who were at heightened risk for the development of food allergies.  The LEAP study was the first to show that the early introduction of dietary peanut is actually beneficial. An extension of the LEAP study published in 2016 called the Learning Early About Peanut Allergy – On (LEAP-On) demonstrated that regular consumption of peanut-containing foods beginning in infancy induces peanut tolerance that persists following a year of avoidance.  This suggests that there are lasting benefits of early-life consumption for infants at high risk for developing peanut allergy.  Investigators found that most children from the original peanut-consumption group remained protected from peanut allergy at age 6. A new study called the Learning Early About Peanut Allergy – Trio (LEAP-Trio), sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), and published in the journal NEJM Evidence on May 28, 2024, further revealed that feeding children peanut products regularly from infancy to age 5 years of age reduced the rate of peanut allergy in adolescence by 71%, even when the children ate or avoided peanut products as desired for many years. The LEAP investigators designed the LEAP-Trio study in order to test whether the protection gained from early consumption of peanut products would last into adolescence if the children could choose to eat peanut products in whatever amount and frequency they desired.  The study team enrolled 508 of the original 640 LEAP trial participants—nearly 80%—into the LEAP-Trio study.  255 participants had been in the LEAP peanut-consumption group and 253 had been in the LEAP peanut-avoidance group. The adolescents were assessed for peanut allergy primarily through an oral food challenge.  This oral food challenge involved giving participants gradually increasing amounts of peanut in a carefully controlled setting to determine if they could safely consume at least 5 grams of peanut, the equivalent of more than 20 peanuts. The study found that 15.4% of the participants from the early childhood peanut-avoidance group and 4.4% of the individuals from the early childhood peanut-consumption group had peanut allergy at age 12 or older.  These results showed that regular, early peanut consumption reduced the risk of peanut allergy in adolescence by 71% compared to early peanut avoidance. The study team also discovered that although participants in the LEAP peanut-consumption group ate more peanut products throughout childhood than the other participants overall, the frequency and amount of peanut consumed varied widely in both groups and included periods of not eating peanut products.  This demonstrated that the protective effect of early peanut consumption lasted without the need to eat peanut products consistently throughout childhood and early adolescence. These results confirm that feeding young children peanut products beginning in infancy can provide lasting protection from peanut allergy and further reinforce the current guidelines about the benefits of the early introduction of peanut products. Despite the research about the early introduction of peanuts in infants, it is very important that every parent or guardian discuss this with their infant’s pediatrician before introducing peanuts to their child.  Parents and guardians should follow their pediatrician’s recommendation and also seek care from a board certified allergist for an allergy consultation. The board certified allergy specialists at Black & Kletz Allergy have been diagnosing and treating food allergies for more than 50 years.  We treat both adult and pediatric patients.  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 food allergies, we are here to help you sort out whether or not you actually have an allergy vs. a food sensitivity.  Our allergists will educate you on what to look for and what to do going forward regarding your specific food allergies.  Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a relaxed, considerate, and professional environment.

Mast Cell Activation Syndrome (MCAS)

November 19, 2024 | Black & Kletz Allergy

Mast cell activation syndrome (MCAS) has been a hot topic in recent years. It seems as though the prevalence is increasing over the last decade.  Mast cell activation syndrome is caused by episodes of the abnormal release of mast cell mediators which can affect any organ system, but tends to involve the skin, nervous system, cardiovascular system, and gastrointestinal tract mostly.  Before delving into the syndrome, it is important to understand the science behind it. Mast cells are types of white blood cells that generally are found in the connective tissues.  There are granules inside the mast cells that contain chemical mediators such as histamine, heparin, tryptase, prostaglandins, leukotrienes, serotonin, and cytokines.  Many of these mediators are inflammatory in nature.  In addition, mast cells have the allergy antibody, known as IgE, attached to their surfaces.  Mast cells play an important role in initiating and promoting immune responses to pathogens (i.e., bacteria, viruses) and toxins (i.e., mold, flying insect stings) by releasing these chemical mediators   Mast cells are also responsible for immediate allergic reactions.  In an allergic reaction, the IgE on the surface of the mast cells bind to the proteins (i.e., allergens) that cause allergies.  The mast cell is now activated, which causes the granules and their contents to be extruded from the mast cells into the tissues in a process called degranulation.  As a result, the chemical mediators, which include histamine and chemicals that cause inflammation, are released into the tissues.  These chemicals cause the typical symptoms that are generally associated with allergies such as anaphylaxis, itchiness (i.e., pruritus), hives (i.e., urticaria), flushing, swelling (i.e., angioedema), nasal congestion, runny nose, wheezing, chest tightness, coughing, shortness of breath, nausea, vomiting, throat tightness, abdominal pain, abdominal bloating, diarrhea, decreased blood pressure, increased heart rate, lightheadedness, and/or headaches. The symptoms an individual with mast cell activation syndrome experiences depends on where the mast cells are degranulating.  In general, children are more likely to have dermatologic symptoms whereas adults tend to have symptoms related to other organ systems as well as the skin.  The symptoms associated with the skin may include generalized itching, flushing, hives and/or swelling.  Gastrointestinal symptoms may include abdominal bloating, abdominal pain, throat tightness, nausea, vomiting, and/or diarrhea.  A patient may exhibit respiratory problems such as coughing, wheezing, shortness of breath, and/or chest tightness.  There may be cardiovascular symptoms such as decreased blood pressure, fainting (syncope), lightheadedness, and/or increased heart rate (i.e., palpitations).  Neurological manifestations may cause “brain fog,” fatigue, headaches, sleep disturbances, and/or inability to concentrate.  If the bone marrow is involved, fractures, bone pain, and anemia may ensue.  The lymphatic system may be involved, thus causing swelling of lymph nodes, spleen, liver, and other organs. There is evidence that mast cell activation can be associated with postural orthostatic tachycardia syndrome (POTS).  Postural orthostatic tachycardia syndrome is a condition where one’s pulse rate increases by a substantial amount, usually greater than 30 beats per minute) upon standing or sitting up. There is also evidence that mast cell activation can be associated with connective tissue diseases such as hypermobile type of Ehlers-Danlos syndrome (hEDS).  A proportion of individuals with the hypermobile type of Ehlers-Danlos syndrome also have mast cell activation syndrome, leading to the possibility of a link between the 2 conditions.  In one study, 66% of patients with both a high heart rate when standing [i.e., postural orthostatic tachycardia syndrome (POTS)] and Ehlers-Danlos syndrome also had symptoms consistent mast cell activation syndrome. Sometimes mast cells become defective and release mediators because of abnormal internal signals.  Certain mutations in mast cells can produce populations of identical mast cells (i.e., clones) that overproduce and release more chemical mediators.  These abnormal clones can grow uncontrollably and are quite sensitive to mast cell activation.  Individuals with this condition are said to have a disorder referred to as mastocytosis.  Mastocytosis can be further divided into 2 subgroups:  cutaneous mastocytosis and systemic mastocytosis. Cutaneous mastocytosis only affects the skin and is more common in children. It is defined by red or brown itchy lesions on the skin. The most common type of cutaneous mastocytosis is called urticaria pigmentosa. Systemic mastocytosis affects other parts of the body besides the skin such as lymph nodes, bone marrow, stomach, intestines, liver, and spleen.  Very rarely however, mast cell leukemia or mast cell sarcoma can occur in patients with systemic mastocytosis. The diagnosis of mast cell activation syndrome is somewhat difficult in many patients.  Increases in the chemical mediator tryptase may be found in the blood, but normal levels of tryptase does not rule out the diagnosis.  Tryptase should be drawn between 30 minutes and 2 hours after the beginning of an episode, with a baseline level obtained many days later.  In addition to serum tryptase, elevated 24 hour urine levels of N-methylhistamine, 11B -prostaglandin F2α (11B-PGF2α), and/or leukotriene E4 (LTE4) are useful tests in the diagnosis of mast cell activation syndrome. The treatment of mast cell activation syndrome should aim to relieve the annoying symptoms that many find maddening.  H1-blocking antihistamines are effective in reducing many of the symptoms in some individuals.  H-2 blockers may work in conjunction with the H1 antihistamines to give better relief.  Leukotriene antagonists [i.e., Singulair (montelukast), Accolate (zafirlukast), Zyflo (zileuton) may also offer additional help in alleviating unwanted symptoms.  These leukotriene antagonists help by blocking the effects of leukotriene C4 (LTC4) or 5-lipoxygenase (5-LPO), depending on the leukotriene antagonist used.  Mast cell stabilizers (i.e., cromolyn sodium) may be useful in that they stabile mast cell membranes, thus reducing degranulation, and causing less of the chemical mediators to be released into the tissues.  Aspirin and NSAID’s (nonsteroidal anti-inflammatory agents) have a role in treatment, particularly of flushing, as they block the production of the chemical mediator prostaglandin D2 (PGD2).  In recalcitr carry a self-injectable epinephrine device (i.e., EpiPen, Auvi-Q, Adrenaclick)) or Neffy, an epinephrine containing nasal spray, as a precaution.  If the epinephrine is used by the patient, the individual should then go to the closest emergency room.   Although not FDA-approved to treat mast cell activation syndrome, Xolair (i.e., omalizumab), a monoclonal antibody that blocks the binding of the IgE molecules to its receptors, has been reported to reduce mast cell reactivity and sensitivity to activation which can reduce anaphylactic episodes. The board certified allergy specialists at Black & Kletz Allergy treat both adult and pediatric patients.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible and the McLean, VA office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line.  You may also click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been a fixture in the greater Washington, DC, Northern Virginia, and Maryland metropolitan community for over 50 years for our outstanding services for the diagnosis and treatment of mast cell activation syndrome, allergic rhinitis (hay fever), asthma, eczema (atopic dermatitis), insect sting allergies, food allergies, medication allergies, hives (urticaria), swelling episodes (angioedema), contact dermatitis, eosinophilic disorders, and immunological conditions.

Food Allergies and Halloween

October 18, 2024 | Black & Kletz Allergy

It is that time of the year again. Soon you will be seeing children (and some adults) trick or treating in your neighborhood searching for candy. For children, Halloween is a time to be with their friends, eat a lot of candy, and dress in scary costumes. For millions of parents however, Halloween can also be scary, but for a different reason: Their children have food allergies. According to Food Allergy Research & Education (FARE), approximately 6 million or 1 in 13 children in the U.S. have food allergies. This is about 8% of the U.S. pediatric population which is equivalent to about 2 children per classroom. In addition, more than 26 million adults also have food allergies. Together, there are about 32 million individuals with food allergies in the U.S. which is approximately 10% of the population. What is even more frightening is that the food allergy prevalence among children has increased dramatically within the last 30 years.

To give proper perspective, more than 40% of children with food allergies have experienced a severe allergic reaction to a food such as anaphylaxis. Pediatric hospitalizations for food allergies went up 3-fold in the last 30 years. Every 3 minutes, a reaction to a food causes someone to go to the emergency room, for a total of approximately 200,000 individuals per year requiring emergency care for allergic reactions to a food. Although there are more than 170 foods that have been identified to cause food allergy reactions in the U.S., approximately 90% of all food allergies are caused by the same 8 common foods which include egg, milk, peanuts, soy, wheat, tree nuts, fish, and shellfish. Sesame seeds are becoming more common as well. The most common food allergies in children are peanut, milk, shellfish, and tree nuts. The most common food allergies in adults are shellfish, milk, peanut, and tree nuts. The symptoms that a child (or adult) experiences from a food allergy may include nausea, vomiting, abdominal cramping/pain, diarrhea, swelling (i.e., angioedema) of the lips, throat, tongue, or eyes, hives (i.e., urticaria), shortness of breath, worsening eczema (i.e., atopic dermatitis), generalized itching (i.e., pruritus), wheezing. Of course anaphylaxis is a major concern and all food-allergic children and adults should carry a self-injectable epinephrine device (e.g., EpiPen Jr., EpiPen, Auvi-Q, Adrenaclick) or Neffy, an epinephrine-containing nasal spray. The patient should be instructed to go to the closest emergency room, if they use epinephrine. To help insure that a food-allergic child can take part in Halloween and still have as much fun as a nonallergic 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 existence since 2014.  The Teal Pumpkin Project began in Tennessee by the mother of a child with severe allergies.  The project’s aim is to increase awareness of the severity of food allergies as well as to give support to food-allergic children’s families.  In order to participate in the Teal Pumpkin Project, a pumpkin is painted the color teal and then placed on one’s front porch to indicate that “non-food” treats are available at that location on Halloween night.  The color teal was chosen because it represents food allergy awareness.  Classically, “non-food” treats may include toys, stickers, crayons, necklaces, bracelets, rings, balls, whistles, hair accessories, money, bookmarks, finger puppets, glow sticks, vampire fangs, etc. It is important to mention that the Teal Pumpkin Project is not exclusionary as it still promotes the option of handing out “normal” trick-or-treat candy to children without food allergies.  It however recommends that the “non-food” items be placed in a different bowl or box than that a 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. Whether or not a family or child participates in the Teal Pumpkin Project, reading labels on foods is of the utmost importance. Most families of food-allergic children know how to read labels on foods and avoid those foods that contain ingredients that their children are sensitized to. However, it is important to note that most “fun-sized” candies handed out while trick-or-treating either do not have any labeling at all or they may contain different ingredients than regular sized packages. Children with food allergies should also be instructed to graciously refuse homemade foods such as cupcakes, brownies, and cookies that may be unsafe for them. Preventing children with food allergies to trick-or-treat without adult supervision as well as avoiding candies without proper labeling can prevent a life-threatening reaction. As mentioned above, it is a highly recommended that food-allergic children (and adults) carry a self-injectable epinephrine device (e.g., EpiPen Jr., EpiPen, Auvi-Q, Adrenaclick) or Neffy, an epinephrine-containing nasal spray while trick-or-treating or while eating Halloween candy. The board certified allergists at Black & Kletz Allergy hope that everyone enjoys Halloween. We are here to meet your allergy and asthma needs for the people of the Washington, DC, Northern Virginia, and Maryland metropolitan area. We treat both adults and pediatric patients. We have offices on K Street, N.W. in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. There is on-site parking at each of the 3 offices. Our Washington, DC and McLean, VA locations are Metro accessible. Black & Kletz Allergy offers a free shuttle service between our McLean, VA office and the Spring Hill metro station on the silver line. If you suffer from allergies, asthma, sinus problems, hives, or immunological disorders, please call us to make an appointment. You may also click Request an Appointment and we will get back to you within 24 hours by the next business day. Again, we wish you a Halloween.

Update on Adult Immunizations

October 15, 2024 | Black & Kletz Allergy

Immunizations are one of the most effective and safe ways of preventing or reducing the risk of serious illness from various infections.  Vaccinations also prevent infections from spreading from one individual to another, thus protecting the health and well-being of the general population.  One should always check with one’s primary care provider before getting a vaccine.  The CDC recommends vaccines for adults based on a variety of factors which may include age, travel destinations, sexual activity, health history, occupation, lifestyle, and previous vaccinations.  The CDC currently recommends the following immunizations:

All adults should routinely receive the following vaccines:

1. Influenza (i.e., flu) vaccine
2. Tdap (i.e., tetanus, diphtheria, and whooping cough) or Td vaccine
3. COVID-19 vaccine

Special Situations:

1. Diabetes mellitus (Type 1 & 2), heart disease, lung disease [i.e., asthma, chronic obstructive pulmonary disease (COPD)]:   pneumococcal vaccine (see details below)
2. Liver disease:  hepatitis A, hepatitis B, and pneumococcal vaccines
3. End-stage kidney disease:  hepatitis B and pneumococcal vaccines
4. Weakened immune system excluding HIV infection (i.e., cancer, patients on immunosuppressive medications):  Hib [i.e., Haemophilus influenzae type b for individuals with a complement deficiency and for those who have received a hematopoietic stem cell transplant (HSCT, or a bone marrow transplant)], pneumococcal, meningococcal (both MenACWY and MenB for individuals with a complement deficiency), and shingles vaccines
5. HIV infection:  Vaccine recommendations may differ based on CD4 count. hepatitis A, hepatitis B, meningococcal conjugate vaccine (MenACWY), pneumococcal, and shingles.  [If the CD4 count is 200 or greater:   In addition to the vaccines listed above, one may also need the chickenpox vaccine (recommended for all adults born in 1980 or later) and the MMR vaccine (recommended for all adults born in 1957 or later)].
6. Asplenia (i.e., individuals without a spleen):  Hib (i.e., Haemophilus influenzae type b), meningococcal (both MenACWY and MenB), and pneumococcal vaccines
7. Pregnancy:  Tdap (between 27 and 36 weeks of pregnancy), hepatitis B, influenza, and Covid-19 vaccines.  Pregnant women should only receive a vaccination if first approved by their Ob/Gyn physician.

Additional Vaccines:

1. Chickenpox vaccine:  All adults born in 1980 or later
2. Hepatitis B vaccine:  All adults up to 59 years of age and ages 60 and over with some known risk factors
3. HPV (i.e., human papilloma virus) vaccine:  All adults until 26 years of age.  It is also recommended for selected adults with risk factors from the age of 27 to 45
4. MMR vaccine:  All adults born in 1957 or later
5. Shingles vaccine:  All adults 50 years of age and older
6. RSV (i.e., respiratory syncytial virus):  All adults ages 75 and older and ages 60 to 74 with lung and/or heart disease

Pneumococcal Diseases:

• Caused by a bacteria known as Streptococcus pneumoniae
• Mild infections:  Ear and sinus infections
• Serious infections:  Pneumonia (lung), bacteremia (bloodstream), meningitis (brain and/or spinal cord)

There are 2 types of pneumococcal vaccines:

1. Conjugate vaccine (PCV15, PCV20, or PCV21):  For adults 65 years of age or older and younger than 65 years of age with an increased risk
2. Polysaccharide vaccine (PPSV23):  For those who received PCV 15 before

How do you know if your immunizations are up to date? In order to get the information about the immunizations you have already had, talk to your parents, if possible.  Ask them if they have records of your immunizations that you received when you were a child.  You can also check with your primary care provider and/or pediatrician’s office to see if they have your immunization records on file. In some circumstances, you may need to check with healthcare organizations where you received care when you were younger.  It may be helpful to check with your schools, employers, or military facility who required immunizations.  You can also contact your state health department to see if it has a registry on file that includes adult immunizations. If you cannot find your records, your primary care provider or immunization clinic may be able to do bloodwork on you in order to see if you are immune to certain diseases that vaccines can prevent.  You may in fact need to get some vaccines again, depending on the results of the bloodwork. 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 field of immunizations/vaccinations.  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 5 decades and we pride ourselves in providing excellent allergy, asthma, and immunology care in a highly professional and pleasant setting.

Milk Allergy

September 24, 2024 | Black & Kletz Allergy

Milk is one of the most common foods to cause allergic reactions.  Almost 3% of children younger than 3 years of age are allergic to milk.  Notwithstanding, a vast majority of children spontaneously outgrow their milk sensitivities.

CAUSES: In children with milk allergy, the immune system falsely identifies the protein in the milk as potentially dangerous, and as a result, mounts a defensive attack.  The “pre-formed” milk specific antibodies (i.e., immunoglobulin E or IgE) react with the protein in the milk (i.e., antigen), causing release of chemical substances (e.g., histamine, leukotrienes, prostaglandins) into the tissues.  These chemical substances are what causes the symptoms of allergic reactions. Cow's milk is the most common cause of milk allergy although milk from sheep and goats can also cause allergic reactions in certain sensitized children.  Children are more likely to have a milk allergy if there is a history of a food allergy in other family members. SIGNS and SYMPTOMS: Children usually begin manifesting symptoms of milk allergy within a few minutes after consuming milk products.  In some children, however, symptoms can sometimes be delayed for a few hours.

• Skin itching, hives, and/or swelling of soft tissues
• Redness, itching, and/or tearing of the eyes
• Fullness/tightness in the throat, difficulty in breathing and/or swallowing
• Nasal congestion, itching, sneezing, and/or clear runny nose
• Abdominal pain, cramping, vomiting, and/or diarrhea
• Irritability, restlessness, and/or dizziness
• Drop in blood pressure, and/or loss of consciousness

The severity of symptoms can vary from mild to severe life-threatening anaphylactic reactions, depending on the severity of the allergy. DIAGNOSIS:

• Comprehensive history taking of the milk reaction with focus on the time of exposure to milk, onset time of symptoms, and progression of symptoms.
• Family history of food allergies
• Skin prick testing with a commercially available milk protein antigen with negative and positive controls.  If the wheal diameter of the milk protein is more than 3 mm. than that of the negative control, the test is considered positive, signifying the presence of IgE antibodies to milk.
• A blood test can also be utilized to detect and measure the quantities of milk specific IgE antibodies and should be obtained for more severe milk reactions.
• Oral challenge with incremental exposure to milk beginning with a tiny amount and slowly increasing the amount at regular intervals while closely monitoring for signs and symptoms of a reaction.  These oral challenges should be undertaken only when trained professionals are readily available to identify and treat possible untoward reactions as soon as they occur.

TREATMENT:

• Total avoidance of milk and dairy products
• Read labels and identify the ingredients of packaged foods
• In cases of accidental exposures, antihistamines can be given orally or by injection if the symptoms are limited to hives and/or itching of the skin.
• If the symptoms are rapidly progressing and/or in case respiratory, gastro intestinal, and/or cardiac symptoms, epinephrine should be injected into the muscle on an urgent basis.  Patients should be prescribed a self-injectable epinephrine device (i.e., EpiPen, Auvi-Q, Adrenaclick) and told to go immediately to the closest emergency room if that device is used.
• Oral immunotherapy is a process of desensitization to milk, which reduces the risk of severe reactions after inadvertent exposure to milk products. This process entails ingestion of small quantities of milk protein in a controlled setting to monitor for reactions.  The amount of milk protein will be gradually increased under close medical supervision.
• Xolair (i.e., omalizumab) injections can be given either every 2 or 4 weeks in order to prevent a severe milk allergy, as well as any other food allergy.

  Note:  “Lactose intolerance” is sometimes confused with milk allergy.  Intolerance in this case signifies a difficulty in processing and digesting the sugar in the milk (i.e., lactose) as the enzyme that is needed to break it down (i.e., lactase) is lacking in sufficient quantities.  This process does not involve the immune system and the symptoms are usually limited to the gastrointestinal tract. The typical symptoms may include abdominal bloating, abdominal pain, diarrhea, nausea, and/or vomiting.  These children will be able to tolerate lactose-free milk and dairy products. PREVENTION:

• Milk allergy itself may not be preventable, due to a genetic predisposition and susceptibility.
• Diligent avoidance of milk and dairy products such as cream, cheese, butter, ice cream, and yogurt may prevent severe reactions.
• Having a self-injectable epinephrine (e.g., EpiPen, Auvi-Q, Adrenaclick) device readily available at all times can reduce the risks of life-threatening anaphylactic reactions.

Close monitoring by a board certified allergist, like the ones at Black & Kletz Allergy, as well as testing for milk allergy at regular intervals, may identify the children who outgrow their milk allergy.  At this point, milk and dairy products may possibly be gradually reintroduced into their diets. The board certified allergy doctors at Black & Kletz Allergy have been diagnosing milk and other food allergies in both adults and children for over 50 years.  We have 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The allergists are able to test for milk allergy and most foods which can be done by either blood tests or allergy skin tests.  We offer onsite parking at each one of our locations 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.  If you feel you may have a milk allergy, other food allergy and/or a food intolerance, please call us today to schedule an appointment. Alternatively, you may click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy are eager to help you find out if you are allergic to milk or other foods.  This will allow you live in less fear as you will be able to avoid the offending food as well as have a detailed plan on what to do if you would accidentally ingest the given food.

Update on Generalized Itching (Pruritus)

September 12, 2024 | Black & Kletz Allergy

Generalized itching (i.e., generalized pruritus) is a condition which can be quite annoying.  It is when an individual has diffuse itching of the body usually without an associated rash.  Approximately 20-25% of the general population experiences generalized pruritus at least one time in their life.  The itching may be intermittent or it may be chronic in nature.  “Acute” itching is when the itching has been present for less than 6 weeks.  “Chronic” itching is defined by having it for 6 or more weeks.  The itching may last for years in certain individuals.  The severity of the itching may vary from very mild to very severe where it can interfere with one’s quality of life.  If the itching becomes chronic, it is important to see a board certified allergist, like the ones at Black & Kletz Allergy, so that a cause of the itching can hopefully be identified.  Note that generalized itching may also be associated with hives (i.e., urticaria) and/or swelling (i.e., angioedema).

There are many causes of generalized itching.  Allergies are a very common cause of itching.  Allergies to oral and topical medications, foods, cosmetics, fragrances, metals, shampoos, nail polish, latex, poison ivy, poison oak, and poison sumac are just some of the common allergies that may cause itching.  Contact dermatitis and eczema, (i.e., atopic dermatitis) are 2 other allergic conditions that may cause itching.   Although allergies may be the cause of a lot of individual’s itching, it by no means the only reason for the pruritus.  There are a variety of underlying conditions that may cause a person to have itching even though it may not be the most common symptom of the disease.  Some of the underlying conditions that can cause itching may include diabetes mellitus, hepatitis B, hepatitis C, kidney disease, thyroid disease, malignancy, iron deficiency anemia, dyshidrotic eczema, HIV, folliculitis, ringworm, seborrheic dermatitis, neurodermatitis, shingles, xerosis (i.e., dry skin), psoriasis, bed bugs, parasitic infections, pregnancy, as well as many others.  It is important that a cause be identified so that either the allergen is avoided or the management can be focused on the underlying condition responsible for the itching. The diagnosis of generalized itching begins with a comprehensive history and physical examination.  By performing a comprehensive history, the allergist is trying to ascertain the cause of the itching.  It is common for a patient to forget or not bring up pertinent information that can help the allergist figure out the cause, so it is important for the allergist to ask a variety of questions in order to try to establish a cause or trigger of the pruritus.  Asking questions such as, “Have been on any recent antibiotics or new medications?” or “Do you take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)?” are good questions because many patients will not volunteer this information because they do not feel that it is important enough to mention to the physician.  In reality, antibiotics, new medications, aspirin, and NSAIDs use are very common reasons for generalized itching.  If no obvious allergen can be identified and the itching has lasted 6 weeks or more, looking for an underlying condition is the next step.  This is usually done by blood tests. The treatment of generalized itching is directed at avoiding the offending agent.  If for example a new medication appears to be causing the itching, the medication should be stopped or changed to another appropriate medication.  If it is a certain cosmetic or a specific food, then obviously the cosmetic or food should be avoided.  In addition, using oral H1 blockers (i.e., antihistamines) is the most common treatment.  Sometimes, adding an H2 blocker and/or a leukotriene antagonist to the Hi blocker is needed.  Rarely, oral corticosteroids are needed for severe cases.  Topical creams/ointments have been used with limited success.  In most cases, medications may only be needed for 1 or 2 weeks, but can be necessary is some individuals for several years.  If the itching persists for more than 6 weeks and bloodwork is obtained in order to rule out underlying conditions, then treating the underlying condition may in fact get rid of the itching. The board certified allergy doctors at Black & Kletz Allergy have been diagnosing and treating generalized itching for more than 50 years.  We treat both pediatric and adult patients.  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.  To schedule 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 generalized itching, hives, swelling episodes, or any other allergic condition, the allergy specialists at Black & Kletz Allergy are happy to help you.  We are dedicated to providing you with the highest quality allergy care in a relaxed, considerate, and professional environment.

New Treatment for Anaphylaxis

August 21, 2024 | Black & Kletz Allergy

Anaphylaxis is an acute, severe, and life-threatening allergic reaction.  The most common triggers for anaphylaxis include allergenic foods, medications, and insect stings.  Symptoms usually begin within a few minutes of exposure of the triggering agents.  Initially, the symptoms characteristically involve the skin which typically causes itching and hives followed by swelling of the soft tissues.  Unless treated, the reaction may rapidly progress and may involve other organ systems (e.g., respiratory, gastrointestinal, cardiovascular) resulting in symptoms such as shortness of breath, wheezing, coughing, nausea, vomiting, abdominal pain, dizziness, drop in blood pressure, and/or loss of consciousness. The only effective treatment for anaphylaxis is epinephrine.  If given early in the process, it can stop the reaction from progressing and can be life-saving.  As anaphylactic reactions can occur after accidental exposures anywhere and at any time, it is recommended to have epinephrine readily available at all times for those at risk for anaphylaxis. Until now, the only form of epinephrine available was an injectable form.  The epinephrine is injected into a muscle either with a syringe and a needle or with an autoinjector device.  There are a few autoinjectors available in different shapes and sizes and dome of the brand names include EpiPen, Auvi-Q, and Adrenaclick.  Autoinjectors are preloaded with different doses of epinephrine suitable for adults and children.  One problem with autoinjectors is that some patients and parents of children at risk for anaphylaxis are not comfortable in using them because they are squeamish about needles.  As a result, a hesitancy in the use of epinephrine can lead to a delay in administering the needed treatment in a life-threatening situation which can be detrimental. On August 9, 2024, the Food and Drug Administration FDA) approved a new form of epinephrine that is delivered into the nostrils by way of a nasal spray device.  It is called Neffy and it uses the same delivery device used to administer other medications into the nasal cavity such as Narcan, a drug useful in reversing the effects of opiates. Neffy delivers 2 mg. of epinephrine into the nasal cavity. (Epipen is available in 0.3mg. and 0.15mg. dosage strengths).  In clinical trials, Neffy resulted in comparable blood levels of epinephrine to injectable forms, with a shorter onset of action.  It also showed that it can increase the blood pressure and heart rate rapidly, which are indicators for the reversal of the reaction. This nasal epinephrine formulation is approved for adults and children weighing 30 kg. (66 lbs.) and above.  Neffy is a single dose nasal spray administered into one nostril.  It is available as a 2-pack, which is similar to injectable forms.  It is recommended to administer the second dose on Neffy from a different device into the same nostril if the anaphylactic symptoms persist 5 minutes after the initial dose. It is hoped that the nasal spray would remove some barriers for early usage of epinephrine (i.e.  the fear of injections) and thus would meet an unmet need.  The manufacturer says that most commercially insured patients will pay approximately $25 as copay for a 2-pack, while also offering assistance for patients who are not insured.  The medication has a shelf-life of about 30 months and is stable at wide temperature ranges. Neffy was also studied in patients with nasal congestion due to allergies and infections and it was shown to be well absorbed from the nasal cavity without losing its efficacy.  Note however that Neffy was not studied in patients with nasal polyps and in patients after nasal surgeries, so its efficacy in these patients is currently unknown. The side effects observed in clinical trial participants included throat irritation, tingling sensation in the nose, runny nose, nasal congestion, headaches, jitteriness, and dizziness. Neffy should also be used with caution in patients with a history of allergic sensitivity to sulfites. Neffy is expected to be available in the pharmacies in October 2024. The board certified allergists at Black & Kletz Allergy see both adult and pediatric 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 look forward to providing you with the newest cutting edge allergy care in a welcoming and relaxed environment.  

Ragweed Allergy Update

August 2, 2024 | Black & Kletz Allergy

As the Summer marches on and we are now in the month of August, many allergy sufferers are about to get ready for another foe, namely ragweed. Usually about August 15th of every year, ragweed pollen begins to blanket the Washington, DC, Northern Virginia, and Maryland metropolitan area like clockwork. The dissemination of ragweed pollen generally comes to an end in our region in late October during the first frost. With the rising temperatures and rising carbon dioxide (CO₂) levels, the ragweed season is now longer than it has been historically and it now may begin as early as early August. Ragweed is a flowering plant and considered a weed. Ragweed is widespread in the U.S., particularly in the Midwestern and Eastern and regions of the U.S. Though many weeds (e.g., cocklebur, mugwort/sagebrush, pigweed, Russian thistle) pollinate in the Fall, ragweed is the most common and predominant allergen in our geographical area. The only state without ragweed is Alaska.  It is typically found in fields, on the side of roads, in vacant lots, and near riverbanks. There are at least 17 species of ragweed in North America. Even though each ragweed plant lives only 1 season, it can produce approximately 1 billion pollen grains, plenty enough to cause havoc amongst allergy sufferers. Increased humidity in conjunction with warm weather and wind enhances the release of ragweed pollen. The ragweed pollen, like other pollens, is transported by the wind and can travel hundreds of miles due to its light weight. The wind causes the ragweed to become airborne for days which provides an easy way for individuals to become sensitized to the ragweed pollen. The ragweed pollen count is typically lowest in the early morning and it tends to reach its highest in the midday. When a previously sensitized individual has been is exposed to ragweed again in the air, the ragweed proteins trigger specialized cells in the immune system to release increased levels of histamine and other chemical mediators which are responsible for numerous allergic symptoms which is known by the names allergic rhinitis (i.e., hay fever) and/or allergic conjunctivitis (i.e., eye allergies). Some of these symptoms may include runny nose, sneezing, nasal congestion, post-nasal drip, itchy nose, sinus congestion, headaches, itchy throat, fatigue, snoring, itchy eyes, watery eyes, puffy eyes, and/or redness of the eyes. In asthmatics, coughing, chest tightness, wheezing, and/or shortness of breath may also occur. In some ragweed-sensitive individuals, consuming certain fresh fruits or vegetables [e.g., bananas, melons (watermelon, cantaloupe, honeydew), cucumber, zucchini, artichokes, sunflower seeds, white potato, chamomile tea, dandelion] may cause itching and tingling of mouth, tongue, and throat. This condition is called “oral allergy syndrome” or “pollen-food allergy syndrome” and is a result of the cross-reacting proteins in the pollen and fresh fruits or vegetables. The syndrome is caused by allergens in foods that are derived from plants. Thus, only foods that come from plants can cause the syndrome.  Ironically, when the fruit or vegetable is canned or cooked, the protein is denatured and destroyed which usually prevents the allergic reaction from happening. Most of the time, individuals can tolerate canned and/or cooked fruits or vegetables. Avoidance is the key to combatting ragweed, if at all possible. Some avoidance measures may include the following:

• Keeping the windows and doors at home as well as the windows in automobiles closed and use air-conditioning.
• Decreasing outdoor activities, especially in the early morning hours when the pollen counts tend to be at their highest.
• Showering to remove ragweed pollen from the skin and hair after coming indoors.
• Washing clothes upon returning from outdoors.
• Nasal irrigation can wash the ragweed pollen from the nasal passages.
• Washing the fur and coats of one’s pets after being outside.

If it is impossible to avoid ragweed using the avoidance measures listed above or one still develops those annoying allergy symptoms, there are some medications available in order to prevent or minimize the symptoms of ragweed allergy. They include oral antihistamines, oral decongestants, leukotriene antagonists, nasal antihistamines, nasal decongestants, nasal anticholinergics, nasal corticosteroids, ocular antihistamines, ocular decongestants, ocular anti-inflammatory agents, and/or ocular mast cell stabilizers. For those patients who have asthma, the treatment may include short-acting beta 2 agonists, long-acting beta 2 agonists, inhaled corticosteroids, leukotriene antagonists, monoclonal antibody injections, and/or oral corticosteroids in more severe cases. In addition to the medications listed above, allergy shots (i.e., allergy immunotherapy, allergy injections, allergy desensitization, allergy hyposensitization) are a very effective tool in the treatment of allergic rhinitis, allergic conjunctivitis, and asthma. They have been given to patients in the U.S. for more than 100 years. Allergy shots work in 80-85% of patients who undergo them. They are typically given for 3-5 years. Allergy immunotherapy will offer the most effective long-term relief of symptoms and can reduce or eliminate the need for medications. The board certified allergists at Black & Kletz Allergy have 3 office locations in the Washington, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. The allergy specialists at Black & Kletz Allergy diagnose and treat both pediatric and adult patients. For an appointment, please call one of our offices or alternatively, click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy have been helping patients with hay fever, asthma, sinus disease, hives, eczema, insect sting allergies, food allergies, medication allergies, and immunological disorders for more than 5 decades. If you suffer from allergies, it is our mission to improve your quality of life by reducing or preventing your unwelcome and irritating allergy symptoms.