Update on Angioedema (Swelling Episodes)

February 13, 2025 | Black & Kletz Allergy

Some individuals have episodes of swelling or “angioedema” of various tissues that may occur without any known rhyme or reason.  They may have 1 episode or they may have multiple or recurrent episodes.  Most people with this condition are very surprised and nervous when they notice an area of their body swelling up right in front of their eyes.  The swelling can occur on any part of the body or even internally.  They may occur by themselves or they may be accompanied with hives (i.e., urticaria) and/or generalized itching (i.e., pruritus).  The severity of the swelling can range from very mild to extremely severe.  The swelling occurs because there is seepage of fluid through small blood vessel walls which in turn results in soft tissue swelling. The allergic causes of angioedema are varied and may include the following:

• Allergies to Food – Peanuts (legumes), tree nuts, fish, shellfish, eggs, milk, etc.
• Insect Sting Allergies – Honey bees, wasps, yellow jackets, hornets, fire ants, etc.
• Medication Allergies – Penicillin, sulfa, erythromycin, tetracycline, aspirin, nonsteroidal anti-inflammatory drugs (NDAIDS), vaccines, etc.
• Natural Rubber Latex – Gloves, balloons, condoms, catheters, dental dams, etc.

The nonallergic causes of angioedema are also varied and may include the following:

• Autoimmune Disorders – Rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, polymyositis, scleroderma, Grave’s disease, Hashimoto’s thyroiditis, etc.
• Certain cancers
• Infections – Hepatitis B, syphilis, etc.

Nonallergic reactions to some medications may cause angioedema and some of these medications may include:

• Angiotensin II Receptor Antagonists - Diovan (valsartan), Cozaar (losartan), Atacand (candesartan), Micardis (telmisartan), Benicar (olmesartan), Avapro (irbesartan), etc.
• Proton Pump Inhibitors - Prevacid (lansoprazole), Nexium (esomeprazole), Dexilant (dexlansoprazole), Prilosec (omeprazole), Aciphex (rabeprazole), Protonix (pantoprazole), etc.
• Angiotensin Converting Enzyme (ACE) Inhibitors - Altace (ramipril), Vasotec (enalapril), Zestril (Lisinopril), Capoten (Captopril), Lotensin (benazepril), Accupril (quinapril), etc.
• Selective Serotonin Reuptake Inhibitors (SSRI’s) - Lexapro (escitalopram), Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), etc.
• Statins - Zocor (simvastatin), Lipitor (atorvastatin), Pravachol (pravastatin), Crestor (rosuvastatin), Lescol (fluvastatin), Mevacor (lovastatin), etc.

There is a genetic cause of angioedema which is in a category all by itself: Hereditary angioedema is a condition that is genetic that will cause swelling episodes.  In this disorder, there is an inherited abnormal gene that causes a deficiency of a normal blood protein called “C1 esterase inhibitor.”  If an individual has this deficiency, they may have repetitive swellings which may last for 1 to 2 days in duration.  Hereditary angioedema usually begins to cause swelling episodes in patients after puberty.  These swelling episodes are not accompanied by hives (i.e., urticaria) whereas with allergic causes of angioedema, hives are quite commonly associated with the swelling episodes.   The episodes of swelling in individuals with hereditary angioedema can be spontaneous or they may be triggered by alcohol, physical or emotional stress, and/or hormonal factors. If no cause of the angioedema can be identified, the individual is said to have idiopathic angioedema.  Idiopathic means that an unknown reason is causing the swelling episodes, however many causes have been ruled out as a cause. The diagnosis of angioedema begins with a comprehensive history and physical examination.  Allergy testing and bloodwork may be necessary depending on the history and physical examination findings.  Allergy skin tests are often performed to rule out food, medication, insect sting, or latex, or allergies.  Blood testing is usually done if the swelling episodes become more chronic in nature, (more than 6 weeks), in order to rule out underlying conditions that may be causing the angioedema. The treatment of angioedema depends on the severity and length of time of the swelling episodes. In mild to moderate acute angioedema, taking an oral antihistamine and/or corticosteroid may be beneficial in curtailing and eliminating the swelling.  Alternatively, intramuscular administration of an injection of epinephrine can be performed along with an intramuscular injection of an antihistamine and/or a corticosteroid. Severe acute angioedema is treated similarly, however, keeping the airway open is the main objective.  In order to maintain an open airway, intramuscular epinephrine is often used, particularly if the angioedema occurs in the throat or respiratory tract.  In such patients, a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, adrenaclick) should be prescribed and used if the throat or respiratory tract is involved.  The patient should also go immediately to the closest emergency room if the self-injectable epinephrine device is used.  The treatment of chronic recurrent angioedema often involves the use of oral antihistamines, leukotriene antagonists, H2-blockers, and/or corticosteroids. Hereditary angioedema management typically involves the use of intravenous C1 inhibitor concentrate, the deficient enzyme causing the condition.  The C1 inhibitor concentrate can also be infused prophylactically about 1 hour before a surgical procedure in order to prevent swellings due to physical trauma.  It should be noted that hereditary angioedema generally does not respond well to antihistamines.  There are also various complement system blockers that can be used via injection to treat acute symptoms.  Newer medications such as Kalbitor (ecallantide) and Firazyr (icatibant) may also be used to treat this genetic condition. The board certified allergy doctors at Black and Kletz Allergy have over 5 decades of experience in diagnosing and treating angioedema.  We treat both adult and pediatric patients.  Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day.  We have been servicing the greater Washington, DC metropolitan area for many decades and we look forward to providing you with the utmost state-of-the-art allergy care in a friendly and professional environment.

The Quademic

February 11, 2025 | Black & Kletz Allergy

Four viral infections are surging in the country this year.  Three of them are respiratory viruses and one is a gastrointestinal infection. Influenza (“flu”) usually tends to peak in the Winter.  The Centers for Disease Control’s (CDC) statistics reveal that more than 30% of the lab tests were positive for the flu in January of this year and the numbers are climbing.  16 deaths related to influenza were reported, bringing the total to 47 deaths so far this season. Respiratory syncytial virus (RSV) numbers peaked in January of this year and are slowly dropping in case numbers. COVID-19 cases have not peaked yet as they did in the previous years but there could be an upsurge in the coming weeks. Norovirus, which causes gastrointestinal infections, circulates all year round, with an uptick in the number of cases during the Winters. The symptoms of all the 3 respiratory viral infections mentioned above are usually similar.  In order to diagnose an infection with each of the viruses, laboratory tests are needed to confirm the diagnosis.  The viruses usually begin as upper respiratory infections with symptoms such as nasal congestion, runny nose, itchy eyes, sore throat, and/or cough.  As the infection progresses, people may also experience fever, achiness, fatigue, headache, and/or shortness of breath.  Norovirus infections, in addition to the upper respiratory symptoms listed above, may cause nausea, vomiting, and/or diarrhea. Though one can have more than one infection at the same time, it is very unlikely to have all 4 viruses.  Most cases tend to be mild and only require symptomatic treatment.  Anti-viral medications, to be optimally effective, need to be started in the first few days after the onset of symptoms. RSV infections usually peak in the months of December and January every year.  Almost all children are affected with respiratory syncytial virus in the first 5 years of life. Although most cases are mild and only cause cold-like symptoms for a few days, it should be noted that RSV infections can be severe and dangerous in infancy, the elderly, as well as in immunocompromised individuals. The stomach and intestines are typically inflamed by norovirus infections.  When this occurs, people tend to say they have the “stomach flu.”  It is highly contagious and can survive on surfaces for a long period of time, as in days or weeks.  Outbreaks of norovirus are quite common in cruise ships and other crowded places such as college dormitories and nursing homes.  Drinking contaminated water, eating contaminated food, being in close contact with a person who has a norovirus infection, and touching one’s hand to one’s mouth after the hand has been in contact with a contaminated object or surface are common ways in which an individual may get a norovirus infection.  As a result of being infected with norovirus, it is not unusual for individuals to become dehydrated which can occur rapidly.  In such individuals, rapid oral or intravenous (IV) rehydration is often necessary. Vaccinations are available for influenza, RSV and COVID-19.  It should be stated that vaccines are not perfect.  Immunized individuals can and do get infected with the virus that they have been immunized against.  The benefit of the vaccination is that the symptoms associated with the virus tend to be less severe and less likely to lead to serious complications.  In addition to protecting the individual, vaccines also reduce the chances of the infections spreading to others, thus benefiting the community at large.  It occurs when a sufficient percentage of the population has become immune to an infection, whether by vaccination or previous infection.  This is known as herd immunity. The board certified allergy doctors at Black & Kletz Allergy have expertise in diagnosing and treating many types of viral and bacterial infections, as well as all types of allergic conditions, asthma, and immune problems.  We are board certified to treat both pediatric and adult patients and our allergists have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  If you suffer from recurrent viral or bacterial infections, environmental allergies, sinus-related symptoms, asthma, eczema (i.e., atopic dermatitis), hives (i.e., urticaria), generalized itching (i.e., pruritus), swelling episodes (i.e., angioedema), insect sting allergies, food allergies, medication allergies, and/or immune disorders, we are here to help you sort out your allergies and find a way to combat and control your symptoms so that you can enjoy a better quality of life.  Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a comfortable, considerate, and professional environment.

Update on Hives

January 16, 2025 | Black & Kletz Allergy

Hives, also known as urticaria, is a very bothersome problem for those affected. They are usually quite itchy although they do not have to be. A hive is typically a raised welt, wheal, or bump on the skin that may have an accompanying red blotch surrounding the bump. Hives however can be flush with the skin in some cases. The shape and size of a hive is very variable, ranging from pinprick-looking dots to large irregularly-shaped blob-like skin lesions. Not only can hives occur anywhere on the skin, but in some cases, they may be in the soft tissues (e.g., throat, tongue, lips, eyelids) or internally such as the gastrointestinal system (e.g., stomach, intestines). If the hives occur in the throat, the individual may experience a throat-tightening sensation. If the hives affect the tongue, lips, or eyelids, the person may develop localized swelling in these tissues. On the other hand, if they occur in the stomach, the patient may experience abdominal cramping, abdominal pain, nausea, and/or vomiting Usually, multiple hives occur at one time, but it is also possible to just have 1 isolated hive appear from time to time. A hive generally resolves within 24 hours, but may last longer. Hives tend to come and go and generally do not stay in one place for days, week, or months as is common with some other skin disorders such as eczema (i.e., atopic dermatitis). The causes of hives are numerous. Some of the more common causes may include allergies to a medication (e.g., aspirin, nonsteroidal anti-inflammatory drugs, antibiotics), food, (e.g., peanuts, tree nuts, egg, wheat, fish, shellfish, soy, milk), or flying insect sting (e.g., bee, wasp, yellow jacket, or hornet sting). Some other causes of hives may include personal care products, environmental agents, infections (e.g., viral, bacterial, fungal, parasitic), inflammatory conditions (e.g., vasculitis), autoimmune disorders (e.g., systemic lupus erythematosus, Sjögren’s syndrome, giant cell arteritis, polyarteritis nodosa, scleroderma, polymyositis, dermatomyositis), physical stimuli (e.g., cold, heat, exercise, vibration, pressure, solar exposure, water exposure), and/or rarely cancer. Hives can be categorized into 2 basic types - acute and chronic. “Acute” urticaria is defined as one having hives for less than 6 weeks. “Chronic” urticaria, on the other hand, is defined as one having hives for 6 or more weeks. Approximately 20-25% of the U.S. population will have hives at some point in their life. Acute urticaria is much more common than chronic urticaria, although chronic urticaria is not that uncommon. It should be noted that it is not uncommon for someone who has either the acute form or the chronic form of hives to also have associated swellings (i.e., angioedema). These swellings may occur in conjunction with one’s hives or they may occur separately from one’s hives. The diagnosis of hives is generally made after an allergist performs a comprehensive history and physical examination. In many cases, bloodwork, urinalysis, allergy skin tests, chest X-ray, and/or skin biopsy may be needed, particularly when a diagnosis of chronic urticaria is made. In these cases, it is important to rule out an underlying condition that may be the cause of the hives. If such a condition is identified, treatment of the underlying disorder may be all that is necessary in order to free the person of their hives. The treatment of hives primarily relies on the use of antihistamines. Since histamine is the primary chemical that is responsible for the development of hives, most cases of hives are responsive to antihistamines which 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 [e.g., Claritin (loratadine), Clarinex (desloratadine), Allegra (fexofenadine), Zyrtec (cetirizine), Xyzal (levocetirizine) leukotriene antagonists [e.g., Singulair (monteleukast)], histamine-2 blockers [Pepcid (famotidine)], corticosteroids, immune modulators, and “biologicals” [e.g., Xolair (omalizumab) injections] or various combinations of the above-mentioned medications. The board certified allergy specialists at Black & Kletz Allergy have more than 50 years of experience in diagnosing and treating hives, as well as swelling episodes. They also diagnose and treat allergies, asthma, generalized itching, eczema, insect sting allergies, medication allergies, food allergies, eosinophilic disorders, mast cell activation syndrome, and immune disorders. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and offer on-site parking at all locations. The Washington, DC and McLean, VA offices are Metro accessible and we provide a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. To schedule an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy is proud to provide high quality allergy care to the Washington, DC, Northern Virginia, and Maryland metropolitan area residents in a welcoming and professional setting.

Hypereosinophilic Syndrome

January 9, 2025 | Black & Kletz Allergy

An eosinophil is a type of white blood cell that has a role in fighting against parasitic infections and responding to allergens.  Eosinophils normally constitute about 5 to 8% of the white blood cells in one’s bloodstream.  Their absolute numbers range from 100 to 500 eosinophils per microliter of blood. In individuals who are atopic, (i.e., people with a higher incidence of allergic disorders), there will be a higher number of eosinophils in the blood.  When there are higher number of eosinophils in the blood than normal, the condition is called eosinophilia.  In a disorder named hypereosinophilic syndrome (HES), there are much higher numbers of eosinophils in the blood.  Individuals with hypereosinophilic syndrome usually have more than 1,500 eosinophils per microliter in their blood for 6 months or more, and the cause cannot be identified. In addition to being located in the bloodstream, the eosinophils in hypereosinophilic syndrome may also accumulate in various tissues.  This excessive eosinophil deposition into the tissues may lead to tissue damage and loss of function. Many organs including the heart, lungs, brain/nervous system, kidneys, stomach/intestines, bone-marrow, and skin may be affected in hypereosinophilic syndrome.  Untreated, this condition can be life-threatening, however, early diagnosis and specific treatments can protect the organs from getting damaged. Fortunately, hypereosinophilic syndrome is a rare condition.  It has a predilection for the male gender, with a male to female ratio of approximately 8 to 1.  It occurs most commonly in individuals between 20 and 50 years of age, although it can affect anyone of any age. Causes of Hypereosinophilic Syndrome: The exact cause of hypereosinophilic syndrome is not well understood, however, some patterns are known to occur as below:

• Some types of hypereosinophilic syndrome tend to run in families.  There are some abnormalities in the genes coding for eosinophils in certain individuals.
• Higher than normal levels of a protein called Interleukin-5 (IL-5), a growth factor for eosinophil growth and differentiation, may be found.
• Some types are associated with certain kinds of cancers such as myeloproliferative disorders.  These disorders are characterized by excessive blood cell production in the bone marrow.
• May be associated with certain infections (i.e., parasitic)

Symptoms of Hypereosinophilic Syndrome: The symptoms of hypereosinophilic syndrome are dependent on the organs primarily affected.  Some of the symptoms associated with the syndrome may include:

• Skin rash, pruritus (i.e., itching)
• Cough, shortness of breath
• Dizziness
• Fatigue
• Fevers
• Abdominal pain, diarrhea
• Joint stiffness, joint pain
• Mouth sores
• Memory loss
• Tingling and numbness of the extremities
• Blurred vision, slurred speech

Diagnosis of Hypereosinophilic Syndrome: It is important to rule out other conditions with similar symptoms since the symptoms of hypereosinophilic syndrome are quite common.  Some of these conditions may include allergic diseases, parasitic infections autoimmune disorders, and drug reactions.  Below are some standard recommended diagnostic tests that may help diagnose the syndrome:

• Blood counts:  Absolute eosinophil count greater than 1,500 per microliter on at least 2 occasions
• Anemia:  Found in more than 50% of patients
• Serum tryptase levels:   Elevated in some genetic variations
• Bone marrow biopsy:   May be needed in specific situations
• Electrocardiography (EKG)
• Echocardiography
• Troponin levels
• Pulmonary function tests (PFT)
• Tissue biopsy:  May be required to demonstrate eosinophilic infiltration

Treatment of Hypereosinophilic Syndrome:

• In all patients without a genetic mutation, glucocorticoids are the first-line therapy.
• Interferon-alpha and hydroxyurea are the recommended second-line drugs.
• For third-line therapy, high-dose (400 mg/d) imatinib (i.e., Gleevec) is the treatment of choice.
• For patients with a genetic mutation, imatinib (i.e., Gleevec) is the drug of choice.
• In 2020, the U.S. Food and Drug Administration (FDA) approved mepolizumab (i.e., Nucala) for adults and pediatric patients aged 12 years and older with hypereosinophilic syndrome.  Mepolizumab is a humanized monoclonal antibody specific for interleukin-5 (IL-5), and is the first treatment shown to reduce disease flares.
• In refractory cases, particularly those resistant to imatinib (i.e., Gleevec) therapy, hematopoietic stem cell transplantation (HSCT) has been shown to reverse the organ dysfunction.

Monitoring Hypereosinophilic Syndrome:

• Peripheral blood eosinophil count and serum troponin levels every 3 months.
• Echocardiograms and pulmonary function tests every 6 months.

The board certified allergy specialists at Black & Kletz Allergy see both adult and pediatric and have over 5 decades of experience in the field of allergy, asthma, and immunology.  Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day.  We have been servicing the greater Washington, DC, Northern VA, and Maryland metropolitan area for over 50 years and we look forward to providing you with the highest state-of-the-art allergy care in a welcoming and relaxed environment.

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.