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Symptoms such as nasal congestion, clear runny nose, and itchy throat are most commonly due to sensitivity to common “allergens” in the environment (e.g., pollens, dust mites, mold spores, animals).  Our immune system mistakes them as potentially harmful and thus mounts a defensive attack on these substances when it encounters them.  During this process, there is a release of chemical substances (e.g., histamine, prostaglandins, leukotrienes) into the tissues inside the nose and eyes and these chemicals are responsible for the symptoms of allergies.

The symptoms may be relieved with medications that block the actions of these chemicals which can be utilized to make allergic individuals more comfortable.  The symptoms may also be prevented either by avoiding the exposure to the allergens, by environmental controls, or by getting desensitized to the allergens by allergy immunotherapy (allergy shots, allergy injections, allergy desensitization, allergy hyposensitization).  Sensitizing allergens can vary from person to person and allergy tests obtained by skin or blood testing are needed to identify the offending allergen in order to consider specific environmental controls and/or desensitizing treatments.

What if one has all the symptoms suggestive of “allergies” but all the tests are negative?  You may have a condition called vasomotor rhinitis or more appropriately called non-allergic rhinitis.

The symptoms of non-allergic rhinitis may include:

• Nasal congestion
• Runny nose
• Sneezing
• Mucus (i.e., phlegm) in the throat (e.g. post-nasal drip)
• Cough

These symptoms can be long term or may last only a short period of time.  They can come and go all year-round.  Itching of the nose, eyes, and/or throat are not present in non-allergic rhinitis as they are more likely to be features of allergic rhinitis (i.e., hay fever).

The exact cause of non-allergic rhinitis is not known.  The effect is widening of the blood vessels inside the nostrils and leakage of fluids into the tissues resulting in excessive mucus and swelling of the mucus membrane linings and nasal turbinates.

The common triggers of non-allergic rhinitis are:

• Environmental or occupational irritants: Dust, smoke, pollutants, strong odors, perfumes, colognes, potpourri, chemical sprays, fumes, etc.
• Weather changes: Fluctuations in temperature and humidity.
• Food: Hot and spicy foods, certain alcoholic beverages.
• Infections: Viral infections such as the common cold or influenza (i.e., the flu)
• Medications: Aspirin, Ibuprofen, certain blood pressure medications (e.g., beta-blockers ACE inhibitors), sedatives, antidepressants, and oral contraceptives.
• Rhinitis medicamentosa: Prolonged and/or overuse of over-the-counter decongestant nasal sprays (e.g., Afrin, Neosynephrine) can cause rebound congestion and habituation.
• Hormonal changes: Pregnancy, menstruation, and hypothyroidism.
• Stress: Emotional or physical stress.
• Other triggers: Sleeping posture, sleep apnea, acid reflux, etc.

Complications:

• Nasal polyps: These are soft, benign growths that develop on the lining of the nose or sinuses due to chronic inflammation.  Small polyps may not cause problems, but larger ones may block the airflow through the nose, making it difficult to breathe.  They also increase the likelihood of recurrent sinus infections.
• Sinusitis: Prolonged nasal congestion due to non-allergic rhinitis may increase the chances of developing sinusitis, an infection or inflammation of the membranes that line the sinuses.
• Middle ear infections: Increased fluid and nasal congestion may lead to middle ear infections.
• Interrupted daily activities: Non-allergic rhinitis may affect focus and concentration and in turn impact learning at school and/or productivity at work.

The diagnosis is established when one presents with the classic symptoms of rhinitis and when the skin tests and/or blood tests fail to identify specific environmental sensitivities.  Common infections of the nose and sinuses also need to be ruled out by examination and imaging tests. There are no confirmatory tests for non-allergic rhinitis and it is usually an exclusion diagnosis.

Treatment:

Avoidance of the common triggers is the first step in the management of non-allergic rhinitis.  When avoidance is not possible or when it does not work, the following actions may be helpful.

• An over-the-counter nasal saline spray or homemade salt water solution to flush the nose of irritants and help thin the mucus and soothe the membranes inside the nose.
• Corticosteroid nasal sprays (e.g., fluticasone, triamcinolone, budesonide) may help reduce the congestion due to their anti-inflammatory effect by shrinking the swelling and reducing excessive mucus production.
• Antihistamine nasal sprays (e.g., azelastine, olopatadine) are more helpful than oral antihistamines in relieving the symptoms of non-allergic rhinitis.
• Anticholinergic nasal sprays (e.g., ipratropium bromide) can help to dry up the excessive nasal secretions and relieve runny nose and post nasal drip.
• Oral decongestants (e.g., pseudoephedrine, phenylephrine) can help relieve nasal stuffiness by shrinking the blood vessels and reducing mucus buildup. Side effects of these medications however may include elevated blood pressure, rapid pulse, restlessness, sleep disturbances, palpitations, and/or tremors.

Prevention:

A recent small study showed that eating oily fish (e.g., herring, mackerel, salmon) at least once a week may reduce the risk of rhinitis.  However more studies are needed to confirm this finding.

The board certified allergists at Black & Kletz Allergy have 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  The allergy specialists at Black & Kletz Allergy are extremely knowledgeable regarding non-allergic rhinitis as well as allergic rhinitis.  We diagnose and treat both pediatric and adult patients.  In addition, we treat patients with food, medication, insect sting, and skin allergies, asthma, eosinophilic esophagitis, sinus disease, and immunological disorders.  To schedule an appointment, please call any of our offices or you may alternatively click Request an Appointment and we will respond within 24 hours by the next business day.  We have been servicing the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years and we look forward to providing you with comprehensive state-of the-art allergy care in a friendly and professional environment.

Does eating local honey help treat allergies?  This question has been asked for decades.  Many individuals swear that consuming local honey does help alleviate their seasonal allergy symptoms known as allergic rhinitis (i.e., hay fever).  Beekeepers generally also agree with this theory.  In order to answer this question, another important question to ask is “how does local honey help allergies?”, if in fact it does help.

The theory behind this hypothesis is rooted in the fact that when bees land on flowering trees and plants, the pollens that are on the flowers stick to the bees’ abdomens.  When bees make honey, the pollen that is on their abdomen is incorporated in the honey.  Local honey contains the pollen of these flowering trees and plants.  Processed honey that you would typically buy at a grocery store is usually micro-filtered and pasteurized.  These processes generally remove the pollen from the honey.  The thought is that local “raw” honey contains pollens from local trees and plants and by eating the honey, an individual will develop a “resistance” to the pollens that are in the local honey.  This would then lead to less or no allergic symptoms when exposed to these local pollens.  In theory, this sounds good, but in fact, there are flaws in this concept which are as follows:

The first fault in this idea is that individuals suffering from seasonal allergies in the Spring are allergic to non-flowering trees such as maple, birch, elm, hickory, cedar, ash, beech, and oak trees.  They are not generally allergic to the pollen from flowering trees and plants such as cherry trees, Bradford pear trees, redbud trees, dogwood trees, and forsythia bushes.  The reason for this is fairly simple.  The pollen of flowering trees and plants are heavy in weight and thus are not wind-dispersed.  Since the pollen is heavy, through evolution, these types of trees and plants had to develop flowers in order to attract bees so that they could cross-pollinate and thus reproduce.  The bees land on a flower and the pollen then sticks on the abdomen of the bees.  The bees then fly to another same species flowering tree or plant and when they land on these flowers, the pollen on their abdomen gets distributed on this new flower and hence cross-pollination occurs.  The fact that the pollen is heavy and not wind-dispersed means that individuals do not inhale the pollen and therefore do not become sensitized or allergic to these pollens.  Unlike flowering trees and plants, the non-flowering tree pollens are light in weight and are wind-dispersed, thus able to cause sensitization and allergy symptoms to allergic-prone individuals.  This translates into the fact that eating local honey (which is composed of flowering tree pollens) will not reduce one’s allergies in the Spring because it does not contain the correct types of pollens that cause hay fever.

In addition, the amount of pollen in local honey is not consistent between different bottles of honey from the same beekeeper yet from different beekeepers.  It is not standardized.  The idea of allergen desensitization (i.e., allergy immunotherapy, allergy hyposensitization) is to give a very low tolerable dose and increase the amount slowly over time, so that an individual can become tolerant to that allergen (e.g., tree pollen).

Another major flaw in this theory is that there have been no good scientific studies showing any advantage in using local honey to treat allergies.  There are a few studies that are flawed in the manner the studies were done as well as the number of participants are too small to make a general correlation between consuming local honey and its effects on allergies.  The use of honey to treat allergies is also not endorsed by either the American Academy of Allergy, Asthma & Immunology or the American College of Allergy, Asthma & Immunology.

Honey does have some advantages however.  It is not uncommonly used to help alleviate coughs and of course, it tastes good!  It is also interesting to point out that honey does not spoil.  This is thought to occur because organisms cannot survive long enough within a jar of honey due to the very low moisture that exists in a jar of honey and thus does not have the chance to spoil.

All in all, honey has its merits, but treating allergies is not one of them.  If you suffer from allergies, please contact Black & Kletz Allergy so that you can see one of our board certified allergists in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  After a comprehensive history and physical examination, allergy testing may be done and the appropriate avoidance measures will be discussed.  Depending upon each individual’s results, medications and/or allergy shots (i.e., allergy immunotherapy) may be prescribed.  Allergy shots have been prove to be effective in 80-85% of patients undergoing injections and they have been given in the United States for over 100 years.  Unlike consuming local honey, there are numerous studies demonstrating the efficacy and benefits of allergy immunotherapy when administered in the proper way.

The allergy doctors 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 of the 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 and Northern Virginia community for over 50 years for our exceptional services for the diagnosis and treatment of allergic, asthmatic, and immunological conditions.

Eczema (i.e., atopic dermatitis) is a genetically determined condition which causes long term inflammation of the skin which may result in itching, thickening, redness, and occasionally ulcerations of the skin.  A similar appearance can sometimes be seen in other chronic skin conditions.

Eczema or atopic dermatitis affects an estimated 7% of the population with varying degrees of severity.  It often begins in early childhood and may wax and wane throughout a lifetime.  The severity can vary from mild dryness and/or excessive creasing of the skin to a severe debilitating illness presenting with painful sores and/or skin infections.  The intractable itching often does not respond to medications and may lead to loss of sleep, inability to focus on work and/or school, and/or emotional problems.

Unfortunately there is no known cure for the condition yet.  The flare-ups of this disorder are typically treated with topical and/or oral corticosteroid medications, which usually offer only short-term relief.  The numerous topical corticosteroids available vary in potency and should be prescribed based on the severity of the eczema as well as the location of the eczema on the body.  The side effects of the corticosteroid medications can also be worrisome, so it is important to use them sparingly and to avoid excessive use.  A few new non-steroidal topical medications and injectable biological medications have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of atopic dermatitis.  It is important to note that the response rates to these medications are highly variable.  There are also side effects one should be aware of regarding the biological medications in particular.

Allergy shots (i.e., allergen immunotherapy, allergy injections, allergy desensitization, allergy hyposensitization) is a systematic treatment option which helps the immune system to develop tolerance to the offending allergens that cause allergy symptoms.  As a result, individuals have less or even no allergy symptoms when subsequently exposed to these allergens.  This method has been practiced for over 100 years in the United States and is highly effective in reducing the symptoms and lessening the need for medications for patients with respiratory and eye allergies such as hay fever (i.e., allergic rhinitis), asthma, and allergic conjunctivitis.

Despite the fact that allergy immunotherapy is so efficacious in allergies of the respiratory tract and eyes, allergy immunotherapy has not been studied extensively in patients with eczema.  A case-study, however, presented at a recent annual scientific meeting of the American College of Asthma, Asthma & Immunology, offers hope.

In this case-study, a 48 year-old man who had suffered from severe eczema involving a large part of his body since his childhood was observed.  He had tried many therapies for years including both mild and high-strength topical corticosteroid creams, other topical anti-inflammatory creams, and topical moisturizer creams without adequate relief.

Since he also had respiratory allergy-related symptoms, his doctors tested him for environmental allergies and diagnosed him with sensitivity to dust mites, molds, animal dander, trees, grasses, and weeds.  In fact allergic rhinitis, asthma and eczema constitute the “atopic triad” and share a similar genetic predisposition.

Because his allergies could all be treated with allergy shots, his doctors thought that treating his allergies may also be beneficial for his eczema.  After one year of allergy shots, he reported significant improvement of his eczema symptoms.  Once he reached a maintenance dose on his allergy shots, he no longer needed high dose corticosteroid treatment for his eczema.

There is a need for more extensive controlled studies investigating the benefits of allergy shots for individuals with moderate to severe eczema.  If further studies substantiate the data observed in this patient, allergy shots have the potential to benefit thousands of people with severe recalcitrant eczema.

The board certified allergists at Black & Kletz Allergy see patients of all ages and have over 50 years of experience in the field of allergy, asthma, and immunology.  In addition to allergic rhinitis, allergic conjunctivitis, and asthma, skin disorders such as eczema, contact dermatitis, poison ivy, poison oak, poison sumac, hives (i.e., urticaria), generalized itching (i.e., pruritus) are common skin ailments that we routinely diagnose and treat.  Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and all locations have on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  The allergists at Black & Kletz Allergy are happy to answer any questions or concerns you may have about any allergic, asthmatic, or immunologic concern.

As we enter the Spring season in the Washington, DC, Northern Virginia, and Maryland metropolitan area, many allergy sufferers will begin to experience the classic hay fever (i.e., allergic rhinitis and allergic conjunctivitis) and/or asthma symptoms.

The typical hay fever signs and symptoms may include sneezing, runny nose, nasal congestion, post-nasal drip, a horizontal crease at the bottom third of the nose, itchy nose, itchy eyes, watery eyes, redness of the eyes, puffy eyes, dark circles under the eyes, a line or fold in the skin below the lower eyelids, itchy mouth and throat, itchy ears, clogged ears, coughing, itchy skin, and/or sinus pressure.  In the Spring in the Washington, DC metro area, the tree and grass pollens as well as molds are generally to blame for these annoying allergy symptoms.  In the Fall, ragweed and molds are generally the culprits when it comes to causing hay fever symptoms.  Ragweed generally begins to pollinate in mid-August and is typically ends at the first frost which is usually at the end of October.

In asthmatics, the characteristic symptoms that may occur include chest tightness, wheezing, shortness of breath, and/or coughing.  The most common allergens that cause an increase of these asthma symptoms include tree pollens in the early Spring, grass pollens in the late Spring, and molds, which occur throughout the Spring.  It is important to know that molds are prevalent throughout every month of the year and are present both indoors and outdoors.  As mentioned in the paragraph above, ragweed, along with molds are the principle allergens that cause asthma exacerbations in the Fall.

It is interesting to note that there are a variety of other rarer symptoms that some individuals may notice in the Spring and Fall.  In fact, these symptoms may be perennial in nature which can be confusing since they can signify other medical conditions.  These less common allergy symptoms may include fatigue, “fogginess” feeling of the head, ringing of the ears (i.e., tinnitus), joint achiness, headaches, itchy mouth, abdominal pain, diarrhea, sore throat, behavioral issues (e.g., moodiness, hyperactivity, inability to concentrate), snoring, and/or rashes.

Note that the combination of fatigue, achiness, runny nose, nasal congestion, and sneezing can easily be misconstrued for the common cold.  One should be aware that the common cold is caused by a virus, and that in general, “colds” usually last no more than 7-10 days.  This means that if an individual is experiencing “cold” symptoms for a long period of time (i.e., greater than 2 weeks) and/or if he or she is experiencing recurrent “cold” symptoms every Spring or Fall, then allergies should be seriously considered and one should make an appointment with a board certified allergist such as the ones at Black & Kletz Allergy.

A few words about some of the less common seasonal allergy symptoms are discussed below:

• Fatigue: Usually occurs due to poor quality or quantity of sleep as a result of poorly controlled allergies.  In some individuals, this fatigue can be rather severe.
• “Fogginess” feeling of the head: May be due to increased sinus pressure.
• Ringing of the ears: Usually due to blockage of the Eustachian tube which stems from sinus congestion.
• Joint achiness: May be due to inflammation caused by allergies
• Headaches: Seasonal allergic headaches are usually due to increased nasal and sinus congestion.  They tend to be in the forehead and cheek regions of the face.
• Itchy mouth, Abdominal pain, and/or Diarrhea: Some pollen-allergic individuals have a condition called oral allergy syndrome (i.e., pollen-food allergy syndrome) whereby they have a local reaction in the gastrointestinal tract (i.e., mouth, esophagus, stomach) to certain foods (usually fresh fruits and/or vegetables).  Usually these individuals will experience an itchy mouth or throat from eating these raw fruits and vegetables, however, sometimes more severe gastrointestinal reactions may occur such as abdominal pain and/or diarrhea.  Some common cross-reactive foods and pollens include:  birch tree pollen – apples, pears, peaches, celery, carrots; ragweed pollen – melons, bananas, kiwi.
• Sore throat: Usually associated with a post-nasal drip but can also be caused by excessive dryness due to the use of antihistamines.
• Behavioral issues: Usually die to poor quality or quantity of sleep.
• Snoring: Usually due to increased nasal congestion.  Note that an increase in nasal congestion may also worsen obstructive sleep apnea and thereby cause an increase in snoring.
• Rashes: Seasonal allergies can cause a flare-up of eczema (i.e., atopic dermatitis).  Some allergic individuals may develop itching and rashes when they come in direct contact with an allergen such as grass.

The board certified allergy specialists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC metro area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  Our McLean, VA office location offers a complementary shuttle that runs between this office and the Spring Hill metro station on the silver line.  For an appointment, please call one of our offices or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  If you suffer from allergies or asthma, it is our mission to help alleviate or end your undesirable symptoms, so that you can enjoy a better quality of life.  We have been serving the community’s allergy and asthma needs for more than 50 years.  Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a caring, relaxed, and professional environment.

The most common cause in the Washington, DC, Northern Virginia, and Maryland metropolitan area for itchy, red eyes in the Spring and Fall high pollen seasons is inflammation of the thin membrane covering the eyeballs (i.e., conjunctivae).  This inflammation is triggered by allergen exposure to susceptible individuals.   However, inflammation to the conjunctivae can also be caused by infections by microorganisms such as viruses, bacteria, and rarely fungi and parasites.

It is very important for a board certified allergist to distinguish the difference between these two conditions as the treatment options are determined by the causative factors and differ greatly.

Though it is not always possible to differentiate the conditions by symptoms alone, the following information can be a helpful beginning.

If the discharge from the eye(s) is anything more than normal tears, it is more likely to be something more than allergies.  Though allergies also can cause much discomfort, pain in the eye(s) is more indicative of an infectious process.

A definitive diagnosis can only be made by examination and testing by trained and experienced professionals.

Allergies are not contagious to others but infections can easily spread from person to person or from one eye to the other eye.  The signs and symptoms of eye allergies (i.e., allergic conjunctivitis) are more likely to occur in both eyes, whereas infections are more likely to develop in one eye initially, although both eyes may be affected.

Prevention and Treatment:

Allergic Conjunctivitis:

Prevention should include reducing one’s exposure to known allergens by restricting outdoor activities on high pollen days, keeping windows closed, keeping pets out of the bedrooms, and using air purifiers and dehumidifiers to minimize dust mite and mold growth.

Treatment involves using over-the-counter eye drops containing antihistamines and mast cell stabilizers.  These are often helpful in relieving the itching and redness that are characteristic of allergic conjunctivitis.  They can be supplemented with oral medications (e.g., antihistamines) especially if nasal and sinus symptoms are also present.  Over-the-counter artificial tears also can help keep eyes moistened and flush out allergens.  In case of persistent symptoms, certain nasal corticosteroids, but not all, have the indication to help alleviate the allergic eye symptoms that may be extremely bothersome to the allergic individual.  Though they are more efficacious, the risks of adverse effects are also higher.

Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) is very effective in treating individuals with allergic conjunctivitis whether they have associated hay fever (i.e., allergic rhinitis) or not.

Infectious Conjunctivitis:

Prevention should entail avoiding exposure to people battling viral and bacterial infections to the best of their ability.  In addition, frequent hand washing can reduce the risks of contracting and spreading infectious eye conditions.

The treatment of infectious conjunctivitis varies depending on the microorganism.

Most viral infections resolve after a few days without any specific antiviral medications.  Lubricating eye drops and cold compresses can help relieve the discomfort and facilitate recovery.

Bacterial infections need antibiotic eye drops, instilled several times a day for about a week in order to treat the infections.  Rarely infections can also be caused by fungi and/or parasites.  In these rare cases, anti-fungal and anti-parasitic medications can be administered.

If eye infections are mistakenly self-treated with over-the-counter allergy medications, one can run the risk of damaging the eyes.

Other Ocular Allergies:

Of note, there are 3 other forms of ocular allergies that are more severe than allergic conjunctivitis which include the following:

Vernal keratoconjunctivitis (VKC):  A chronic inflammatory swelling of the outer lining of the eyes due to an allergic reaction.  It typically affects boys and young males who live in hot dry climates in a seasonal manner, most often occurring in the Spring and/or Summer.  It usually occurs in patients with a family history of allergies.  The classic symptoms may include watery eyes, itching, redness, and/or increased sensitivity to light (i.e., photophobia) of both eyes.  The treatment is similar to that of allergic rhinitis (see below), but in addition, individuals with severe cases may need topical corticosteroids, cyclosporine, or tacrolimus.  Rarely, oral corticosteroids may be necessary in recalcitrant cases.  It should be noted that rarely, VKC can lead to corneal scarring and vision loss if not properly treated.

Atopic keratoconjunctivitis (AKC):  A genetic disorder that is more common in adults (men more than women) where the immune system produces higher amounts of antibodies in response to a given allergen.  Although AKC is perennial in nature, the symptoms may worsen in the Winter.  Individuals usually have a history of eczema (i.e., atopic dermatitis).  The typical symptoms may include red eyelids, burning, itching, watery eyes, and/or increased sensitivity to light (i.e., photophobia) of both eyes.  The treatment is similar to that of VKC.  It should be noted that rarely, AKC can lead to corneal scarring and vision loss as mentioned above with VKC.  This complication however occurs more often in individuals with AKC than with VKC.

Giant papillary conjunctivitis (GPC):  A disorder that causes inflammation in the inside part of the eyelid.  It is most often caused by a reaction to eyelid movement over a foreign substance such as contact lenses.  It can develop at any time after wearing contact lenses.  An allergic reaction is thought to be one of the causes of GPC.  Some individuals are allergic to either their contact lenses or the chemicals used to clean them.  An allergic reaction between the skin of the eyelid and the contact lenses or chemicals may be a cause.  Other causes of GPC may include repetitive rubbing of the eyes, eye implants, and/or sutures in the eyes from a previous eye surgery.  The symptoms may include watery eyes, redness, burning, itching, and/or pain.  Treatment includes changing one’s contact lens regularly and limiting the time of wearing them to a few hours per day.  Disposable contact lenses may be of some benefit as well.  In more severe cases, the individual should stop using contact lenses altogether.

The board certified allergy specialist physicians at Black and Kletz Allergy have over 50 years of experience in diagnosing and treating all types of eye conditions whether allergic or infectious.  We treat both pediatric and adult 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 welcoming and pleasant environment.

In the Washington, DC, Northern Virginia, and Maryland metropolitan area, tree pollen usually begins to pollinate in mid-February.  The pollination is usually dependent upon the weather such that towards the end of Winter, when it first becomes warm outside, pollen begins to be released from the trees.  Depending on the temperatures, tree pollination can occur as early as early February or as late as early March.  When the trees produce their pollen, allergy sufferers are usually the first to know because they typically will develop symptoms of hay fever (i.e., allergic rhinitis) and/or asthma.  As we approach Spring (late March), the tree pollen counts rise and so do the symptoms of individuals with tree pollen allergies.  In the Washington, DC metro area, tree pollen counts continue to rise and generally peak in April.  This milestone is usually recognized by millions of people as they become aware that all of the cars appear “yellow” in color.  The yellowish color of the cars is due to the yellow-colored tree pollen falling on and sticking to the numerous motor vehicles that dominate the DC metro area.  The tree pollen count will then decrease and usually end by the end of May.  Note that as tree pollination decreases, grass pollination begins.  Grass pollen is also a major allergen in many allergic individuals.

It is noteworthy to mention that most people in the DC metro area, who are unfamiliar with allergies, think that it is the cherry trees that are causing their allergy symptoms.  This fallacy is believed and propagated because people with tree pollen allergies usually feel miserable around the same time that the cherry trees in the Washington, DC area begin to bloom.  What most people do not realize is that in general, flowering trees and plants do not cause allergic symptoms for the most part.  The reason for this is that individuals who suffer allergy symptoms from tree pollen need to breathe in the pollen in order to develop the typical symptoms of hay fever.  The pollen of flowering trees and plants is heavy compared with non-flowering trees.  The lighter pollen found on non-flowering trees (e.g., birch, cedar, elm, ash, beech, hickory, maple, oak) are wind-dispersed.  These pollens will travel in the air for hundreds of miles sometimes in order to settle on other trees which will cause the trees to continue to reproduce.  With flowering trees and plants, since the pollen is heavy, wind will not suffice to spread the pollen.  In order to reproduce, the pollen on flowering trees and plants require the aid of bees, hummingbirds, moths, butterflies, beetles, etc. to land on the flowers to help with the cross-pollination.  For example, a bee will be attracted to a flower and as it lands on the flower, the tree pollen sticks to its abdomen.  When the bee then lands on another flowering tree or plant, the pollen is transferred to that flower and cross-pollination occurs which allows further reproduction.  An easy way to think of it is as follows:  It is the pollen of the “ugly” trees that are wind-dispersed and thus cause allergies.

The symptoms that individuals generally experience with tree pollen allergies may include one or more of the following:  sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy eyes, watery eyes, redness of the eyes, itchy throat, itchy ears, clogged ears, sinus pressure, headaches, snoring, fatigue, wheezing, chest tightness, coughing, shortness of breath.

The diagnosis of tree pollen allergies can be made by seeing a board certified allergist such as the ones at Black & Kletz Allergy.  A comprehensive history and physical examination are obtained and then usually allergy testing is performed in order to identify an allergy to a specific allergen (e.g., tree pollen).  Allergy tests can be done by either skin testing or blood testing, although skin testing is generally the preferred method.

Once an individual is diagnosed with tree pollen allergies, avoidance measures are discussed, although the goal of allergy treatment is to allow the person to enjoy their hobbies (e.g., gardening, golf, hiking) rather than being restricted to being indoors for 3 months every Spring.  In addition, there are numerous medications that an allergist can prescribe in order to help alleviate the unwanted allergy symptoms of the allergy sufferer.  These medications come in the forms of tablets, syrups, nasal sprays, eye drops, lung inhalers, and injections.  If an individual has additional allergies such as grasses, weeds, dust mites, molds, pets, etc., then allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) may be recommended.  Allergy shots are effective in 80-85% of the patients that take them.  They have been used in the United States for more than 100 years.  They are given to little children as well as older adults.  The average person is on allergy shots for 3-5 years.

If you think that you may have tree pollen allergies, or any other type of allergy, the board certified allergists at Black & Kletz Allergy would be happy to help you.  We have 3 convenient offices in the DC metro area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our office offer on-site parking.  Our Washington, DC and McLean, VA locations are Metro accessible.  There is also a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  Please call us for an appointment.  Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  The allergists at Black & Kletz Allergy have been treating both adults and children in the Washington, DC metropolitan area for allergies, asthma, sinus disease, and immunologic disorders for more than 50 years.  We strive to provide top-of-the-line allergy relief in a caring and professional environment.

Acute sinusitis may also be referred to as acute rhinosinusitis or more commonly as a classic “sinus infection.”  By definition, the symptoms of acute sinusitis will last less than 4 weeks in duration, rather than the 12 weeks or more necessary to characterize a sinus infection as chronic sinusitis or a chronic sinus infection.  Of note, some physicians classify a sinus infection that lasts from 4 to 12 weeks as subacute sinusitis.  The term recurrent sinusitis refers to repeated acute sinus infections but can easily be confused with a chronic sinus infection.  This distinction is particularly important to differentiate as an allergist because the workup and treatment of recurrent sinus infections is quite different than the workup and treatment of a chronic sinus infection.

Acute sinusitis is most commonly caused by the “common cold” or another type of virus.  Most of the time, the acute sinusitis is self-limited and resolves without treatment in 7-10 days.  Approximately 1-2% of sinusitis caused by viruses will result in a subsequent bacterial sinus infection.  Rarely, a fungus may be the cause of a sinus infection.  Other factors that predispose an individual to develop acute sinusitis include allergic rhinitis (i.e., hay fever), a deviated nasal septum, nasal polyps, a fixed nasal obstruction (e.g., tumor, foreign body), cystic fibrosis,  immunological deficiencies (e.g., HIV/AIDS, diabetes mellitus, common variable immunodeficiency), immunosuppressant medications (i.e., medications that suppress the immune system such as azathioprine, cyclosporine, corticosteroids, and many “biological” medications such as adalimumab, secukinumab, abatacept, infliximab, etanercept), dental and/or periodontal infections, and chemical irritation (e.g., cigarette smoke, chemical fumes).

The symptoms of acute sinusitis typically involves one or more of the following:

• Nasal congestion
• Discolored nasal discharge (e.g., yellow, green, brown discharge)
• Post-nasal drip
• Sore throat
• Sinus pressure
• Sinus headaches
• Bad breath
• Fatigue
• Fever
• Radiation of pain to the teeth and/or ears
• Clogged ears
• Cough

Complications from acute sinusitis is uncommon nowadays in the era of better diagnostic techniques and antibiotics, however, a few complications can still occur and are as follows:

• Meningitis
• Osteomyelitis (i.e., bone infection)
• Cellulitis (i.e., skin infection)
• Chronic sinusitis
• Visual disturbances (if the infection spreads to one’s eye)
• Decreased or loss of sense of smell

The diagnosis of acute sinusitis is usually a clinical one.  The history that the patient describes along with certain findings on physical examination in most cases is usually enough to diagnose the individual.  Other methods that are utilized by physicians may include allergy testing, rhinolaryngoscopy (i.e., small endoscopic instrument used to obtain direct visual inspection of the nose, throat, and vocal cords), radiological studies (e.g., CT scan, MRI), and/or nasal cultures.

The treatment of acute sinusitis most of the time requires no treatment at all.  This is so because most cases of acute sinusitis are caused by a virus which usually resolves on its own.  In patients who have a bacterial sinus infection or who develop a secondary bacterial infection, antibiotics may be needed to eradicate the infection, particularly if the symptoms persist, worsen, or are severe.  In addition, supplemental use of saline nasal irrigation, nasal corticosteroids, decongestants, and/or over-the-counter analgesics are quite helpful in many cases of acute sinusitis to reduce symptoms.  It is also recommended to stay hydrated by drinking water.

The prevention of episodes of acute sinusitis can be facilitated by seeing a board certified allergist, like the ones at Black & Kletz Allergy.  The allergy specialist will perform a comprehensive history and physical and if necessary will do allergy skin testing to identify if and what allergens are allergenic to the patient.  Depending on the frequency of episodes of acute sinusitis and/or allergy symptoms, the allergy doctor will prescribe different medications (i.e., antihistamines, decongestants, nasal sprays, eye drops) used to alleviate the individual’s allergy symptoms.  He may also recommend allergy shots (i.e., allergy injections, allergy immunotherapy, allergy hyposensitization) which is effective in 80-85% of patients receiving allergy shots.  The allergists at Black & Kletz Allergy treat both adults and pediatric patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than one half a century.

Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  The allergists at Black & Kletz Allergy are extremely knowledgeable regarding the diagnosis and treatment of acute sinusitis and other sinus diseases.  In addition, we treat patients with environmental allergies, medication allergies, insect sting allergies, food allergies, eczema, asthma, hives, swelling episodes, generalized itching, contact dermatitis, eosinophilic esophagitis, and immune disorders.  To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day.  We have been servicing the greater Washington, DC area for many years and we look forward to providing you with excellent state-of-the-art allergy care in a friendly and professional environment.

Nasal polyps (i.e., nasal polyposis) are soft tissue growths that form on the lining of the nasal passages and inside the sinuses (i.e., air-filled cavities within the facial bones).  They are painless and non-cancerous.  They are usually in the shape of teardrops and characteristically look like glistening moist grapes.  Nasal polyps generally develop when the mucus membranes of the nose and/or sinuses are chronically inflamed.  This results the tissue to swell up over a prolonged period of time.

When the nasal polyps grow large enough, they can obstruct the nasal passages and cause breathing difficulties due to the polys blocking the flow of air through the nose.  They can also block the free passage of secretions from the sinuses into the nose and predispose individuals to sinus infections.

Any condition which results in chronic inflammation inside the nose and sinuses can lead to nasal polyp formation.   Some of these conditions include:

• Allergic rhinitis (i.e., hay fever)
• Chronic sinusitis
• Aspirin sensitivity
• Asthma
• Cystic fibrosis
• Eosinophilic disorders
• Allergic fungal sinusitis

What are the causes of nasal polyposis?

It is believed that inflammation causes the buildup of fluid within the mucus membranes.  When this buildup of fluid occurs, it results in the formation of fluid-filled growths, which over time expand to become polyps.

There is a condition known as Samter’s triad which is characterized by nasal polyps, asthma, and aspirin intolerance.  Samter’s triad is also known as aspirin exacerbated respiratory disease (i.e., AERD) or aspirin triad.

What are the symptoms of nasal polyps?

• Nasal congestion
• Runny nose
• Post-nasal drip
• Decreased or lack of the sense of taste and/or smell
• Sinus and/or facial pressure
• Sinus headaches
• Snoring

How is the diagnosis of nasal polyps established?

• Endoscopic examination of the nose
• Imaging studies (e.g., X-rays, CT scans)
• Allergy testing (e.g., skin testing or blood testing)
• Sweat test to rule out cystic fibrosis (particularly in children)

What are some complications that may arise as a result of having nasal polyps?

• Long-term or repeated sinus infections
• Nose bleeds (i.e., epistaxis)
• Exacerbations of asthma
• Obstructive sleep apnea
• Double vision (i.e., diplopia)

How are nasal polyps treated?

Corticosteroid nasal sprays are the usual first line of treatment.  Decongestants are sometimes useful to help shrink the size of the nasal polyps.  Antibiotics may be needed in the event that a bacterial sinus infections occurs due to the nasal polyps.

If the nasal polyps continue to grow in spite of treatment with various medications and/or if complications arise, the polyps may need to be surgically removed.  It must be noted, that it is not uncommon for nasal polyps to “grow back” after they are surgically removed, especially if an underlying untreated allergy causing chronic inflammation is still present.  The recurrence of the nasal polyps can be as quick as a few months after surgical intervention, however, it also may take a couple of years for the nasal polyps to return.  Some studies have demonstrated that regular use of a corticosteroid nasal sprays can reduce the chances of polyp regrowth after surgery.

How can nasal polyps be prevented?

The aggressive treatment of predisposing conditions such as hay fever (i.e., allergic rhinitis) with a combination of environmental controls , medications, and desensitization procedures (i.e., allergy shots, allergy injections, allergy immunotherapy, allergy hyposensitization) may inhibit polyp formation.  Avoidance of exposure to smoke, strong odors, and chemicals is important in order to reduce nasal irritation and excessive tissue growth.

Patients with established chronic sinusitis may require antibiotics, nasal/sinus irrigations, and/or sinus surgery.  Patients with a history of aspirin sensitivity will do better after desensitization to aspirin in terms of better asthma control, as well as a reduction in recurrences of nasal polyps.

The board certified allergists at Black & Kletz Allergy located in the Washington, DC, Northern Virginia, and Maryland metropolitan area will readily answer any questions you have regarding nasal polyps and/or allergy symptoms.  We have 3 offices with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking.  In addition, the Washington, DC and McLean, VA offices are accessible by Metro.  There is also a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Please make an appointment by calling any one of our 3 offices, or alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  Black & Kletz Allergy diagnoses and treats both adults and children and we are proud to serve the Washington, DC metro area residents for which we have done for more than 50 years.

In this ever increasing complicated and stressful world that we live in, many individuals find themselves complaining of fatigue.  Most people chalk it up to being overworked or to too much stress in their lives, but fatigue can be a symptom of a multitude of illnesses.  Amongst these ailments, fatigue is often a symptom of allergies.  When an individual suffers from allergies such as hay fever (i.e., allergic rhinitis), asthma, or sinus disease (as a result of allergies), it is not uncommon to feel fatigued.  This is often from the body becoming “worn down” from constantly “fighting” the offending allergens.  In asthmatics, patients may also complain of fatigue because the shortness of breath that frequently accompanies asthma contributes to their lethargy.  In patients with sinus disease, there is often an associated sinus infection (e.g., acute sinusitis, chronic sinusitis) which also may “wear down” the body as most infections typically do, and as a result, fatigue develops in these individuals.

There are some patients with allergies where the only symptom is fatigue.  It is important however for the board certified allergist such as the ones at Black & Kletz Allergy, to recognize that not everyone with fatigue suffers from allergies.  In addition, even if someone has allergies, their fatigue may not be the cause or sole cause.  There are many other diseases and/or conditions where an individual may complain of fatigue.  These conditions should be ruled out rather than just assume that their allergies are the sole cause of their fatigue.

What are some conditions that can cause fatigue other than allergies, asthma, or sinus disease?  Below are some of the more common factors and/or disorders that can be associated with fatigue not including the aforementioned allergies, asthma, and sinus disease:

• Anemia
• Chronic obstructive pulmonary disease (COPD) (e.g., chronic bronchitis, emphysema)
• Depression
• Liver disease
• Kidney disease
• Heart disease
• Thyroid disease
• Diabetes
• Autoimmune disorders (e.g., systemic lupus erythematosus, rheumatoid arthritis)
• Fibromyalgia
• Sleep apnea
• Inflammatory bowel disease (e.g., chronic ulcerative colitis, Crohn’s disease)
• Medications (e.g., antihistamines, antidepressants, anti-anxiety medications, blood pressure medications)
• Alcohol or drug use

There are numerous other factors and/or conditions that may play a role in causing fatigue and it is advisable to also be examined by your primary care physician when you are experiencing fatigue.

The diagnosis of allergies begins with a comprehensive history and physical examination.  Allergy testing is usually performed by utilizing the skin testing method, however, blood tests can also be done.  The treatment of allergies begins with avoidance measures in order to reduce the exposure of an individual with the offending allergen.  If avoidance measures are not satisfactory, medications are used in order to alleviate the symptoms.  There are a wide variety of medications used to treat allergies and thus the fatigue that may be associated with them.  Ironically, many over the counter allergy medications (e.g., antihistamines) can cause fatigue and/or drowsiness.  Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) is a very effective treatment modality used for the treatment of allergies and allergic asthma.  It is effective in 80 – 85% of the patients that undergo allergy immunotherapy.  The usual course of treatment with allergy shots is usually between 3 – 5 years.

The board certified allergy specialists at Black & Kletz Allergy has 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our office locations have on-site parking.  In addition, our 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 allergists of Black & Kletz Allergy diagnose and treat both pediatric and adult patients.  For an appointment, please call our office or alternatively, you can click Request an Appointment and we will reply within 24 hours by the next business day.  The allergy doctors at Black & Kletz Allergy have been helping patients with fatigue, hay fever, asthma, sinus disease, hives, eczema, medication allergies, food allergies, insect sting allergies, and immunological disorders for more than a half a century.  If you suffer from fatigue and want to decipher if they are being caused by allergies, it is our mission to determine if your fatigue is stemming from allergies.  Then it is our goal to improve your quality of life by reducing or preventing your unwanted and aggravating allergy symptoms including fatigue.

Do probiotics have a role in preventing allergies?

While some studies demonstrated a protective effect of probiotics on the development of eczema, other studies have shown no effect on the development of other allergic diseases.  In view of the conflicting results of various studies, probiotics are not currently recommended for preventing allergies.

How about fish oils?

There is no convincing evidence at this time that taking fish oil supplements have any significant benefit in preventing allergies.

Will dust mite avoidance measures cut down the risk of developing allergies and/or asthma?

Unless an individual is already sensitized to dust mites, avoidance measures to reduce the exposure to dust mites have not proved to reduce the chances of developing allergies, eczema, or asthma.

Should I avoid pets?

There is no reason to remove pets from the household unless a person’s allergies and/or asthma flares up when he or she is exposed to the pets.  Even if an individual’s symptoms are tied to their exposure to pets, it is often very difficult for them to get rid of their pets, as the pets are considered part of the family.  If an allergy sufferer’s symptoms appear to worsen when exposed to their pets and he or she is unwilling to remove the pets from their home, it is advised to keep the pets out of the bedroom where that individual usually spends at least 7-8 hours per day or night.

If I restrict some foods while I am pregnant and/or while breastfeeding, would that prevent my child from having food allergies?

Avoidance of common allergy-causing foods such as peanuts, tree nuts (e.g., almonds, Brazil nuts, cashews, hazelnuts, pecans, walnuts), eggs, fish, shellfish, soy, dairy, etc. has not been shown to reduce the risk of children developing food allergies.  In fact, restrictions in one’s diet during pregnancy and lactation have been linked to a decreased weight gain by babies and should be avoided.

Should I delay introduction of any foods to my infant to prevent food allergies?

Some studies showed that babies exclusively breastfed for the first 3 to 4 months of life are less likely to develop food allergies and eczema during the first 2 years of life.  As a general rule, solid foods should be introduced around 6 months of age, preferably while still breastfeeding.  This however should be confirmed by your pediatrician.  Common allergenic foods containing peanut, egg, fish, cow’s milk and soy should be given to babies before 12 months of age.  Again, this should be determined by your pediatrician.  Studies of children at high risk of developing allergies (i.e., children with eczema and/or with a family history of allergies) have demonstrated that early introduction of these foods will reduce the risk of developing food allergies in later life.

Is soy milk or goat’s milk better to prevent allergies than cow’s milk formula?

No.  Studies have showed that soy-based formulas or goat’s milk does not prevent the development of food allergies in children.

What should I do if I suspect that my child has a food allergy?

Accurate diagnosis by standardized testing is essential before treatments are contemplated.  If the tests confirm allergies to specific foods, avoidance of those foods and substitution with suitable alternatives, supervised by your board certified allergist, like the allergy specialists at Black & Kletz Allergy are recommended.  Special alternative formulas are available for children with cow’s milk and/or soy milk allergies.

Will allergy injections (i.e., immunotherapy, desensitization) prevent allergies?

The current indications for allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is to treat established environmental allergies.  However, there is emerging evidence that treating children with allergic rhinitis (i.e., hay fever) with allergy injections to “switch off” their allergies may reduce the risk of them developing new allergies and asthma later in life.

The board certified allergists at Black and Kletz Allergy have been diagnosing and treating allergies and asthma for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We see both adults and pediatric patients.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each of our 3 locations.  Our Washington, DC and McLean, VA offices 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 respond within 24 hours by the next business day.  Black & Kletz Allergy is dedicated in providing the most state-of-the-art allergy treatment in a warm, caring, and professional environment.

As we approach the Winter in the Washington, DC, Northern Virginia, and Maryland metropolitan (Mid-Atlantic) area, the temperatures naturally fall and the resulting cold air can play havoc with many people.  “Allergic” signs and symptoms may appear in allergic patients as well as non-allergic individuals.  The “allergic” symptoms can vary in intensity and they commonly affect different parts of the body such as the nose, eyes, lungs, and/or skin.

Symptoms based on the parts of the body:

Nose:  The cold air of Winter can act as an irritant to anyone whether the individual has allergies or does not have allergies.  The typical symptoms that may occur include runny nose, nasal congestion, post-nasal drip, and nosebleeds (i.e., epistaxis). 

Patients with nonallergic rhinitis (i.e., vasomotor rhinitis) will experience these symptoms despite the fact that allergy testing is negative because these individuals are bothered by irritants such as cold air, cigarette smoke, air pollution, dusts, strong odors, chemicals, etc.  Nosebleeds are usually a result of the cold dry air which is common during the Winter.

On the other hand, patients with allergic rhinitis (i.e., hay fever) can exhibit the same symptoms during the Winter as the patient with nonallergic rhinitis, however, their symptoms are generally due to a true allergy to allergens that are prevalent in the Winter months.  The most common allergens during these months include dust mites, molds, pets, and cockroaches.  Nosebleeds may be due to either a side effect of a corticosteroid nasal spray (e.g., Flonase, Nasacort, Rhinocort, Nasonex, Qnasl, Omnaris) used in the treatment of allergic rhinitis or the result of the cold dry air that accompanies the Winter weather.

Eyes:  Similar to the effects that the cold air has on the nose, the cold air can affect ones’ eyes in very much the same way.  The two characteristic symptoms exhibited when the eyes come in contact with cold air in an allergic or nonallergic individual include watery eyes and redness of the eyes.  Itching of the eyes is generally not seen unless an individual is allergic and is reacting to one of the allergens common during the Winter (e.g., dust mites, molds, pets, cockroach).

Lungs:  Cold air is a common trigger that exacerbates asthma symptoms (e.g., chest tightness, shortness of breath, wheezing, coughing) in asthmatic individuals.  Most asthmatics have an underlying allergic diathesis and in turn their asthma may also be exacerbated by common Winter allergens such as molds, dust mites, pets, and/or cockroaches.  Of note, cockroaches are a very common and potent allergen that aggravates the symptoms of asthma in asthmatic children living in inner cities.  In nonallergic, non-asthmatic people, the cold air can also cause asthma-like symptoms, but generally the symptoms are milder in severity.

Skin:  When the temperature drops in the Winter, the cold air can cause two similar conditions referred to as Raynaud’s disease (i.e., primary Raynaud’s) and Raynaud’s phenomenon (i.e., secondary Raynaud’s) depending on whether there is an underlying medical problem.  Raynaud’s disease is not associated with another medical condition and is more common than Raynaud’s phenomenon which is associated with other medical conditions.  The most common underlying medical problems that may be associated with Raynaud’s phenomenon may include connective tissue diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis, scleroderma, Sjögren’s syndrome), smoking, atherosclerosis, carpal tunnel syndrome, injuries to the hands and/or feet, and certain medications (e.g., migraine headache medications, beta blockers, ADHD medications).

Regarding the skin, there are 4 conditions that all act on the skin and can be lumped into one entity as they are all very similar.  The only difference between them is the severity of the reaction when an individual is exposed to the cold. The 4 conditions include cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, and cold-induced anaphylaxis.  In cold-induced pruritus, the cold air will cause a susceptible person to have itchy skin. In cold-induced urticaria, the individual will develop hives upon contact with something cold. People with cold-induced angioedema will develop swelling episodes when exposed to the cold.  Lastly, some individuals may develop anaphylaxis when they are exposed to the cold which obviously can be very serious and potentially fatal. It is important to see a board certified allergist if you have one of these conditions, as a self-administered epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) is typically prescribed, particularly for cold-induced angioedema and cold-induced anaphylaxis.  It is also important to note that any person who needs to use a self-administered epinephrine device should go immediately to the closest emergency room after using the device.

Winter is almost here and the temperatures outside have already begun to drop into the “cold” range.  The board certified allergists at Black & Kletz Allergy have 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  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 doctors of Black & Kletz Allergy diagnose and treat both pediatric and adult patients.  For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy have been helping patients with hay fever, asthma, sinus disease, hives, eczema, generalized itching, anaphylaxis, medication allergies, insect sting allergies, food allergies, and immunological disorders for more than 50 years.  If you suffer from allergies, it is our mission to improve your quality of life by reducing or preventing your unwanted and aggravating allergy symptoms.

About 2% of children in the United States are allergic to cow’s milk.  The condition usually begins in the first year of life and can affect both breastfed and formula-fed infants.  A majority of the children usually “outgrow” the allergy by 5 years of age, however not all children “outgrow” milk allergies.

Immediate hypersensitivity reactions (Type I allergy reactions) to cow’s milk are mediated by an antibody (i.e., Immunoglobulin E or IgE) to the protein in milk.

Symptoms:

The symptoms of milk allergy usually appear within minutes of ingestion and may involve multiple body systems.  Below are some common symptoms that may be associated with cow’s milk allergy:

Skin:  Itching, redness, hives, swelling

Respiratory:

Upper:  Nasal congestion, runny nose, sneezing, hoarseness

Lower:  Coughing, wheezing, chest tightness, shortness of breath

Eyes:  Redness, itching, puffiness of eyelids

Heart:  Pallor, fainting, dizziness

Gastrointestinal:  Abdominal pain and/or cramping, vomiting, diarrhea

Diagnosis:

• Skin prick testing
• Cow’s milk specific serum IgE via blood testing
• Oral food challenge

A double-blind oral challenge with food under controlled conditions under medical supervision is considered the gold standard in the diagnosis of food allergies. It may not be needed however when the clinical presentation is highly suggestive of the diagnosis and when it is supported by appropriate test results.

Treatment:

Currently, the only FDA-approved treatment for cow’s milk allergy is strict avoidance of all exposure to cow’s milk protein.  It is also very important to have an emergency treatment plan in case of an accidental ingestion and/or exposure.

Cow’s milk proteins are found in all dairy products including milk, cheese, yogurt, butter, ice cream, and pudding.  Other foods such as breads, cookies, crackers, and cakes may also contain milk products. In packaged foods, milk may be listed as a major ingredient or in the “may contain” list.  Sometimes, a product will convey that the food was made in the same facility as other foods that contain milk. Parents also must be aware of the possibility of cross contamination of milk with other foods, especially in restaurants.  Other products that contain casein, whey, hydrolysates, lactose, lactulose, lactoglobulin, lactoferrin, lactalbumin, ghee, rennet, artificial butter flavor, artificial cheese flavor, and/or curd should also be avoided. It is also a good idea for parents of a child with cow’s milk allergy to share his or her allergy with caregivers, teachers, principals, school nurses, neighbors, relatives, and parents of the child’s friends so that they are all aware of the allergy and what to do if the child comes in contact with cow’s milk.

Some children with cow’s milk allergy may be able to tolerate baked milk foods as prolonged heating at high temperatures can denature the protein making it less allergenic.  However children with established cow’s milk allergy should be fed baked milk foods only if they pass the oral challenge with baked food under medical supervision. It is best and recommended, however, to avoid baked milk foods just to be on the safe side.

Medications:

Self-injectable epinephrine devices (e.g., EpiPen, Auvi-Q, Adrenaclick) should be readily available to treat a severe reaction after accidental exposures.  Milder reactions may be treated with antihistamines such as Benadryl (i.e., diphenhydramine).

Resolution:

As mentioned before, an oral food challenge is the gold standard to establish if the allergy has been “outgrown,” however, in some cases, this may not be feasible to do in a doctor’s office.  The board certified allergist may repeat food allergy tests may every year to determine whether it is safe to perform oral food challenges.

Cow’s milk is a very important source of nutrition in infants and young children, as it contains carbohydrates, fats, protein, and various essential minerals and vitamins. When milk is being avoided, children should be fed proper nutritional substitutes in adequate quantities and parents may need guidance from a certified dietician to choose the alternative foods.

The board certified allergists at Black & Kletz Allergy have 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  The allergy specialists at Black & Kletz Allergy are extremely knowledgeable regarding cow’s milk allergies as well as other food allergies.  We diagnose and treat both pediatric and adult patients.  In addition, we treat patients with environmental, medication, insect sting, and skin allergies, asthma, sinus disease, and immunological disorders.  To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day.  We have been servicing the greater Washington, DC area for more than 50 years and we look forward to providing you with excellent state of the art allergy care in a friendly and professional environment.

Every year, thousands of people in the U.S. get very sick from diseases that could be prevented by vaccines.  People with asthma and chronic obstructive pulmonary disease (COPD) (e.g., emphysema, chronic bronchitis) are at a higher risk than the general population for complications from vaccine-preventable diseases.

Asthma and COPD cause the airways of the lungs to swell.  In addition, these conditions cause mucus secretions to become thick, resulting in the blockage of the swollen airways which may lead to breathing difficulties.  Certain viral and bacterial infections affecting the lungs can also cause swelling of the airways and thicken the secretions. This combination can lead to serious complications such as pneumonia and/or respiratory failure.

Immunizations provide the best protection against infections which may aggravate asthma and/or COPD.  The side effects from vaccinations are generally mild and self-limited.

The following vaccinations are strongly recommended for people with lung diseases:

The 2018-2019 vaccine has been updated from last season’s vaccine to better match circulating viruses.  Immunity from this vaccination usually begins to develop after approximately 2 weeks.

Injectable influenza vaccines (i.e., flu shots) are approved for use in individuals aged 6 months and older.  Flu shots have a long established safety record in people with asthma. Individuals with asthma can receive either a trivalent or a quadrivalent vaccine.

The nasal spray vaccine is recommended as an option for use in people 2 through 49 years of age.  It should be noted that anyone with asthma is at increased risk for wheezing after receiving the nasal spray flu vaccine.  Nasal spray vaccine is also not recommended for pregnant women, individuals with weakened immune systems and their care givers, and children 2 through 4 years of age who have had a history of wheezing in the past 12 months.  It is important to note that the influenza virus in the nasal spray vaccine a live attenuated (i.e., weakened) virus compared with a killed virus that is used in a flu shot.

People with egg allergies can receive any recommended age-appropriate influenza vaccine that is otherwise appropriate, if given the approval by their primary care physician.  Individuals who have a history of severe egg allergy (i.e., those who have had any symptom other than hives after exposure to egg) should be vaccinated in a medical setting, supervised by a physician who is able to recognize and manage severe allergic reactions.  Again, if one has an egg allergy, one should always check with their primary care physician about getting a flu vaccination and only receive it, if approved by the primary care physician.

In addition to getting a flu vaccine, people with asthma should take everyday preventive actions including covering coughs, washing hands often, and avoiding individuals who are sick.

Pneumococcus is a bacteria that causes thousands of infections, such as meningitis, bloodstream infections (e.g., sepsis), pneumonia, and ear infections. Pneumococcal vaccines are very good at preventing severe disease.  Two types of vaccines are available:

The pneumococcal conjugate vaccine (e.g., PCV13 or Prevnar) protects against 13 strains of pneumococcal bacteria.  It is recommended for young children and adults 65 years of age or older. Older children and adults younger than 65 years of age who are at increased risk for getting pneumococcal disease may also need a dose of PCV13.

The pneumococcal polysaccharide vaccine (e.g., PPSV23 or Pneumovax) protects against 23 types of pneumococcal bacteria.  It is recommended for all adults 65 years of age and older, as well as for individuals 2 years of age and older who are at increased risk, such as those with asthma and/or COPD.

Both vaccines are recommended and generally they should be given 1 year apart.

This combination vaccine protects against 3 serious bacterial infections, namely diphtheria, tetanus, and pertussis (i.e., whooping cough).  DTaP is the childhood vaccine, and Tdap is the pertussis booster vaccine for preteens, teens, and adults. A Td booster is recommended once every 10 years.  Most Ob/Gyn doctors will recommend the Tdap to all pregnant women. It is usually recommended in the 3rd trimester.  The Tdap is also usually recommended for each subsequent pregnancy.  In addition, pediatricians generally recommend that all care-givers and individuals that will be in close and frequent proximity to the newborn also be vaccinated with Tdap.

Shingles is a painful and/or itchy rash that usually develops on one side of the body, often the face or torso.  It is caused by the re-activation of the chickenpox virus (i.e., varicella-zoster virus) that has been lying dormant in a nerve of an individual.  The rash consists of small blisters that typically scab over in 7 to 10 days and generally clears up within 2 to 4 weeks. For some individuals, the pain can last for months or even years after the rash disappears.

A new shingles vaccine called Shingrix (i.e., recombinant zoster vaccine) was licensed by the U.S. Food and Drug Administration (FDA) in 2017.  It is recommended that healthy adults 50 years of age and older receive two doses of Shingrix, 2 to 6 months apart. Shingrix provides strong protection against shingles and the complication of long term pain.  Patients who have previously received Zostavax, an older shingles vaccine, are recommended to subsequently receive Shingrix, as it is more efficacious.

The board certified allergists/immunologists at Black & Kletz Allergy have expertise is immunizations as well as the diagnosis and treatment of immunological conditions.  In addition to diagnosing and treating immune disorders, the allergy specialists at Black & Kletz Allergy diagnose and treat a wide array of allergic conditions such as hay fever (i.e., allergic rhinitis), sinus disease, asthma, hives (i.e., urticaria), swelling episodes (i.e., angioedema), generalized itching (i.e., pruritus), anaphylaxis, insect sting allergies, food allergies, medication allergies, and eosinophilic esophagitis.  We have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We offer parking at each location and the Washington, DC and McLean, VA locations are Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.

If you would like to schedule an appointment, please call us to schedule a visit at your desired location.  Alternatively, you may click Request an Appointment and we will respond to you within 24 hours by the next business day.  Black & Kletz Allergy has been treating allergy, asthma, and immune-related conditions for more than 50 years in the Washington, DC and Northern Virginia metropolitan area.  We are board certified to see both adult and pediatric patients and we are determined to improve the quality of life in individuals who may suffer from unwanted allergies, asthma, sinus disease, or immune dysfunction.

Many individuals are unsure whether they have sinusitis (i.e., sinus infection) vs. typical “allergies.”  Sinusitis generally refers to infected sinuses, however, sinusitis technically means “inflammation of the sinuses.”  Typically, sinusitis is a direct result of either a “cold” or allergies (i.e., allergic rhinitis, hay fever).  The symptoms of each condition are usually very similar and the differences can be very subtle, however there are several things to look at in order to help differentiate between the two disorders.  In both allergic rhinitis and sinusitis, most patients will experience one or more of the following symptoms: nasal congestion, runny nose, post-nasal drip, sneezing, itchy eyes, and/or watery eyes.  Patients with sinusitis, however, may also experience one or more of the following symptoms in addition to the symptoms above: sinus headaches, thick discolored mucus from the nose, sore throat, cough, sinus pressure, teeth pain (particularly the upper teeth), fatigue, malodorous breath, decreased sense of taste/smell, and/or mild fever.

When someone develops a sinus infection, it may be acute, chronic, or recurrent:

Acute sinusitis is the most common form of sinusitis.  It is the classic example of a sinus infection. Individuals typically will complain of sinus or facial pressure, headaches, nasal congestion, thick discolored nasal mucus, post-nasal drip with or without a sore throat, and/or cough.  Patients often will say that they had a “cold” before the sinus infection began. Others will give a history of being exposed to something that they were allergic to such as pets, pollens, dust, etc. The treatment may entail the use of antibiotics (generally if the symptoms have been present for more than 1 week), nasal corticosteroids, antihistamines, decongestants, and/or mucolytics (i.e., mucus thinners).  It should be noted that most cases of acute sinusitis are caused by viruses and thus antibiotics are not necessary. If the symptoms persist and/or get worse, however, antibiotics are often used.

Chronic sinusitis is not as common as acute sinusitis, but is generally more difficult to treat.  An allergist should suspect chronic sinusitis when the patient has had symptoms for a long time, a sinus infection is recurrent, and/or fatigue becomes more prevalent.  The symptoms of chronic sinusitis may include all of the symptoms found with acute sinusitis except a fever is less common with chronic sinusitis. In addition to the symptoms found in acute sinusitis, patients with chronic sinusitis may exhibit a decreased sense of taste/smell, fatigue, malodorous breath, and/or cough.  The cough tends to be a “barky” cough, although any cough may occur. The diagnosis of chronic sinusitis is usually verified by a CT scan of the sinuses. It will show thickened mucus membranes of the sinuses compared with an “air-fluid level” found in patients with acute sinusitis. In addition to using antihistamines, nasal corticosteroids, decongestants, and/or mucolytics, the treatment of chronic sinusitis generally involves a 30 day course of antibiotics.  If the infection is recalcitrant, another 30 day course of an antibiotic may be necessary. In some individuals, sinus surgery may be necessary in order to eradicate the infection. The surgical procedure may also be directed at creating better drainage of the sinuses, in order to help prevent future sinus infections.

Recurrent sinusitis is actually repetitive acute sinus infections.  They can occur for a variety of reasons, some of which are as follows:

1.) If an acute sinus infection is not completely eradicated, the focus of the bacterial infection remains, and the bacteria may grow back causing another acute sinus infection.

2.) The wrong antibiotic or an antibiotic that the bacteria is not as sensitive to may cause a sinus infection to return.

3.) Allergic patients that have been exposed and re-exposed to large amounts of allergen(s) can develop recurrent sinus infections.

4.) Re-exposure to different viruses may cause recurrent sinusitis

5.) Individuals with immune dysfunctions may develop recurrent sinusitis.

It is important to note that many individuals think that they are experiencing recurrent sinus infections, when in fact they have an indolent chronic sinus infection with intermittent worsening symptoms.  This gives the patient the false impression that they are getting recurrent acute sinus infections. It takes a board certified allergist in order to realize that the individual may have a chronic sinus infection instead of recurrent infections, as the treatment of the 2 conditions is very different.  The treatment of recurrent sinusitis is essentially the same as that of an acute sinus infection.

The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating all types of sinus infections, as well as all types of allergic conditions and asthma.  We are board certified to treat both adult and pediatric patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than a half a century.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  If you suffer from allergies and/or sinus-related symptoms, we are here to help alleviate or hopefully end these unwanted symptoms that have been so bothersome, so that you can enjoy a better quality of life.  Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a relaxed, caring, and professional environment.

Approximately 15 million Americans are affected by some form of food allergy and nearly 6 million of those are children under 18 years of age.  Many epidemiological studies indicate that the prevalence (i.e., the proportion of individuals in a population having the condition) of food allergy is increasing over the past 2 decades.  Genetic and possibly environmental factors predispose individuals to the development of many allergic disorders including food sensitivity.

Though a large number of foods can cause allergic reactions, in the United States, milk, egg, and peanut are the 3 most common allergenic foods.  Current management strategies require strict avoidance of these foods. Despite the intent of strict avoidance, accidental ingestion of allergenic foods can and does happen.  This may result in a severe reaction which may require the use of a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick). An individual who is susceptible to severe food allergies may result in considerable anxiety which may impact the quality of life of that individual as well as their families.

Several clinical trials are now looking at various treatment options in an attempt to reduce the risk of severe reactions with accidental exposures.  These involve different types of gradually increasing exposures to foods at regular intervals under controlled conditions.

Several types of immunotherapy, including oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT), are under active investigation for the treatment of food allergy.

In comparing the different types of immunotherapy for food allergy, OIT has the greatest amount of clinical desensitization, followed by SLIT and then EPIT.  Allergic side effects to the different treatments are in the same order with OIT having the most allergic side effects.

Despite the 3 types of desensitization methods that are utilized for food allergies, there are still gaps in our knowledge and unanswered questions to be answered:

Though these treatment options are not yet approved by the FDA, the future looks promising for the treatment of food allergies as research continues to answer some of previous unanswered questions.

The board certified allergists at Black & Kletz Allergy have been diagnosing food allergies in both adults and children for over 5 decades.  As of yet, there are no FDA-approved methods to treat food allergies, although several methods are being researched at this time.  As of now, the gold standard approach to treat food allergies is to strictly avoid the offending food. It is very important to identify the specific food that one is allergic to in order to avoid it in the future.  Black & Kletz Allergy has 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 allergy specialists are able to test for most foods and 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 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 doctors at Black & Kletz Allergy are eager to help you find out if you are allergic to foods and to identify which ones.  This will allow you live in less fear by avoiding the offending food as well as have a detailed plan on what to do if you would accidentally ingest the given food.