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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.

Histamine is the chemical that is responsible for most allergy-related symptoms. It is usually stored inside cells called mast cells.  When one is exposed to allergens that he or she has been previously sensitized to, (e.g., pollens, dust mites, molds, animals, certain foods), the preformed specific antibodies react with their proteins (i.e., antigens) which cause a release of histamine and other similar substances from the mast cells into the tissues of the body.  These chemicals in turn trigger various symptoms such as itching, sneezing, wheezing, coughing, runny nose, watery eyes, nasal congestion, post-nasal drip, etc.

Fish is one of the most common foods that cause food allergies.  Sensitive individuals may experience allergic reactions after consuming fish.  The classic mechanism of this type of allergic reaction is caused by antigen-antibody interactions.  However, there are some people who are not sensitized or allergic to fish but can experience similar symptoms after eating fish.  In these individuals, the symptoms are brought on by a different mechanism.

Many types of fish naturally contain a chemical called histidine.  When the fish are not properly stored and refrigerated, bacteria overgrowth occurs in and on the fish.  These bacteria release an enzyme called histidine decarboxylase which converts the naturally occurring histidine in the fish to a chemical called histamine.  The enzyme is resistant to freezing and heating and can persist even after the bacteria are eliminated by normal cooking techniques. The resulting high levels of histamine cause the same symptoms as an allergic reaction, but the underlying mechanism is a type of toxicity rather than a true allergy.

This condition used to be called scombroid fish poisoning, as fish belonging to Scombridae family (e.g., tuna, mackerel, marlin, swordfish) were originally implicated.  Later, many other non-scombroid fish such as mahi-mahi, sardine, herring, anchovy and bluefish were also found to cause this condition. The preferred current terminology is called “acute histamine toxicity.”

The symptoms usually begin 30 minutes to 2 hours after eating the fish.  The most common manifestations may include:

The diagnosis is usually made from the patient’s history.  The appearance of the fish is sometimes described as honeycombed. Some affected individuals also experience a sharp, metallic, bitter, and peppery taste while eating the fish.  Laboratory tests are usually not helpful as histamine is rapidly degraded and cannot be detected in blood or urine samples within 1 to 2 hours after the onset of symptoms. The presence of a specific IgE antibody in the blood to the fish usually indicates an allergic reaction and not a toxic reaction due to the high levels of histamine.  Clusters of individuals exhibiting similar symptoms after eating the same meal generally points more to histamine poisoning rather than an allergic reaction.

The treatment of this condition involves medications that focus on the relief of symptoms. Antihistamines are useful in relieving the itching and rash.  Corticosteroids may be appropriate in certain more severe situations. Bronchospasm which may cause wheezing, shortness of breath, chest tightness, and/or coughing can be treated with albuterol inhalations. Rarely, some people may also need intravenous hydration.  Fortunately, most cases of histamine toxicity are self-limited and the symptoms often resolve spontaneously within 6 to 8 hours.

The prevention of acute histamine toxicity requires proper and continuous refrigeration of fish until the time of cooking.  This should prevent bacterial overgrowth and likewise the conversion of histidine to histamine.

The board certified allergists at Black and Kletz Allergy have 3 convenient locations in the Washington, DC metropolitan area.  The allergy doctors have been trained in providing allergy care for both adults and children.  They in fact have been diagnosing and treating adults and children with allergies for more than 50 years.  They will promptly answer any questions you may have regarding food allergies, food sensitivities, food toxicities, and related disorders.  The allergy specialists can also help you with other allergic conditions such as asthma, hives, swelling episodes, insect sting allergies, medication allergies, contact dermatitis, generalized itching, eczema, sinus disease, anaphylaxis, eosinophilic disorders, and immune disorders.

All 3 offices of Black & Kletz Allergy offer on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  Please call our office to schedule an appointment or alternatively, you may click Request an Appointment and we will respond within 24 hours by the next business day.

As we enter the grass season in the Washington, DC, Northern Virginia, and Maryland metropolitan area, it is interesting to note that grasses can cause a multitude of symptoms.  These symptoms may vary from mild to severe and are most notable from the months of May through July in the mid-Atlantic region.  Grasses have been implicated in a variety of disorders ranging from allergic rhinitis (i.e., hay fever), allergic conjunctivitis, asthma, urticaria (i.e., hives), pruritus (i.e., generalized itching), angioedema (i.e., swelling episodes), and anaphylaxis.

The most common disorder caused by exposure to grasses is allergic rhinitis.  Individuals with this condition experience symptoms which may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, sore throat, sinus congestion, sinus headaches, fatigue, and/or snoring.

Allergic conjunctivitis is manifested by itchy eyes, watery eyes, swollen eyes, and/or redness of the eyes.  It is not unusual for individuals with allergic conjunctivitis to experience the feeling of their eyes sticking together from copious amounts of discharge from the eyes.  Rarely, photophobia (i.e., sensitivity to light) may occur in severe cases.

Grasses may also exacerbate asthma symptoms in asthmatic patients.  These patients may experience wheezing, shortness of breath, coughing, and/or chest tightness when exposed to grass pollen.  Many of these individuals find it even more difficult to exercise outside when the grass pollen count it high. Such individuals should be encouraged to minimize their exposure to grass pollen as asthma may be life-threatening in severe cases.

Occasionally grass-allergic patients may develop itchy hives when exposed to high levels of grass pollen and/or when an individual’s skin comes in contact with grass.  These highly grass-allergic patients should be advised to avoid contact with grass, as occasionally the hives can progress to more severe life-threatening symptoms. People who play sports on grassy areas are particularly at risk for this type of reaction.

Similar to patients that develop hives on contact with grasses is a condition where individuals develop generalized itching of their skin without the accompanying rash or hives.  These patients should take the same precautions as the allergic individuals who develop hives from grass exposure.

Another related disorder that may occur upon exposure to grass is called angioedema.  Individuals with this entity may develop swelling of different body parts that either come in direct contact with grasses or are exposed to grass pollen by indirect contact.  Angioedema is a very serious sign, particularly since the swelling may occur internally, such as in the throat, which may obstruct an individual’s breathing. Patients with this disorder should be prescribed and taught how to use a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick).  If used, the patient is to go immediately to the closest emergency room.

On rare occasions a highly grass-sensitive individual may be exposed to an abundance of grass or grass pollen and develop anaphylaxis.  Activities that cause grass stains on the skin (e.g., football, rugby) are more likely to cause anaphylaxis then other activities where hard direct physical contact with grass is not common (e.g., tennis, basketball).  In any case, anaphylaxis is a medical emergency and anyone with anaphylaxis should be treated with epinephrine and be followed up immediately at the closest emergency room. It is imperative that these individuals carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick).

As one can see from the examples above, grasses may cause many different symptoms among a variety of conditions.  The symptoms may be mild, moderate, or severe. The board certified allergists at Black & Kletz Allergy have been treating individuals with grass allergies for over 50 years.  If you suffer from any of the symptoms above in the Spring or Summer, please call our office for an allergy consultation in order for us to determine if you have grass or other allergies that may cause any of the symptoms above.  We have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area with office locations 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.  Black & Kletz Allergy specializes in treatment of both pediatric and adult patients.  Alternatively, to schedule an appointment, you may click Request an Appointment and we will respond within 24 hours by the next business day.  The allergists at Black & Kletz Allergy pride themselves in providing superior allergy and asthma care in a professional and compassionate environment.

“Exercise-induced asthma” or “exercise-induced bronchospasm” is a condition in which individuals develop asthma symptoms only when exercising.  The bronchial tubes become narrowed making it difficult to move air out of the lungs. If one has chronic asthma however, one can still have their asthma triggered by exercising, but in addition, their asthma may be exacerbated by other factors such as allergies (e.g., dust mites, cockroaches, pets, molds, pollens), upper respiratory tract infections, cold air, hot air, increased or decreased humidity, cigarette smoke, diesel fumes, strong scents, and other irritants.  Many individuals with exercise-induced asthma are not diagnosed in a timely fashion since many clinicians do not recognize the condition.  It may go undiagnosed for years and the symptoms may be attributed to poor exercise tolerance or just being “out of shape.” Children often avoid exercise without telling anyone that exercise is bothersome.

The classic symptoms of exercise-induced asthma include wheezing, chest tightness, coughing, and/or shortness of breath.  Individuals with exercise-induced asthma generally develop asthma symptoms within 5 to 20 minutes after beginning their exercise.  It is also typical for them to have symptoms after they stop exercising. Exercise-induced asthma tends to occur more often on cold, dry days rather than on warm, humid days.

The diagnosis of exercise-induced asthma is made by way of a comprehensive history and physical examination in conjunction with pulmonary function tests.  It is also helpful for the patient to have a peak flow meter to use at home so that he or she can measure their outflow of air before and after exercise. A decrease in the peak flow while or after exercising helps the allergist determine if the patient is exhibiting an exercise-related decrease in air flow.  Other conditions that should be ruled out include cardiac disease, GERD (i.e., acid reflux), chronic sinusitis, chronic obstructive pulmonary disease , anxiety attacks, and vocal cord dysfunction, to name a few.

Although patients with exercise-induced asthma develop symptoms upon exercise, it is important that the patient understand that with treatment, it is usually possible to exercise.  In fact, exercise is generally encouraged in almost all individuals with this condition. There are many examples of famous athletes who have won Olympic Gold Medals, football championships, etc. that have had exercise-induced asthma.  It may be helpful for the some individuals to get an asthma action plan from their allergist so that he or she knows exactly what to do to treat or prevent the symptoms. In addition, the use of a short-acting beta-2 agonist rescue inhaler medication such as albuterol e.g., (Proventil, Ventolin, ProAir, Xopenex) about 30 minutes before exercise may prevent symptoms from developing.  If needed, the inhaler may also be used after symptoms occur if this plan is discussed and agreed upon with an allergist. There are other medications which can be utilized such as Singulair (i.e., montelukast) which have been shown to help prevent the symptoms of exercise-induced asthma. More severe cases may need inhaled corticosteroids in order to control the condition. In addition to medications, warm-ups and cool-downs may mitigate or even prevent symptoms.  It is also prudent to avoid exercising in the high pollen season if the individual is allergic to pollens. Avoidance of exercise is also recommended if the person is experiencing an upper respiratory tract infection or if the air is cold and dry.

The board certified allergy specialists at Black & Kletz Allergy are always available for our patients to ask any questions that they may have regarding asthma or allergies.  We have been treating pediatric and adult patients with exercise-induced asthma, as well as patients with chronic asthma, allergic rhinitis (i.e., hay fever), allergic skin conditions such as eczema and hives, insect sting allergies, medication allergies, eosinophilic disorders, other allergic maladies, and immune disorders for more than 5 decades.  We have 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking and 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 would like to be evaluated today for exercise-induced asthma or any other allergic or immunologic problem, please call us today.  You may also click Request an Appointment instead and we will respond to your request within 24 hours by the next business day.  The allergists at Black & Kletz Allergy pride ourselves in providing the highest quality asthma and allergy care in the Washington, DC metro area.

Molds are fungi that grow in the form of multicellular filaments that are called hyphae.  Fungi that grow in a single celled environment are called yeasts. Mildew is also a fungus that closely resembles mold; however, the color of mildew tends to be white whereas mold tends to be black, blue, green, or red.  Regardless, mold, mildew, and yeast can all play havoc to individuals who are either sensitive or allergic to them. Mold and mildew produce unwanted odors that many individuals find offensive or downright problematic as they can cause ailments to those exposed.

The physical appearance of molds usually is recognized by a discoloration and fuzziness presentation.  Molds can be found anywhere outdoors or indoors and are typically found on old or expired foods, rotten decaying debris (e.g. wet fallen leaves in the Fall, compost piles, grasses, rotting wood), and in places where increased moisture or water exists (e.g., basements, bathrooms, kitchens).  Molds produce mold spores which are their tiny microscopic reproductive structures. The size of a mold spore generally ranges from 3 to 45 microns in diameter which is less than half the width of a human hair. These spores begin to germinate and multiply. The spores multiply by producing reproductive hyphae.  They and are released into the air and given their microscopic size, they are able to float in the air sight unseen. Mold spores can grow in any environment with a constant source of moisture. There are even types of molds that can survive in very arid conditions such as deserts. During the growth process, mold spores begin to undergo chemical reactions that allow them to consume nutrients and further multiply.  These chemical reactions cause fumes to be released into the atmosphere. These fumes are responsible for the unpleasant musty mold odor. Of note, there are over 400,000 types of molds.

In the Washington, DC, Northern Virginia, and Maryland metropolitan area, the numbers of mold spores in the environment are generally higher than in many other parts of the country.  Washington, DC was built on a swamp. In addition, the Washington, DC metropolitan area tends to have a fairly high relative humidity when compared to many other areas of the U.S.  This combination exposes the residents of our metro area to a higher concentration of molds. In turn, it places us at a greater risk to develop mold allergies and other non-allergic mold-related conditions that may occur in sensitive individuals.  Non-allergic mold-related illnesses may result from either the growth of pathogenic molds within the body or from the effects of ingested or inhaled toxic compounds called mycotoxins which are produced by molds. The molds that produce mycotoxins can pose serious health risks to humans and animals.  Some studies claim that exposure to high levels of mycotoxins can lead to neurological problems and prolonged exposure may be particularly harmful. The research on the health effects of these types of molds has not been conclusive. The term “toxic mold” refers to molds that produce mycotoxins, such as Stachybotrys chartarum and not to all molds in general.

Mold allergies are very common and the symptoms are the same as other causes of hay fever (i.e., allergic rhinitis) and/or asthma.  The symptoms may include runny nose, sneezing, nasal congestion, post-nasal drip, itchy nose, itchy eyes, watery eyes, redness of the eyes, sinus headaches, wheezing, coughing, chest tightness, and/or shortness of breath.  Symptoms often worsen when a sensitive individual is in a damp or moldy environment such as a basement or crawl space.

Approximately 1-2% of patients with asthma have an allergic or hypersensitive reaction to a type of mold known as Aspergillus fumigatus.  Similarly, 2-15% of children with cystic fibrosis have the same reaction to this mold.  Aspergillus fumigatus is generally found in the soil.  Asthmatics and cystic fibrosis patients with that react to this mold have a condition called allergic bronchopulmonary aspergillosis (ABPA).  ABPA is more common in adolescents and male individuals.  The symptoms of ABPA are very much the same symptoms of asthma; however they may also cough up mucus with brownish flecks and may also have a mild fever.  The diagnostic workup may include radiographic studies, bloodwork, sputum culture, pulmonary function tests, and allergy skin testing. The treatment may involve the use of oral corticosteroids and/or antifungal medication in addition to the typical asthma medications such as corticosteroid inhalers, long-acting beta agonists, leukotriene antagonists, short-acting beta agonists, and/or theophyllines.

The diagnosis of mold allergy is done by a board certified allergist who will do a comprehensive history and physical examination.  Allergy testing to molds can be done via skin testing or blood testing.

Treatment of mold allergy should always begin by trying to prevent exposure to mold.  There are many things that can be done in one’s home or workplace that may help reduce one’s exposure.  Reducing the humidity, fixing any leaks, wearing a mask when doing yardwork, limiting outdoor activities when the mold counts are high, using air conditioning with a HEPA filter, installing a dehumidifier, and removing carpeting from places where it can get wet are some of the ways to reduce mold exposure.  The allergist may prescribe allergy medications (e.g., antihistamines, decongestants, nasal corticosteroids, nasal antihistamines, eye drops, leukotriene antagonists, asthma inhalers) to help alleviate one’s symptoms. Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are extremely effective in the treatment of mold allergy.  They are effective in 80-85% of the patients who take them. They have been utilized in the U.S. for more than 100 years and get more to the root of the underlying problem by causing an individual to develop protective antibodies against mold as well as other allergens (e.g., pollens, dust mite, pets, cockroach).

The board certified allergists at Black & Kletz Allergy have 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking and the Washington, DC and McLean, VA offices are also 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 at Black & Kletz Allergy diagnose and treat both adult and pediatric patients.  To make an appointment, please call our office or you may click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy have been helping patients with mold allergies and other causes of hay fever, asthma, hives, sinus disease, eczema, food allergies, medication allergies, insect sting allergies, and immunological disorders for more than half a century.  If you suffer from mold allergies or any other type of allergies it is our mission to improve your quality of life by reducing or preventing your undesirable and irritating allergy symptoms.

Sinuses are air filled cavities within the facial bones.  They are located behind the forehead (e.g., frontal), behind the eyes (e.g., ethmoid, sphenoid), and behind the cheek bones (i.e., maxillary).  The membranes lining the inside of these cavities secrete mucus which normally drains into the nasal cavity through small openings.

When the nasal cavity becomes inflamed (i.e., rhinitis) either due to allergen or irritant exposure or due to microbial infections, the pores through which the sinuses drain can become clogged.  This clogging of the pores may lead to the back up of secretions within the enclosed sinus cavities. Accumulation of mucus within the sinuses can result in proliferation of viruses and bacteria and can lead to chronic sinus infections (i.e., chronic sinusitis), defined as persisting sinus-related symptoms lasting for more than 12 weeks.

The common symptoms of a chronic sinus infection or chronic inflammation of the sinuses may include facial pressure/pain, headache, discolored nasal and post-nasal secretions, cough and/or malaise.  The diagnosis of this condition requires a detailed history of onset and progression of specific symptoms, a physical examination, and imaging studies such as sinus X-rays and/or CT scans.

Some common medical treatments of chronic sinusitis are as follows and may include combinations of the treatment regimens listed below:

Preventive measures for chronic sinusitis include identification of specific allergen sensitivities by allergy testing by a board certified allergist.  Allergy testing can be done by skin testing or blood testing depending upon the circumstance and age of the patient.  The aggressive treatment of allergic seasonal and/or perennial rhinitis (i.e., hay fever) promotes proper sinus drainage and improves upper airway function.

The board certified allergists and immunologists at Black & Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland  metropolitan area.  Our allergists have been treating chronic sinusitis as well as acute sinusitis and other sinus-related conditions for many years.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking and 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 or someone you know has an allergic condition that predisposes you to sinus problems or sinus infections, please make an appointment so that we may help you.  Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  The allergy specialists 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 and would be happy to provide allergy and sinus relief for you in a caring and professional atmosphere.

The common cold is the most common cause of a cough.  It usually subsides spontaneously after 2 to 3 weeks. However, a persistent cough may be the first sign of a more serious disease process.

A chronic cough (defined as lasting for more than 8 weeks in adults and more than 4 weeks in children) is one of the most common presenting complaints in ambulatory medical clinics across the country, according to the Centers for Disease Control (CDC).

Though they are a number of different causes for chronic cough, 4 conditions account for the vast majority of cases:

Additional causes may include:

An excessive or chronic cough can seriously impair the quality of life of an individual and lead to vomiting, muscle pain, rib fractures, urinary incontinence, fatigue, syncope, and/or depression.  Some of the “red flags” indicating a more serious issue may include an association of a cough with fever, weight loss, hoarseness, and/or blood in the sputum. When a cause is not obvious, a chest X-ray is usually obtained to rule out common infections, inflammatory conditions, and/or tumors.

UACS:  It is the most common cause of chronic cough.  The condition is a result of inflammation of the tissues inside the nasal cavity (i.e. allergic or non-allergic rhinitis).  The symptoms may include runny nose, nasal congestion, sneezing, and/or post-nasal drip but their absence does not exclude UACS.  Physical examination may reveal a pale and moist lining of the nasal cavity, swelling of turbinate tissues, redness and/or a cobblestoning appearance in the back of the throat.  Apart from specific treatments of identifiable causes, the symptoms can be relieved by a combination of decongestants, antihistamines, nasal sprays (e.g., saline, corticosteroids, antihistamines, anticholinergics).  Improvement in symptoms can take a few weeks after the initiation of treatment.

Asthma and/or COPD:  Close to one fourth of all cases of a chronic cough may be due to asthma.  The diagnosis is suspected when a cough is associated with chest tightness, shortness of breath, and/or wheezing.  However, a cough may be the only manifestation of asthma in some instances (i.e., cough variant asthma). The diagnosis is established by spirometry before and after the inhalation of a bronchodilator medication.  If inconclusive, asthma can be provoked by inhalation of a medication called methacholine, as part of a diagnostic work-up. Treatments may include inhaled corticosteroids, inhaled bronchodilators, oral anti-inflammatory medications, and rarely short courses of oral corticosteroids.  Cough and other asthma symptoms usually respond to therapy in less than a week.

Signs and symptoms suggestive of asthma may also occur in persons with COPD. Spirometry is diagnostic, and purulent sputum production may also be present. Treatment usually includes an inhaled bronchodilator, inhaled anticholinergic, inhaled corticosteroid, and occasionally a 1-2 week course of oral corticosteroids (with or without antibiotics).

Non-asthmatic eosinophilic bronchitis:  This condition is characterized by a chronic cough without evidence of airflow limitation on pulmonary function tests but the presence of eosinophils in the sputum.  This condition does not respond to inhaled bronchodilators but does respond to inhaled corticosteroids. Avoidance strategies are recommended when the inflammation is due to occupational exposure or inhaled allergens.

GERD/LPR:  Suspicion for these conditions arise when symptoms of heartburn, regurgitation, sour taste, and/or hoarseness are associated with a chronic cough. Consensus guidelines recommend empiric therapy for at least eight weeks in conjunction with lifestyle modifications such as dietary changes and weight loss.

Obstructive sleep apnea:  Obstructive sleep apnea usually presents with night time snoring, restless sleep, and/or daytime somnolence, however, cough can be a manifestation is some cases.  CPAP machines help to relieve the obstruction by forcing air through the upper airways.

ACE inhibitors:  A cough may begin as a side effect in about 10 to 20% of patients receiving these medications and is more common in women.  The cough may appear several months after beginning an ACE inhibitor which often makes it more difficult to diagnose. The only treatment of a cough caused by an ACE inhibitor is the discontinuation of the ACE inhibitor.  After discontinuing the ACE inhibitor, it may take 1-2 months for the cough to subside.

Children:

The most common causes of a chronic cough in children 6-14 years of age are asthma, protracted bacterial infections, and UACS.  Bacterial bronchitis generally requires a 2 week course of an antibiotic such as Augmentin in children who are not allergic to penicillins or clavulinic acid, the components of Augmentin.  UACS is rare in children younger than 6 years of age. Exposure to tobacco smoke, pets, and environmental irritants should be minimized. Of note, rarer conditions such as foreign body aspiration, congenital malformations, and certain immune disorders can also cause a chronic cough in children.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating chronic coughs in both adults and children in patients in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years.  Patients are carefully screened for allergies, asthma, GERD, upper respiratory tract infections, medication usage, sinus disease, and other causes of a chronic cough.  Black & Kletz Allergy has 3 offices in the Washington, DC metro area with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  We offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  If you suffer from a chronic or intermittent cough, please call us to make an appointment at one of our conveniently located offices.  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 confident that we will be able to help you identify the cause of your cough as well as treat the underlying condition in order to terminate your cough.

Now that it is officially Spring, many people will begin to feel the unwanted allergic symptoms of hay fever (i.e., allergic rhinitis).  In the Washington, DC, Northern Virginia, and Maryland metropolitan area the allergens responsible for these symptoms are mostly due to the tree and grass pollens.  If someone continually notices allergic symptoms throughout the year, then they may also be allergic to other allergens such as dust mites, molds, weed pollen, cats, dogs, and/or cockroaches.  The typical allergic symptoms that are characteristic for this time of year may include some or all of the following: runny nose, nasal congestion, post-nasal drip, sneezing, itchy nose, itchy eyes, watery eyes, puffy eyes, redness of the eyes, dark circles under the eyes, itchy throat, snoring, wheezing, shortness of breath, chest tightness, coughing, fatigue, headaches, sinus congestion, and/or sinus pain.

In many individuals, their underlying environmental allergies predispose them to sinus issues.  Patients with sinus problems should be skin tested for allergies to environmental allergens by an board certified allergist to see if there is an underlying allergy that is predisposing them to sinus symptoms.  In some, it is just a matter of experiencing mild sinus congestion, nasal congestion, post-nasal drip, and/or sinus pain.  Often there is associated discolored nasal mucus with colors ranging from light yellow to green to brown. In others, the sinus symptoms can be debilitating resulting in a poor quality of life.  Many develop sinus infections (i.e., sinusitis) as a result of their underlying allergic diathesis.  There are 3 types of sinusitis: acute sinusitis, chronic sinusitis, and recurrent sinusitis.  Below each one is discussed a little further:

Acute sinusitis:  This is the most common type of sinus infection.  It is usually caused by the development of an infection with either a virus, bacteria, fungus, or rarely a parasite.  Most cases of acute sinusitis are caused by viruses. Many of these infections are self-limited and they will resolve on their own.  It may be helpful to use saline irrigation, antihistamines, decongestants, mucus-thinning medications, nasal sprays, and/or over the counter analgesics in selected patients.  It is however not uncommon for a viral acute sinus infection to be secondarily infected with a bacteria. If this occurs, it is important that one see their board certified allergy doctor, as it is usually necessary in this case to treat the bacterial acute sinus infection with a course of antibiotics.  In recalcitrant cases, it may be necessary to use longer courses of antibiotics to completely rid the sinuses of the causative bacteria.

Chronic sinusitis:  This type of sinus infection is not as common as an acute sinus infection and usually results from a non-complete resolution of an acute sinus infection.  Chronic sinus infections are more difficult to treat, however, they can be eradicated most of the time. They are usually caused by bacteria or a fungus. The symptoms that one exhibits when they have a chronic sinus infection may be the same as with an acute sinus infection, however, the symptoms may be much more indolent.  It is therefore not uncommon for individuals with chronic sinus infections to only have one or more of the following non-specific symptoms: cough, sore throat, chest congestion, wheezing, and/or headaches. The diagnosis of chronic sinusitis may be difficult and elusive due to its non-specific symptoms that often present in these individuals.  The diagnosis is generally made by obtaining a CT scan of the sinuses. The treatment is usually a prolonged course of antibiotics for generally a 30 day course. It may be necessary to repeat another prolonged course of antibiotics if the symptoms resolve and then re-occur. In rare instances, sinus surgery may be needed. If one suspects a chronic sinus infection, it is necessary to see your allergist, so that treatment can ensue.

Recurrent sinusitis:  This type of sinusitis manifests itself as an acute sinus infection that is treated and re-occurs usually within 1-2 months of completing a course of antibiotics.  It can continue to re-emerge and it is not uncommon for some patients to have 6-8 sinus infections per year! In patients with recurrent sinusitis, it is imperative that they seek advice of a board certified allergist/immunologist like the ones at Black & Kletz Allergy who have decades of experience in diagnosing and treating these types of sinus problems.  In individuals with recurrent sinusitis, it is important for the allergist to do an immune workup, in addition to skin testing for environmental allergies, in order to ascertain if there is an immune deficiency.  If there is an immune defect, then intravenous immunoglobulin or subcutaneous immunoglobulin therapy can be implemented to “reverse” this immunodeficiency and thus prevent further sinus infections.

If you suffer from hay fever (i.e., allergic rhinitis), asthma, or sinus-related symptoms, please call Black & Kletz Allergy and schedule an appointment with one of our board certified allergists.  They specialize in both pediatric and adult allergy, asthma and immunology.  Black & Kletz Allergy has 3 locations in the DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All office locations have on-site parking and the Washington, DC and McLean, VA offices are also Metro accessible.  We also offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  In addition to calling one of our 3 office, 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 have been treating allergies, asthma, immune disorders, and sinus disease for more than 50 years.  We use the most current leading-edge diagnostic techniques along with the administration of a variety of medications in order to diagnose and treat each specific patient’s unique condition(s) that ultimately results in an improved quality of life for that individual.  We make it a point to cater specific therapies to each individual’s needs and desires.