Go to our "CLOSINGS" tab on our website to see our updated Coronavirus Policy

Blog

Holidays and Allergies

For many people with a history of allergies and asthma, a few precautions during the holiday season will ensure full enjoyment of the festivities.

  1. Food allergies:  There is usually some increase in the incidence of emergency room visits due to adverse reactions from foods during December and January.  While attending parties, a thorough reading of the labels of all foods consumed reduces the risk of allergic reactions.  For home-made dishes, the preparer should be made aware of the known allergies of all the attendees beforehand.
  2. Though the Christmas trees themselves are unlikely to be responsible for allergic reactions, they can carry different type of irritants and molds indoors.  Exposure to mold spores in sensitive individuals can trigger acute allergic reactions resulting in ocular, nasal, and sinus related symptoms.  Thorough shaking and cleaning of the trees before they are brought inside can help reduce the exposure.  In addition, many live trees have a strong pine-like scent that can act as an irritant to certain individuals.  Alternatively, one can use an artificial tree instead of a live tree.
  3. Artificial trees, ornaments, and other decorations stored in damp basements or attics can also gather dust and molds and trigger allergic reactions.  Storing these in dry and air tight containers will reduce the risks.
  4. Strong odors from incense, potpourri, plugged in room fresheners, cleaning chemicals etc. are known irritants for many sensitized people.  Smoke from burning candles and/or a fireplace is very deleterious for asthmatic individuals.
  5. A seasonal increase in the prevalence of certain viruses and bacteria, coupled with overcrowding in closed spaces during holiday gatherings, are responsible for an increase in respiratory infections, which can aggravate asthma and may precipitate an acute attack.  Frequent hand washing, avoidance of contact with “sick” people, and vaccinations against communicable diseases can help prevent infections.
  6. While travelling, please always remember to pack your regular medications.  Do not forget to pack rescue inhalers and self-injectable epinephrine devices (e.g., EpiPen, Auvi-Q).

The board certified allergists and staff and Black & Kletz Allergy are always available to answer your questions and address your concerns.  We have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our office locations are in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  Our McLean office has a free shuttle between our office and the Spring Hill metro station on the silver line.  If you would like an allergy consultation with us, please feel free to call us or alternatively, you can click Request an Appointment and we will respond within 24 hours on the next business day.  We treat both adults and children and have been serving the greater Washington, DC area for over 5 decades.

Over-The-Counter Allergy Medications and Their Possible Side Effects

Any Arlington allergist can tell you: millions of allergy sufferers reach for over-the-counter (OTC) allergy medications daily to try to get relief from their allergy symptoms. There are numerous medications available and they come in a variety of routes of administration. The medicines come in the forms of tablets, capsules, syrups, powders, nasal sprays, eye drops, creams, ointments, and inhalers.

Most OTC medications use additional ingredients, referred to as inactive ingredients, which may include preservatives, coatings, dyes, lubricants, sweeteners, flavoring agents, and binding materials. Not all inactive ingredients are always inactive. Alcohol is added to some OTC medications and may be inactive or active. Alcohol is often found in OTC cough syrups which many allergy patients use. Some individuals have allergic reactions and/or untoward side effects to some of these inactive ingredients. Common inactive ingredients that cause reactions for some individuals include: aspartame, benzoates, benzyl alcohol, sulfites, benzoates, lactose, oleic acid, propylene glycol, saccharin, sorbitan trioleate, and soy lecithin. There are over 450 inactive ingredients used in OTC medications.

Many individuals can also have allergic reactions and/or unwanted side effects from the active drug found in OTC allergy medications. The active drug is the drug that is meant to “work” on the symptoms. An allergic reaction to a drug can occur with any drug and usually involves symptoms that may include: hives (urticaria), itching (pruritus), swelling (angioedema), rashes, abdominal discomfort, nausea, vomiting, wheezing, shortness of breath, throat closing sensation, chest tightness, itchy eyes, watery eyes, redness of the eyes, itchy throat, and anaphylaxis (a life-threatening systemic allergic reaction).

OTC allergy medications can be even more confusing since many of them contain more than one active drug. An example of a single drug medication is Claritin, which contains loratadine, whereas an example of a medication that has 2 drugs is Claritin-D, which contains both loratadine and pseudoephedrine. There are many OTC allergy medications that contain more than 3 drugs in a single pill. To the average consumer, whose knowledge of the field of medicine is rudimentary, this can present a potentially serious problem. In the example used above with Claritin and Claritin-D, any allergist in Arlington will agree that a person with high blood pressure (hypertension) and/or heart disease should not take the Claritin-D because the active ingredient, pseudoephedrine, can elevate one’s blood pressure and increase their heart rate. It should also not be taken in individuals with an enlarged prostate, glaucoma, kidney disease, and/or overactive thyroid (hyperthyroidism). In a healthy person, it usually is not a problem; however, in patients with the diseases listed above, it can potentially be devastating.

Another potential problem with using OTC allergy medications involves the interactions they may have with other medications that the individual may be taking. These other medications may be prescribed or they may interact with other OTC medications. Certain medications may diminish the efficacy of other medicines causing them not to work as well as they were intended. On the other hand, certain medicines can have the opposite effect and increase the effect of another medicine making it potentially dangerous as well. An example of the latter would be an individual with attention deficit hyperactivity disorder (ADHD) who takes the medication Adderall (mixture of the salts of amphetamine and dextroamphetamine) with the OTC medication pseudoephedrine (e.g., Sudafed). The pseudoephedrine could potentiate the effect of the Adderall or vice versa. Therefore, an understanding of pharmacology is recommended for self-medicating.

Drugs tend to be classified in “classes.” For example, beta blockers, angiotensin inhibitors, and calcium channel blockers are 3 common classes of high blood pressure medications. Likewise, penicillins, macrolides, and quinolones are 3 common classes of antibiotics. Individuals who are allergic to a drug in a particular “class” of medications tend to be more likely to have an allergy to another drug in that same “class.” For example, someone who is allergic to amoxicillin is more likely to be allergic to another penicillin derivative such as ampicillin. An individual that has a known allergy to a drug may take an OTC allergy medication that may contain an active or inactive ingredient that may be in the same “class” as that drug. The person may not have checked the ingredients in the OTC medicine, may not have known that the OTC medicine was in the same “class,” or more likely, did not even know about cross-reactions to medications within “classes.” A good example of this would be when someone takes a sinus relief allergy OTC medication that contains ibuprofen. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) which is also known under the brand names Advil, Motrin, Nuprin, as well as many other names. That individual may have known that he/she was allergic to naproxen (e.g., Naprosyn, Aleve, Anaprox) but did not know to avoid that “class” of medications, namely NSAIDS’s or he/she did not know that the generic name for Advil was ibuprofen.

In addition to the above reasons to be careful when using OTC allergy medications, one must recognize that there are side effects that are not allergic in nature, but still affect average people in different ways. It is fairly common for many OTC allergy medications to cause drowsiness. There are typically warnings on the sides of the boxes or bottles, but one may become extremely drowsy to a medication whereas someone else may have no drowsiness to the same dose of the same medication. Still others may have a paradoxical effect where it causes them to feel “hyper” and “agitated” like the feeling of too much caffeine (which by the way, is also used in a great deal of OTC allergy and sinus medications).

Even though OTC allergy medications can be beneficial, one must use caution when using them. There are other side effects not listed in this article, but this article is meant to warn people about the possibility of having potentially serious reactions from OTC allergy and sinus medications. If you have allergies and need advice on any type of medication whether OTC or prescribed, please feel free to make an appointment for a consultation with our board certified Arlington allergists at Black & Kletz Allergy. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All our offices have on-site parking and the Washington, DC and McLean offices are Metro accessible. There is a free shuttle that brings patients back and forth between our McLean office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment and we will respond within 24 hours on the next business day. We treat both adults and children and have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years.

Spring Allergy Doctor Washington DC

Black & Kletz Allergy has a full time Spring allergy doctor Washington DC residence trust for the past few decades serving the greater Washington, DC metropolitan area. Some of the conditions diagnosed and effectively treated by our Spring allergy doctor Washington DC inhabitants admire are hay fever (i.e., allergic rhinitis, allergic conjunctivitis), asthma of various degrees of severity, acute and chronic urticaria (i.e., hives), angioedema (i.e., swelling of soft tissues), atopic dermatitis (i.e., eczema), and contact dermatitis (e.g., poison ivy, poison oak, poison sumac). In addition, the Spring allergy doctor Washington DC admires also treats food, insect venom, and medication allergies.

Long-term nasal congestion, copious rhinorrhea (i.e., clear runny nose), sneezing, itchy eyes, red eyes, watery eyes, and itchy throat are some of the symptoms that the Spring allergy doctor Washington DC trusts is experienced in. These symptoms are usually a result of sensitization to the tree and grass pollens. Birch, oak, elm, hickory, and cottonwood are some of the trees that pollinate in the Spring in Washington, DC. Tree pollen usually begins to pollinate in early to mid-February in the Washington, DC, Northern Virginia, and Maryland metropolitan area. It peaks in early April and gradually subsides by mid-May. Timothy, Kentucky blue, orchard, rye, and Bermuda grasses are some of the types of grasses that grow in our area. The grass pollen usually begins to pollinate in early April, peak in early May and gradually subsides by mid-July.

In genetically predisposed individuals, the immune system considers the pollen as potentially dangerous and mounts a defensive attack on the pollen. This “allergic reaction” results in a release of several chemicals, predominantly histamine, into the tissues, causing unpleasant allergy symptoms and causing misery to those inflicted with allergies and/or asthma.

For people who are sensitized to these pollens and suffer from these symptoms every year, the Spring allergy doctor Washington DC respects, who can be seen at any of Black & Kletz Allergy’s offices, offer the necessary diagnostic and treatment services. The diagnosis begins with obtaining a comprehensive history of the specific symptoms, their severity, frequency, and duration, followed by a thorough physical examination.

The Spring allergy doctor Washington DC trusts will probably perform prick skin testing with the common pollen antigens, where a small amount of the liquid antigen is introduced into the superficial layers of the skin with a plastic tooth pick-like lancet. The Spring allergy doctor Washington DC respects will then interpret the results after approximately 20 minutes by measuring the size of the wheal (i.e., small swelling) and flare (i.e., redness surrounding the test site). These measurements are then compared with the positive and negative control test results. A wheal diameter of more than 3 mm more than that of the negative control is generally considered a positive test.

A detailed explanation of the test results will be provided by the Spring allergy doctor Washington DC residents admire to the patient. Various ways of avoiding exposure to the offending agents such as pollen, dust mites, mold spores, and animal dander by way of targeted environmental controls will be explained by the Spring allergy doctor Washington DC inhabitants trust.

There are several medications both over the counter and by prescription that can be used to mitigate the symptoms of allergies. These medications may include oral pills, nasal sprays, and eye drops, among others. The Spring allergy doctor Washington DC trusts will give information about the over-the-counter medications and provide prescriptions where needed.

Many patients continue to have annoying symptoms in spite of rigorous environmental controls and proper medications. Some of them cannot tolerate the side effects of medications or do not like taking long-term medications. For those patients, the Spring allergy doctor Washington DC residents have confidence in offers a very effective long-term treatment approach called allergy immunotherapy. Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a process of desensitization by which the immune system learns to tolerate exposure to the previously sensitized substances instead of adversely reacting to them. This treatment method entails exposing the immune system to gradually increasing doses of the antigens at regular intervals beginning with a very small dose. At the end of the process, the patient notices a substantial reduction in the frequency and severity of the symptoms, decreased need for medications, and improvements in the quality of life. The average length of treatment is 3-5 years. Allergy immunotherapy works in 80-85% of the individuals who get the treatment.

Seasonal allergic sensitivities also play a role in flaring up asthma symptoms in susceptible individuals. At Black & Kletz Allergy, the Spring allergy doctor Washington DC inhabitants trust has the necessary knowledge, skillset, and long-term experience necessary to effectively manage allergic rhinitis, allergic conjunctivitis, and asthma, as well as other related disorders. The supporting staff working with the Spring allergy doctor Washington DC residents trust undergo rigorous training in order to provide the service needed to diagnose and treat allergies, asthma, and immunological disorders to state-of-the-art standards in a courteous and caring manner at Black & Kletz Allergy.

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 your allergy and asthma 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. To make an appointment, please call 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 metropolitan area residents for which we have done for more than 5 decades.

Allergist Northern VA

Hay fever and asthma are the most common conditions treated by allergists in the Washington, DC, Northern Virginia, and Maryland metropolitan area.

“Hay fever” is a colloquial term used to describe symptoms caused by allergic rhinitis (i.e., inflammation of the tissues inside the nostrils). An allergist northern VA residents trust is a physician who is an expert and who has received special training in diagnosis and treatment of allergic rhinitis. Our board certified allergist that northern VA inhabitants admire, treats patients at Black & Kletz Allergy. Our allergist has many years of experience in treating both allergic and non-allergic rhinitis as well as many other related conditions such as asthma, hives, sinus problems, and immunological disorders.

Allergic rhinitis is caused by the sensitization of our immune system to allergens in the environment. Re-exposure to these allergens is the actual trigger for symptoms. Allergens include indoor agents such as dust mites, mold spores, and animal dander, as well as outdoor allergens such as pollen from trees, grasses, and weeds. Irritants are agents that can trigger the same symptoms as allergens, however, they do not technically cause allergic reactions like allergens. The symptoms caused by irritants are said to induce non-allergic rhinitis instead of allergic rhinitis which is as previously mentioned caused by allergens. Some examples of irritants may include smoke, chemical sprays, strong odors, exhaust fumes, and other pollutants.

Our allergist northern VA residents respect can test individuals with allergy symptoms in order to identify their specific triggers. Our allergist northern VA inhabitants trust may prescribe various medications such as oral antihistamines, oral leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, and a variety of ocular medications in order to alleviate the unwanted allergy symptoms and improve their quality of life. Our allergist northern VA residents have confidence in can also desensitize individuals to allergens so that their symptoms can be lessened and their medication can be reduced or eliminated.

At Black & Kletz Allergy, asthma is another condition that our allergist northern VA inhabitants trust has expertise in diagnosing and treating. Our allergist northern VA residents admire has many years of experience in treating both allergic and non-allergic asthma.

Both indoor and outdoor allergens play a role in aggravating allergic asthma. Exposure to non-specific irritants such as smoke and strong chemicals can also trigger asthma flare-ups and result in emergency room visits. Coughing, wheezing, chest tightness, and shortness of breath are some of the most common symptoms of asthma. Too many patients end up in emergency departments of hospitals. Many of them require hospitalizations for the management of severe asthma. It is our goal at Black & Kletz Allergy to prevent the need for hospital visits for asthma. Our allergist northern VA residents respect can help in identifying the triggers, minimizing the symptoms and preventing emergency room visits and hospitalizations by prescribing medications and providing an individualized asthma treatment plan.

Our allergist northern VA inhabitants have confidence in also treats hives (i.e., urticaria). Hives or “welts” are itchy, red, swollen blotches on the skin of various sizes and shapes which can occur anywhere on the body. They can last from minutes to days and can be very frustrating for the patient. The condition may last from days to years. Hives interfere with day-to-day activities and may also affect one’s sleep at night. They can be caused by allergies to foods and medications, as well as be triggered by infections. There are numerous causes of hives that need to be addressed when seeing an allergist.

Our allergist northern VA residents trust will perform a comprehensive history in order to try to identify a cause of the hives. History taking is supplemented by a thorough physical examination. Our allergist northern VA residents respect may also order laboratory tests which may help in the diagnosis. The cause however may remain unidentifiable (i.e., idiopathic) in a majority of instances where the hives are of a chronic nature. For acute cases of hives, the likelihood of establishing a cause is much greater than for chronic cases. Our allergist northern VA inhabitants admire has specialized training and long-term experience in identifying the possible cause(s) of hives. It should be noted that even when the cause cannot be identified, our allergist northern VA residents respect can usually provide relief from the annoying symptoms of hives, by prescribing a variety of helpful medications.

The allergists at Black & Kletz Allergy treat both adult and pediatric patients. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our office locations have on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and the McLean, VA office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line. You may also click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been a fixture in the greater Washington, DC, Northern Virginia, and Maryland metropolitan community for over 50 years for our outstanding services for the diagnosis and treatment of allergies, asthma, and immunological disorders.

Respiratory Infections and Asthma

As we enter into the “cold and flu” season, children and adults with a history of asthma may experience an increase in the frequency and severity of their asthma symptoms triggered by these infections.

Most of us have to contend with a few upper respiratory infections (e.g., cold, flu, sinusitis) each year. Viruses are the usual culprits and the rhinovirus is the most common virus causing upper respiratoryinfections in all age groups.  Respiratory syncytial virus (RSV) usually affects the upper and lowerrespiratory tracts in infants and young children.

Upper respiratory tract infections are usually mild self-limited illnesses in otherwise healthy children and adults.  The common symptoms of nasal congestion, runny nose, post-nasal drip, sneezing, sore throat, achiness, and an occasional dry cough may last for about a week.  However, in individuals with a history of asthma, these infections can trigger a flare-up of their asthma by causing wheezing, coughing, chest tightness, and/or shortness of breath.  Once the asthma symptoms are triggered, they can linger for several days to weeks, even after recovery from the infection.

Viral infections also can predispose one to secondary bacterial infections which can lead to complications like sinus infections causing discolored nasal discharge, facial (sinus) pressure and pain, persistent mucus drainage into throat, and coughing.  Fever, chills, night sweats, fatigue, coughing up discolored sputum, and/or soreness in the chest while breathing, may be indicative of pneumonia. A few precautions may help prevent or alleviate respiratory infections and reduce the risk of asthma exacerbations:

  1. Viruses causing respiratory infections are highly contagious.  Avoid contact with others with active infections can minimize the risk of contracting the illness.
  2. Wash hands frequently with soap and water.  This will eliminate most germs causing infections. Hand sanitizers are useful while traveling.
  3. Refrain from touching one’s eyes, nose, and mouth which can minimize the germs from entering into the body.
  4. An annual influenza vaccine (i.e., flu shot) is highly recommended in all children (above 6 months of age) and adults with asthma.  FluMist (the flu nasal spray vaccine) is not indicated in asthmatics and only approved for use in persons 2 through 49 years of age.
  5. Many children and adults also benefit immensely from a pneumonia vaccine to prevent bacterial infections from pneumococcus, a type of bacteria that causes respiratory tract infections.  The two most common vaccines available are Prevnar 13 and Pneumovax.  It is important to check with your primary care physician to check for documentation of what type of pneumonia shot you may have had and when it was administered.  Depending on this information, your physician will recommend which type of pneumonia vaccine may be needed and when it should be given.  The age of the patient, underlying diseases, and history of previous vaccinations all will play a role in determining what, when, and if the vaccine is needed.
  6. Rest, drinking plenty of fluids, and the use of certain over the counter medications may alleviate some of the symptoms.
  7. Prescription antiviral medications [i.e., Tamiflu (oseltamivir), Relenza (zanamivir), Rapivab (peramivir)] can reduce the duration of the flu and they may also decrease the risk of an increase in asthma symptoms.
  8. Monitoring peak flows is helpful in predicting asthma exacerbations.
  9. If the infection ends up triggering asthma symptoms, one should begin using a rescue inhaler or nebulized medications at regular intervals for symptom relief.
  10. Either initiating the preventative controller medications or increasing their doses at the onset of cold or flu symptoms, (as directed by the physician), may be useful in preventing or reducing the severity of asthma flare-ups triggered by viral infections.

The board certified allergists of Black & Kletz Allergy have been treating adult and pediatric patients with asthma for over 5 decades.  We are very familiar with upper respiratory tract infections as well as other triggers that cause asthma exacerbations.  In addition, we also treat all kinds of upper respiratory infections.  Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have convenient offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our offices in Washington, DC and McLean, VA are Metro accessible with free shuttle service between the Spring Hill metro station and our McLean office.  All 3 locations offer on-site parking.  To make an appointment, please call us, or alternatively you can click Request an Appointment and we will respond within 24 hours on the next business day.  The allergy doctors at Black & Kletz Allergy strive to manage your asthma to your utmost satisfaction in a professional caring environment.

Pink Eye: Allergies or Infection?

Conjunctivitis is the term used to describe the inflammation of the transparent membrane that lines the inside of the eyelids and the eyeballs. Inflammation leads to widening of the small blood vessels in the membrane which causes the redness of the eyes.

Various types and causes:

  1. Allergic Conjunctivitis: Some of us are genetically predisposed to form antibodies called IgE (as opposed to infection fighting antibodies called IgG) against common environmental agents like pollen, dust mites, molds, and animal dander. When these agents come in contact with the conjunctival membrane, the IgE interacts with them causing chemicals like histamine to be released from certain cells. These chemicals produce symptoms like itching, redness, excessive tearing, etc. Pollens from trees and grasses cause these symptoms mainly in spring and pollen from ragweed causes the fall symptoms, whereas indoor allergens like dust mites, pets, and cockroach cause symptoms throughout the year. This allergic eye condition is very common.
  2. Vernal Keratoconjunctivitis: This allergic eye disorder causes long term and severe inflammation of the conjunctivae which is typically seen around the spring and the summer. It is rare in cold climates and much more common in subtropical and tropical areas. It predominantly involves pre-pubertal boys and usually resolves itself after a few years. Patients frequently have a personal or family history of allergic rhinitis, asthma, and/or eczema. In addition to redness and intense itching, a thick ropy discharge from the eyes is a common feature. The insides of the eyelids appear like a cobblestone due to swollen tissues. The junction between the white part and the iris (the part of the eye that is usually brown, blue, hazel, etc.) of the eye called the limbus also becomes swollen and looks more prominent. In about 6% of individuals, it can affect the cornea, which may cause photophobia (difficulty in looking at bright light) and can lead to corneal scarring, glaucoma, or cataracts, resulting in decreased vision and/or blindness. In these cases laser therapy and/or surgical intervention may be necessary to treat the corneal involvement.
  3. Atopic Keratoconjunctivitis: This allergic eye condition is usually associated with eczema of the skin in various parts of the body. The skin over the eyelids is often involved causing swelling and excessive wrinkling of the skin. The predominant symptom is severe itching of the skin over the eyelids (more commonly involves the lower eyelids on both sides). Atopic keratoconjunctivitis usually starts in second or third decade of life and can become less or more severe over the years, often paralleling the activity level of skin eczema. The symptoms are perennial in nature with this disorder. It is also more common in individuals who have asthma and/or allergic rhinitis. As with vernal keratoconjunctivitis, in some individuals, it may affect their cornea which can cause photophobia and potentially lead to decreased vision and/or blindness by causing scarring of the cornea.
  4. Giant Papillary Conjunctivitis: Excessive tissue growths called papillae form under the upper eyelids on both sides causing severe itching and discomfort, a foreign body sensation, and/or blurry vision. There is often a ropy discharge from the eyes in this allergic eye condition. This condition is thought to result from an allergic reaction either to contact lenses or to the solution used to clean the lenses. Deposits over the contact lenses in conjunction with constant rubbing with the insides of the lids lead to friction and severe irritation eventually leading to the formation of large papillae.
  5. Reactive Conjunctivitis: Excessive sensitivity to chemicals in swimming pools, fumes, smoke, foreign bodies, etc. can result in irritation of the conjunctivae causing redness, burning, and/or watery eyes.
  6. Infectious Conjunctivitis: This highly contagious form of eye infection is most commonly caused either by a virus or bacteria. Viral infections generally produce copious amounts of clear discharge from the eyes in addition to redness and itching. Bacterial infections, on the other hand, are usually associated with thicker and discolored secretions. Dried up secretions cause the eyelids to mat together making it difficult to open one’s eyes in the morning. Apart from redness and a gritty feeling in the eyes, some people also experience photophobia. Infectious conjunctivitis tends to affect one eye more often than allergic eye disorders which usually involve both eyes. Nevertheless, infectious conjunctivitis may also affect both eyes. Most infections resolve spontaneously in about a week to ten days, though the duration of the bacterial conjunctivitis can sometimes be cut short by using antibiotic eye drops.

Treatment:

Avoidance of exposure to the known triggering agents is the predominant modality of prevention, as is the case with most other allergic disorders.

Antihistamine pills and/or eye drops are helpful in relieving the itching and redness of the eyes. It should be noted that some types of over the counter eye drops containing medications that constrict the blood vessels may cause rebound symptoms which may paradoxically worsen the condition over the long term. In severe cases unresponsive to antihistamines, steroid and non-steroidal eye medications may need to be employed to provide relief. Allergy immunotherapy (i.e., allergy shots, allergy injections) is very effective in the treatment and prevention of various allergic eye disorders. Laser and/or surgical intervention may occasionally be necessary in cases of corneal involvement with both vernal keratoconjunctivitis and atopic keratoconjunctivitis.

The board certified allergists at Black & Kletz Allergy have decades of experience and expertise in evaluating and treating the various conditions which cause itching, redness, and/or excessive discharge from the eyes. We see both adults and children and have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area, with on-site parking at all 3 offices. The Washington, DC and McLean, VA locations are also Metro accessible with a free shuttle that takes patients to and from the Spring Hill station to our McLean, VA office. If you are suffering from any one of the eye symptoms mentioned above or any other allergy symptoms, please call our office for an appointment. Alternatively, you can click Request an Appointment and we will respond back to you within 24 hours of the next business day.

Exercise-Induced Hives, Angioedema, Anaphylaxis, and Asthma

In a small percentage of individuals, exercise can cause an array of allergic symptoms ranging from itching, to hives, to swelling episodes, to asthma symptoms, to a life-threatening anaphylactic reaction. The reactions can occur either during or after exercise. If you are experiencing any allergic symptom associated with exercise, you should see a board certified allergist.

In a subset of the population, exercise can induce generalized hives. This is called “exercise-induced urticaria.” The hives are itchy and can range in size from small red dots to large “welts” resembling mosquito bites. Other associated symptoms may include flushing, headache, and/or abdominal cramping. Individuals with this condition can develop hives when participating in exercise of any severity, but they tend to have more episodes when involved with moderate exercise such as jogging or running. In addition, aspirin and/or NSAID’s (i.e., ibuprofen, naproxen, diclofenac) and/or exercising in warm, humid, and/or cold climates, may increase the likelihood of developing hives in certain individuals. There is even a smaller population of individuals that have “food-dependent exercise-induced urticaria.” In this variant, individuals will get hives only if they eat a specific food and exercise within a certain amount of time (usually within 5 hours). This group of people can eat that specific food without problems and they can exercise without problems, but if they eat that food and exercise within 5 hours, they will get hives. The most commonly associated food linked with this condition is wheat. Other foods that have been most associated with food-dependent exercise-induced urticaria include crustaceans, buckwheat, celery, tomatoes, dairy products, chicken, octopuses, squid, and/or grapes, however, any food may cause this condition. There is an even a smaller population of individuals that develop hives after eating any food within 5 hours of exercising. Luckily, this condition is even rarer.

“Exercise-induced angioedema” is identical to exercise-induced urticaria except instead of developing hives, one develops swelling of a particular part of their body (usually of the face, lips, tongue, and/or eyes). This can be more serious if the swelling occurs in the throat which can lead to shortness of breath and complete constriction of the throat.

“Exercise-induced anaphylaxis” is a life-threatening condition that needs immediate attention. It essentially is the same condition as exercise-induced urticaria and exercise-induced angioedema, however, other systemic symptoms occur in addition to the itching, hives, flushing, and/or swelling. These systemic symptoms may include wheezing, shortness of breath, constriction of the throat, abdominal pain, diarrhea, vomiting, headache, anxiety, rapid or slow pulse rate, drop in blood pressure, and/or shock. Like exercise-induced urticaria and exercise-induced angioedema, exercise-induced anaphylaxis can be triggered by certain foods in select individuals. This condition also may be more likely to occur in individuals using aspirin and/or NSAID’s and/or exercising in warm, humid, and/or cold climates.

“Exercise-induced asthma” manifests itself with asthma symptoms such as shortness of breath, wheezing, chest tightness, and/or cough. It occurs much more frequently during exercise in allergic individuals and/or asthmatics compared to nonallergic and/or nonasthmatic individuals. However, it is important to note that even in these nonallergic and/or nonasthmatic people, exercise can still cause asthma symptoms. The asthma symptoms typically begin within 10-20 minutes after the start of exercise, but may not occur until 5-10 minutes after the conclusion of exercise. Exercising in the cold air is a common trigger. Air pollution, high pollen or mold levels and upper respiratory tract infections (e.g., sinus infections, “colds”, flu) also predispose a person to exercise-induced asthma. Warming up and cooling down exercises before and after exercise may decrease the likelihood and/or severity of the asthma symptoms.

Although each one of the above conditions is unique, they are all similar with respect to exercise as being the primary trigger. They all can be very serious and dangerous. At Black & Kletz Allergy, our board certified allergists have been treating both adults and children with exercise-induced conditions for over 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We perform a comprehensive history and physical examination in conjunction with allergy skin and/or blood testing, pulmonary function testing, and/or other non-allergic blood testing to obtain an accurate diagnosis. We will discuss non-medication preventive measures with you as well as provide you with prescriptions for the necessary medications (e.g., EpiPen, antihistamines, asthma inhalers) to help prevent and/or treat your condition. Black & Kletz Allergy has office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking. The Washington, DC and McLean, VA offices are also Metro accessible. If you have exercise-induced allergy or asthma symptoms, please call for an appointment or alternatively, you can click Request an Appointment and we will respond within 24 hours on the next business day.

Can Allergies Cause Flushing?

Flushing occurs when the blood vessels dilate and increase the blood supply to the skin. It is manifested as rapid reddening of the skin usually associated with a feeling of warmth. The episodes usually last for a few minutes at a time, but can last longer. If the blood vessels are dilated due to the activity of the nerves on them, flushing is also accompanied by sweating. Irritant chemicals and allergens may also directly act on the vessels producing “dry” flushing. Common triggers of flushing:

Eating:

  • Hot beverages and/or spicy food may cause flushing in normal people.
  • “Gustatory” flushing usually involves the face and can be associated with increased tear production, salivation, and nasal secretions, commonly seen after eating a hot pepper.
  • Injury to a parotid gland (a salivary gland) can cause flushing, warmth and sweating on one side of the face. This is called “Frey’s Syndrome” or “Auriculotemporal Nerve Syndrome.”
  • “Dumping syndrome”: Flushing of the face, sweating, diarrhea, increased heart rate, and fatigue may occur after eating a meal in people who have had certain types of surgeries on their stomachs.

Alcohol:

  • Certain fermented alcoholic beverages like beer and wine contain tyramine or histamine, which can cause flushing reactions.
  • Some Asians have a defective enzyme which leads to a build-up of acetaldehyde which causes flushing after consumption of alcohol. It is referred to as the “Asian Flush Syndrome.”
  • A few drugs like Antabuse (disulfiram), Flagyl (metronidazole) and cephalosporin antibiotics can also contribute to alcohol-induced flushing when used with alcohol.

Food additives:

  • “Chinese restaurant syndrome” refers to generalized flushing caused by MSG (monosodium glutamate) which is used a lot in Chinese restaurants in the U.S.
  • Sulfites, especially potassium metabisulfite, used as a preservative in beers, dried fruits, ciders, dairy products, wines, shrimp, and canned fruit and vegetable products, can induce flushing and wheezing. Asthmatics and people with aspirin sensitivity are more likely to react to sulfites.
  • Nitrites and nitrates in cured meats may cause flushing and headache in susceptible individuals.

Drugs:

  • Niacin (nicotinic acid) present in many multi-vitamin preparations in large doses can result in recurrent flushing. These episodes can be effectively blocked by aspirin or ibuprofen.
  • Medications used to lower blood pressure like vasodilators and calcium channel blockers, thyroid hormones and certain oral steroids can also produce flushing.

Neurologic causes:

  • Anxiety
  • Migraines
  • Spinal cord lesions above T6 level
  • Brain tumors
  • Parkinson’s disease

Menopause:

  • About 80% of postmenopausal woman have flushing associated with sweating.

Rosacea:

  • Chronic flushing from any cause can develop into rosacea. Individuals with rosacea typically have flushing of the cheeks and nose and occasionally on other areas of the face.

Scombroid fish poisoning:

  • Bacteria acting on inadequately refrigerated fish like mackerel, tuna, etc. convert the naturally occurring amino acid, histidine, in the fish to histamine which causes abdominal cramping, diarrhea, vomiting, hives, and flushing on consumption. The histamine can survive cooking so cooked and even canned tuna may also cause facial flushing.

Mastocytosis:

  • High levels of circulating histamine released from excessive numbers of mast cells in one’s body causes flushing, fainting, and shortness of breath.

Tumors:

  • Carcinoid tumors, (mostly of the stomach, small intestine, pancreas, ovaries, testis, and lung) can cause flushing in addition to wheezing, sweating, diarrhea, shortness of breath, palpitations of the heart, and abdominal cramping. If the primary tumor metastasizes to the liver, serotonin production is increased which causes severe flushing reactions.
  • Adrenal tumors like pheochromocytoma secrete catecholamines (epinephrine and norepinephrine) which induce flushing episodes.
  • Brain tumors

As the treatment depends on the cause, an attempt should be made to establish the precise underlying cause in all cases of recurrent flushing reactions with help of a detailed history, physical examination, and relevant blood and urine tests. The board certified allergists at Black & Kletz Allergy have had many decades of experience diagnosing patients who suffer from flushing. Once the cause is identified, the patient is told to avoid the offending trigger or they are referred to the appropriate specialist to treat the underlying condition. If you suffer from flushing, please do not hesitate to call us at Black & Kletz Allergy for an appointment. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA, all with on-site parking. Our Washington, DC and McLean, VA locations are also Metro accessible. Alternatively, you can Request an Appointment and we will respond within 24 hours of the next business day.