Category Archives: BLOG

Exercise-Induced Hives, Angioedema, Anaphylaxis, and Asthma

October 2, 2015
BY BLACK & KLETZ ALLERGY

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.

Mosquito Bite Allergy

Signs and Symptoms

Although mosquito bites are quite common among the general population, allergies to mosquito bites are luckily rather rare. Most individuals experience localized itching, swelling, and/or redness of the skin at the site of the bite. However, if someone is allergic to the mosquito, they may have more severe skin reactions which can include extremely large areas of swelling and redness, blistering, and/or bruising. In rare cases, some individuals may experience anaphylaxis (a severe life-threatening systemic reaction) after a mosquito bite. Such individuals experience symptoms which may include some or all of the following:

1. Throat closing sensation
2. Hives (Urticaria)
3. Generalized itching of the skin
4. Drop in blood pressure
5. Shortness of breath and/or wheezing
6. Dizziness, lightheadedness, and/or fainting
7. Abdominal cramping, nausea, vomiting, and/or diarrhea
8. Rapid and weak pulse
9. Feeling of warmth

Mosquito Facts

Mosquitoes are flying insects that tend to be more prevalent where there is standing water. They are more active early in the morning and early in the evening. Female mosquitoes lay their eggs in stagnant water. Only the female mosquito bites and feeds on human blood, as they need this blood in order to produce their eggs. Male mosquitoes feed on water and nectar. When a person is bitten, the mosquito injects its saliva into the skin which contains proteins that prevent the human blood from clotting. This allows the blood to be transferred to the mosquito’s mouth. The typical localized itching, swelling, and/or redness of the skin that results from the bite is not directly due to the bite itself, but rather caused by the body’s immune response to the proteins in the mosquito’s saliva. An “allergic reaction” to a mosquito bite is defined when there is a severe immune reaction against the salivary proteins of the mosquito, thus causing the more severe symptoms mentioned above.

Diseases Transmitted by Mosquitoes

In addition to causing allergies in selected individuals, mosquitoes are well known for transmitting many infectious diseases such as dengue fever, malaria, West Nile virus, filariasis (elephantiasis), yellow fever, chikungunya, Eastern equine encephalitis, Western equine encephalitis, Venezuelan equine encephalitis, Japanese encephalitis, St. Louis encephalitis, La Crosse encephalitis, Rift Valley fever, Ross River fever, and Zika fever.

Risk Factors

Mosquitoes are attracted to certain people more than others for a variety of reasons. They are more attracted to individuals with the following characteristics: Type O blood, males, obese or overweight people due to increased carbon dioxide (CO 2) levels, specific body odors that are present because of large numbers of certain bacteria, people wearing dark clothing, individuals that are exercising, and increased body heat.

Diagnosis, Prevention, and Treatment

The diagnosis of mosquito allergy can be done via a blood or skin test and is only done in individuals that have had severe reactions that can be ascertained after a thorough history from the patient. Prevention, however, is the key to treatment. One should avoid areas with standing water such as swamps or fresh water reservoirs. Wear light colored long sleeved clothing and hats. Consider wearing permethrin-treated clothing. Use citronella-scented candles when at outdoor events. Use a bed net if sleeping outdoors. Stay in screened in or air conditioned rooms. Apply insect repellent that preferably contains a 10-25% concentration of DEET (N,N-diethyl-3-methyl-benzamide or N,N- diethyl-meta-toluamide). One can alternatively use insect repellents containing either picaridin or oil of lemon eucalyptus.

Besides prevention, the treatment of mosquito bites is aimed at treating the symptoms of the bite. Since most mosquito bites cause only a local reaction, various topical medications can be used which can include calamine lotion, corticosteroid creams, anti-itch creams, and/or topical antihistamines. It may also be advantageous to apply ice or a cold pack to the site of the local reaction. Oral antihistamines may offer more relief in certain individuals. In the cases where anaphylaxis occurs, the individual should use a self-injectable epinephrine device (i.e., EpiPen, Auvi-Q, Adrenaclick), call 911, and go immediately to the closest emergency room. Fortunately, anaphylaxis is quite rare when it comes to mosquito bite allergies, however, it is a possibility and anyone who has symptoms of mosquito bite allergy should see a board certified allergist.

The board certified allergists at Black & Kletz Allergy have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 5 decades and have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA with on-site parking. The Washington, DC and McLean, VA office locations are also Metro accessible. Please call us for an appointment or alternatively, you can click Request an Appointment and we will get back in touch with you within 24 hours of the next business day. Black & Kletz Allergy prides itself in providing quality allergy care to both adults and children in a friendly professional environment.

Can Clogged Ears be Caused by Allergies?

August 4, 2015
BY BLACK & KLETZ ALLERGY

The simple answer to this question is yes.

Eustachian tube dysfunction is a condition where the the eustachian tubes of the middle ear do not open and close the correct way. The eustachian tubes are small tubes that go from the middle ear (the part of the ear behind the eardrum) to the back of the throat. There is one eustachian tube for each ear. The eustachian tubes are about 1 1/2 inches long and regulate the air pressure between the middle ear and the atmosphere outside the ear. The eustachian tubes also serve the purpose of draining fluid and mucus from the middle ear. Normally, the tubes are closed. When there is an increase in atmospheric pressure ( e.g., high altitudes, deep water) people typically will intentionally swallow, yawn, or chew gum in order to force the eustachian tube open which will cause an equalization in pressure. If someone is unable to equalize this pressure difference, one may experience ear pain, a clogged or blocked feeling of the ears, decreased hearing, ringing of the ears (tinnitus), a fullness of the ears, popping of the ears, and/or dizziness.

There are a variety of causes of eustachian tube dysfunction. Swelling of the eustachian tubes can occur due to allergies (i.e., allergic rhinitis, hay fever), upper respiratory infections (URI’s), and sinus infections. The swelling causes the tubes to stay closed, preventing them from opening with the normal everyday functions such as swallowing and yawning. As a result, a pressure difference occurs between the middle ear and the outside atmospheric pressure causing the symptoms of eustachian tube dysfunction to develop. One may complain of ears that are painful, blocked, full, popping, etc. Fluid may also collect in the middle ear which can further increase one’s symptoms. In addition, the fluid can get infected which will often lead to ear infections (otitis media). Note that the length of the eustachian tubes is shorter, and thus more easily blocked, in children than in adults, predisposing them to a higher risk of ear infections; this is a reason to see a pediatric allergist here in McLean, Manassas or Washington, DC as soon as possible. /2015/08/04/can-clogged-ears-be-caused-by-allergies/ /2015/08/04/can-clogged-ears-be-caused-by-allergies/ /2015/08/04/can-clogged-ears-be-caused-by-allergies/ Cigarette smoking, enlarged adenoids, and obesity are other factors that can predispose and/or cause eustachian tube dysfunction.

As mentioned above, allergies play an important role in causing eustachian tube dysfunction. Allergic rhinitis (hay fever) is a condition where there is inflammation and swelling in the nasal and sinus regions due to an allergen such as pollen, dust mites, molds, and animals. It is the swelling component of this allergic condition which contributes to the symptoms of eustachian tube dysfunction.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating children and adults with “clogged ears” for over 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Diagnosing and treating the underlying condition, which often is due to allergies, is the primary way to alleviate the “clogged ears.” There are numerous allergy medications (i.e., decongestants, nasal corticosteroid sprays, antihistamines), as well as allergy immunotherapy (allergy shots) that can be utilized in order to treat and/or prevent “clogged ears.” If you suffer from these symptoms or other allergy symptoms, please call any one of our 3 convenient office locations in the DC metro area. We have offices in Washington, DC, McLean, VA, (Tyson’s Corner, VA), and Manassas, VA. All 3 offices have on-site parking and the Washington, DC and McLean, VA locations are Metro accessible. You can also click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy is dedicated to help you get relief from your allergy symptoms in a caring professional environment.

Tree Pollen Allergies in the Washington, DC Metropolitan Area

March 18, 2015
BY BLACK & KLETZ ALLERGY

Spring is rapidly approaching in the Washington, DC metropolitan area and that means many people will be suffering from hay fever (allergic rhinitis). In the early Spring, tree pollen is mainly responsible for the symptoms that cause hay fever.

There are of course molds in the air simultaneously, but they are always present in Washington. In the DC area, trees usually begin to pollinate at the end of February, peak in mid- to late-April and continue to pollinate through late May and occasionally through early June. Some of the first trees to pollinate in this area include cedar, maple, elm, alder, birch, and poplar. Later in the season, the predominant tree that causes problems for individuals with tree pollen allergies is the oak tree. Other tress that pollinate in this later time frame include hickory, walnut, and pine.

It is interesting to note that, in general, people are not allergic to flowering trees (i.e., cherry tree, dogwood tree). Many people think they are allergic to flowering trees because they develop allergy symptoms when these trees are in bloom, however, it is usually not due to these trees, but due to other non-flowering trees that happen to pollinate at the same time. Nature is behind this sleight of hand trickery. Flowering trees have pollen that is fairly heavy in weight. Since the pollen is heavy, it is not easily wind-disbursed and as a result, individuals do not breathe in the pollen and thus do not become sensitized to these pollens. The flowers are present in order to attract insects such as bees. When the bee lands on the flower, the pollen sticks to the abdomen of the bee. The bee will then fly to another flower of another tree and the pollen will intermingle with that flower. It is by this method that cross-pollination is achieved, made possible by the aid of the bees. Non-flowering trees such as cedar, maple, elm, alder, birch, poplar, oak, hickory, walnut, etc. have very light weight pollen. These pollens are easily wind-disbursed. It is these wind-disbursed tree pollens that individuals breathe in and become sensitized to, that are the cause of hay fever symptoms in sensitized people. It just so happens that people develop their hay fever symptoms at the same time when the flowering trees bloom. People then associate these flowering trees with their symptoms and blame their symptoms on the wrong trees.

The symptoms of tree pollen allergies are the classic symptoms of hay fever. They can include any or all of the following: runny nose, stuffy nose, post-nasal drip (which can lead to a sore throat, hoarseness, and/or cough), sneezing, itchy eyes, watery eyes, red eyes, puffy eyes, itchy nose, itchy throat, sinus pressure and/or pain, wheezing, chest tightness, cough, and/or shortness of breath.

The following are some measures that can be taken to reduce one’s exposure to the tree pollen in the Spring besides living in a “plastic bubble:” It is advisable to keep one’s windows and sunroof closed. It is advisable to turn on the air conditioner and change air filters regularly (about once a month). Use the re-circulate feature in the car so that the air is not coming into the vehicle from the outside. Choose an automobile that has a filter in its air conditioning unit, if possible. Avoid yard work and mowing lawns. If a person needs to do yard work, wear a filtration face mask in order to diminish exposure to the pollen. If one goes outdoors, shower, wash one’s hair, and change one’s clothing upon returning home to decrease pollen exposure. Wash your pets regularly and avoid close contact with a pet that goes outdoors during the pollen season since they carry tree pollen on their coats. Monitor pollen counts daily. Click Today’s Pollen Count to view the daily pollen count. Stay indoors wherever possible when the pollen count is high (generally on dry warmer days). Note that rain washes pollen from the air causing pollen counts to be lower on wet cooler days. Avoid drying clothes outdoors when the pollen count is elevated. Avoid contact lenses which may trap pollen in one’s eyes. Since pollen is released in the early mornings, try to avoid exercising during this time.

The diagnosis and treatment of tree pollen allergies begins with a thorough history and physical examination by a board certified allergist. Our board certified allergists in both adult and pediatric allergy at Black & Kletz Allergy have had more than 50 years of experience diagnosing and treating tree pollen allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area. After the history and physical examination, allergy testing is usually done by skin testing, or in some cases, by blood tests to confirm if the patient is in fact allergic to trees. Once confirmed, there are a multitude of treatment options to alleviate the annoying symptoms of tree pollen allergies. In addition to pollen avoidance measures in the above paragraph, the treatment of tree pollen allergies includes medications which can include oral medications (tablets, capsules, syrups, granules, etc.), nasal sprays, eye drops, and/or lung inhalers. If there are additional environmental allergens that are found in a particular person which correlate with his/her symptoms during a different time of the year (Fall, Winter, etc.), then allergy shots (also referred to as “allergy immunotherapy” or “allergy desensitization”) may be a great way to treat the pollen allergy. They are extremely effective and have been available for over 100 years.

If you would like a consultation for your hay fever symptoms, please do not hesitate to call Black & Kletz Allergy to make an appointment. Alternatively, you can click Request an Appointment and we will get back in touch with you within 24 hours of the next business day. We have 3 convenient locations in the Washington, DC metropolitan area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. There is parking at each location and the Washington, DC and McLean, VA locations are accessible by using the Metro. Whether your hay fever symptoms are seasonal or perennial, we would be happy to help you.

The “Cold” of Winter Has Effect on Allergy and Asthma Patients

The onset of winter in the Washington DC metro area has brought two cold-related health problems to the forefront.

The first one concerns many people with respiratory disorders like asthma and COPD (Chronic Obstructive Pulmonary Disease). Cold dry air is a known irritant to the respiratory passages and can trigger an increase in the frequency and severity of respiratory symptoms like coughing, wheezing, and shortness of breath. In addition, respiratory infections, especially caused by viruses, are more prevalent during the winter months. Influenza (the “flu”) is just one of the many viral infections which are notorious in aggravating asthma and pulmonary-related conditions.

Avoiding exposure to the cold air, in addition to minimizing the chance of developing a viral upper respiratory tract infection by frequent hand washing and covering one’s sneezes and coughs, can help prevent flare-ups in people with breathing difficulties such as asthma and COPD. People with persistent asthma (defined by any asthma symptom which occurs more often than twice a week during the daytime and/or more often than twice a month during the nighttime) need to use their controller medications on a daily basis as prescribed, in order to reduce the chances of exacerbating their asthma. Controller medications may include inhaled corticosteroids, long-acting beta agonists, leukotriene antagonists, and/or theophylline. In more severe asthmatics that meet certain criteria, a humanized antibody called Xolair (omalizumab), may also be prescribed in order to help prevent asthma exacerbations.

The second issue concerns people with a history of a specific type of “hives” called “cold-induced urticaria.” Though there are usually multiple triggers for hives (urticaria), exposure to colder temperatures can result in giant hives over exposed skin in susceptible individuals. The condition can be very serious in selected patients and is usually diagnosed in our office by an “ice cube test,” where an ice cube is placed on the forearm of the patient for 10 to 15 minutes and then removed. When the skin re-warms in a few minutes, an elevated red wheal or hive in the shape of the ice cube confirms this disorder. In rare instances, this condition is also associated with some systemic diseases and blood tests for cold agglutinins and cryoglobulins may be appropriate. Treatment begins with avoiding the cold when possible. In addition, various medications can be used to help prevent the hives and/or anaphylaxis that can occur in people with this condition.

The board certified allergists at Black and Kletz Allergy are experts in cold-related respiratory and skin disorders. Please call any one of our 3 office locations in Washington, DC, McLean, VA (Tysons Corner, VA) or Manassas, VA if you need further information or are in need of an evaluation and advice regarding any of the cold-related disorders above or other cold-related disorder not mentioned above.

Asthma in the Winter

With the onset of cold weather, some children and adults with a history of asthma are experiencing flare-up of their symptoms. Breathing in cold, dry air can irritate and inflame the lungs, causing acute exacerbations of one’s asthma. The other common triggers of asthma symptoms are viral infections, which are usually more common in winter months.

The viral infections usually begin as “cold-like” symptoms with sneezing, followed by copious amounts of clear mucus in one’s nasal secretions and usually are associated with nasal congestion. Some of us also can have a skin rash, low-grade fever, sore throat, and/or frequent cough. Many children and adults recover spontaneously from these infections after a few days. However, they can result in aggravation of asthma, causing the typical symptoms of wheezing, chest tightness, coughing and/or difficulty in breathing.

A few precautions during the coming season may ward off flare-ups of asthma, the suffering, and the loss of productive time:

Avoid exposure to the cold air to the extent possible. Wearing a face mask while walking outdoors during the height of winter can be helpful.
The air can be very dry indoors and can irritate the respiratory passages. A room humidifier will help in hydration of the air we breathe.
General hygiene, frequent hand-washing, avoidance of sharing utensils, etc. may prevent certain infections.
Staying home when sick and covering the sneezes and coughs can keep the infections from spreading.
Plenty of fluids, rest, and eating well will help in a faster recovery.
Antibiotics usually have no role in viral illness, except in rare secondary bacterial infections.
Receiving the influenza vaccination (flu shot) as soon as possible in the season.
Pneumococcal vaccine, as per indications.

Children and adults with a history of frequent flare-ups of asthma during the late fall or early winter should begin taking the daily controller medications on a regular basis starting early in the season. At times, one also may need to increase the doses of preventive maintenance medications.

The board certified allergists and staff at Black and Kletz Allergy practice are always available to answer questions and address the concerns of people in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area who may be dealing with above conditions. Feel free to contact us by phone or via our “Request an Appointment” page on our main website to make an appointment.

SINUS INFECTION vs. “COLD” vs. WINTER ALLERGIES vs. FLU

As Winter approaches, people with dust, mold, and pet allergies tend to suffer more than those with pollen allergies. Pollen levels in the mid-Atlantic region (Washington, DC, Virginia, Maryland, etc.) become immeasurable once the first frost occurs. The first frost usually occurs by November in our region of the country. Therefore, when people experience the typical allergy symptoms during the late Fall and Winter months, dust mites and/or molds are generally the culprits. Keep in mind that there are other causes of these symptoms, namely the common cold, flu (influenza), or other upper respiratory tract infection (i.e., sinus infection, bronchitis). How does one know the difference between winter allergies, a “cold,” the “flu” or other type of upper respiratory tract infection?

WHAT ARE THE SYMPTOMS?

Winter Allergies – the same symptoms as seasonal allergies and can include all or some of the following: runny nose, nasal congestion, post-nasal drip, sore throat, cough, sneezing, itchy nose, itchy eyes, watery eyes, red eyes, itchy throat, fatigue, sinus headaches, wheezing, and shortness of breath.

Common Cold – can include all or some of the above symptoms, but in addition may contain achiness, fever, and chills, although discolored nasal discharge and a fever do not occur in most cases of the common cold.

“Flu” (also referred to as influenza) – can include all or some of the symptoms of the common cold, but unlike a “cold,” there is usually severe achiness and/or headache, and a fever is almost always present.

Note: For the flu season of 2014-2015, one must be cognizant of the recent Ebola epidemic in Western Africa. If a person develops “flu-like” symptoms and has traveled to Western Africa and/or if they have been in contact with someone infected with the Ebola virus in the last 21 days, he or she must assume that they could have Ebola and should contact the CDC (Centers for Disease Control) and local county and state health agencies for guidance about seeking medical care at an appropriate hospital. If one cannot get in touch with the CDC or local health agency, they should go immediately to closest emergency room.

Sinus Infection (also referred to as sinusitis) – can include all or some of the symptoms of the common cold, but unlike a “cold,” there usually is discolored nasal discharge, sinus pain and/or pain that radiates to the teeth.

WHAT ARE THE CAUSES?

Winter Allergies – Dust mites; Molds: Pets; Cockroaches

Common Cold – Viruses [Rhinoviruses, Coronaviruses, Parainfluenza viruses, and Respiratory syncytial virus (RSV) are the most common ones]; Note that there are many more viruses that cause the common cold. “Flu” – Viruses (Influenza virus types A, B, and/or C)

Sinus Infection – Viruses, Bacteria, and/or Fungi (Most are caused by viruses)

HOW ARE THESE CONDITIONS DIAGNOSED? Besides a thorough history of your symptoms and a physical examination, the following also help our physicians distinguish between the 4 common conditions below:

Winter Allergies – An experienced allergist can perform blood and/or skin tests to evaluate if you have a true allergy to one of the many allergens that can cause winter allergy symptoms. When symptoms last longer than 1-2 weeks or there is a history of recurring symptoms every Winter or perennial (year-round) symptoms, allergies should be a top concern.

Common Cold – Typically the symptoms last less than 1 week in duration and resolve on their own.

“Flu” – A fever is the hallmark of this condition. The flu can be very serious particularly in the elderly. There are rapid influenza diagnostic tests that can identify the flu in about 30 minutes. These require that the physician to wipe the inside of the back of one’s throat or nose with a swab and then send it for testing. They are not 100% accurate however.

Sinus Infection – The symptoms may begin as a result of an individual being exposed to an allergen, virus, and/or bacteria. A thorough history together with a complete examination of the ears, nose, mouth, and throat can usually identify a sinus infection in the majority of patients. Further diagnostic studies such as a CT scan of the sinuses may be necessary in some individuals. When there is recurrent sinus infections, the diagnosis of chronic sinusitis and/or an immunologic disorder should be investigated by an experienced allergist.

WHAT ARE THE TREATMENTS?

Winter Allergies – There are many allergy medications that can be used which include tablets, syrups, nasal sprays, and/or allergy shots (allergy immunotherapy or allergy injections).

Common Cold – Usually self-limited and generally does not require treatment except to help relieve symptoms with medications and nasal sprays.

“Flu” – Usually self-limited and generally does not require treatment except to help relieve symptoms with medications and nasal sprays. Occasionally a severe case or a case in the elderly may need hospital care of complications from the flu which can include dehydration, pneumonia, and other more severe complications. Antiviral flu medications can be taken to reduce the duration and severity of the flu. These medications work best if they are taken within the first 48 hours of the beginning of symptoms, however they can still be effective if taken later.

Sinus Infection – May need to be treated with antibiotics if it persists or is recurrent. Other medications may also be used if needed to help alleviate the symptoms with tablets, syrups, and/or nasal sprays.

WHAT CAN BE DONE TO PREVENT THESE CONDITIONS?

Winter Allergies – Avoidance of dust mites, molds, and pet exposure. Allergy medications and/or allergy shots (allergy immunotherapy or allergy injections).

Common Cold – Washing of hands; good hygiene; avoidance of crowded areas.

“Flu” – Flu vaccination (unless one has a reason not to take it such as egg allergy, previous reaction to the flu vaccine or the preservative used in the flu vaccine, etc.). In addition, one should avoid exposure to people with the flu. They should also practice good hygiene, avoid crowded areas during the flu season, wash their hands, etc.

Sinus Infection – Control allergies; washing of hands, good hygiene; avoidance of crowded areas.

As one can see from the information above, it may not be so easy for the average person to distinguish the difference between Winter allergies, the common cold, the flu, and a sinus infection. Many of the symptoms are the same, similar, and/or overlap. The board certified allergists at Black & Kletz Allergy have the expertise to help diagnose the correct ailment and more importantly, treat your problem. We have 3 office locations in the Washington, DC metro and Virginia areas and we will be happy to schedule a visit for you at your earliest convenience.