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Month: December 2018

Winter Allergy Symptoms

Winter Allergy Symptoms Washington DCAs 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.

Cow’s Milk Allergy

49669476_306459563314751_2875648138461315072_nAbout 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.


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


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


  • 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.


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.


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).


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.