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Month: November 2020

Vocal Cord Dysfunction

The vocal cords are V-shaped tissue folds within our voice box (i.e., larynx). The gap between the arms of the V is the opening into our windpipe (i.e., trachea). These are dynamic structures and move with the contraction and relaxation of the muscles attached to them. Normally the vocal cords open when we inhale and exhale, allowing the air to get in and out of lungs. They close while we eat, blocking food from entering into the windpipe. The vocal cords become narrowed when we speak. It is the vibration of the vocal cords that generates voice.

When the vocal cords malfunction, they may become narrowed or even close when we inhale. This narrowing or closing will result in difficulty for air to enter the lungs which may cause a feeling of breathlessness. This shortness of breath may be confused with the symptoms of asthma. When this situation occurs, it is referred to as paradoxical vocal fold movement (PVFM) or vocal cord dysfunction (VCD).

In asthma, the airways (i.e., bronchial tubes) constrict and tighten, making breathing difficult. In vocal cord dysfunction, the vocal cord muscles tighten, which also makes breathing difficult. Unlike asthma, vocal cord dysfunction is not an allergic response. It is usually more difficult to inhale during an episode of vocal cord dysfunction. On the contrary, it is usually more difficult to exhale during an exacerbation of asthma. It is very important to differentiate vocal cord dysfunction from asthma since the treatments are quite different. One study showed that approximately 40% of individuals with vocal cord dysfunction are misdiagnosed as having asthma. It should be noted that in some instances, asthma and vocal cord dysfunction can coexist in a person at the same time.

Vocal cord dysfunction is found in people of all ages, although it tends to be more prevalent in individuals between the ages of 20-40. It is more common in women.


  • Tightness of the throat
  • Hoarseness
  • Choking or suffocation feeling
  • Difficulty in breathing
  • High pitched noise during Inhalation (i.e., stridor)
  • Coughing
  • Wheezing
  • Frequent throat clearing

Causes and Triggers:

  • Strong odors, fumes, or other irritants
  • Upper respiratory infections (URI’s)
  • Post-nasal drip associated with allergic rhinitis (i.e., hay fever) or a URI
  • Acid reflux [i.e., gastroesophageal reflux disease (GERD)]
  • Exercise
  • Emotional stress


  • Comprehensive history of the symptoms and triggers
  • Breathing test (i.e., spirometry) with a flow/volume loop demonstrating diminished air entry into the lungs during an episode
  • Direct inspection of the of the vocal cord through a laryngoscope (i.e., flexible fiberoptic tube with a camera attached) during the episode revealing paradoxical movements
  • An episode may need to be “induced” either by exercise or by inhalation of a chemical called methacholine


There is very little role of medications in the management of this vocal cord dysfunction. The mainstay of treatment is behavioral techniques to relax the muscles in the throat that control the vocal cord movements.

  • Speech therapy by a trained and qualified speech pathologist and therapist is the main course of treatment. One may need several sessions of speech therapy and regular practice at home even during asymptomatic periods in order to manage vocal cord dysfunction.
  • Deep breathing techniques to reduce the discomfort and fear
  • Relaxation techniques, biofeedback, and psychotherapy have been shown to be helpful in controlling vocal cord dysfunction by reducing emotional stress
  • Better control of asthma, if it is co-existent
  • Managing post-nasal drip and acid reflux

The board certified allergy specialists 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 about the most current treatment options for patients with vocal cord dysfunction, asthma, and related conditions and can promptly answer any of your questions. The allergy specialists at Black & Kletz Allergy diagnose and treat both pediatric and adult patients. 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 state-of-the-art allergy and asthma care in a welcoming and pleasant environment.

Thanksgiving and Food Allergies

Thanksgiving Day is usually a time when people gather with family and friends in order to be with each other, watch football, and of course, eat! Unless you or a family member has a food allergy, you may not think about food allergies or food sensitivities much. It is important however to be more than cognizant of the topic of food allergies especially if you are hosting a Thanksgiving Day celebration. One must learn that food allergies can be very serious and even fatal to some individuals. Cooking and preparing Thanksgiving Day food as well as collecting various dishes from other guests, which is commonly done during this holiday, must be taken very seriously with respect to food allergies and food sensitivities.

It is important to note that approximately 4% of adults and 5% of children in the U.S. have food allergies. The most common 8 food allergens are milk, egg, soy, wheat, peanut, tree nut, fish, and shellfish. These 8 foods cause nearly 90% of most food allergy reactions.

It should be noted that peanuts are not actually nuts because they grow from the ground and not from a tree. Peanuts are classified as legumes and are closely related to other legumes such as beans (e.g., black, lima, navy, kidney, pinto, fava, lupin, mung, soybeans), chickpeas (i.e., garbanzo beans), lentils, and peas. Most allergists instruct their peanut allergic patients to avoid all legumes in addition to avoiding peanuts.

Knowing the above information, the person hosting a Thanksgiving holiday celebration should ask their guests if they have a food allergy or food sensitivity. They should also inform their guests who are preparing and/or bringing food to the host/hostess’ house about any food allergies or food sensitivities that any of the guests have so they can provide a list of ingredients used in their dishes. The goal is to make sure that the food-allergic or food-sensitive individual does not ingest any of the offending food allergen on purpose or accidentally.

When one thinks of Thanksgiving, the food most thought of is turkey. Although a turkey allergy is not very common, it is more common to have individuals experience sleepiness or fatigue after eating turkey meat. This adverse reaction to turkey is not an allergy, but classified as a food sensitivity to the amino acid “L-tryptophan.” L-tryptophan is found in high levels in turkey meat. The L-tryptophan travels from the gastrointestinal tract to the brain where it is converted to a serotonin. It is this chemical, serotonin, that is responsible for causing this sleepiness or fatigue.

There are 2 other common food sensitivities that should be known to all. The first food sensitivity is called “lactose intolerance.” It occurs when the body is unable to fully digest the sugar called lactose which is commonly found in milk and dairy products. This inability to break down lactose is due to a lack or decreased amount of the enzyme lactase. Lactose intolerance may cause gastrointestinal side effects such as abdominal bloating, abdominal pain, nausea, and/or diarrhea in affected individuals. The second food sensitivity one hears a lot about recently is called “gluten intolerance” or “gluten sensitivity.” No one is exactly sure of the mechanism of gluten intolerance but individuals with this condition experience abdominal bloating, abdominal pain, nausea, diarrhea, and/or constipation after eating foods containing gluten (i.e., wheat, barley, rye). Some patients also complain of fatigue and headaches as well. The symptoms resemble individuals with wheat allergy (i.e., celiac disease) and/or irritable bowel syndrome. Unlike celiac disease, however, gluten sensitivity does not cause damage the intestines.

The gravy used for turkey and mashed potatoes commonly contains dairy (e.g., milk), wheat, and/or soy. It is important to remember that tiny amounts of a food allergen may be all that is necessary to cause a severe allergic reaction is a sensitive individual. One must be careful about every ingredient in a food or dish.

Common food allergens such as milk, egg, soy, wheat, nuts, and peanuts are often found around the Thanksgiving Day table. Tree nuts are frequently found on string beans as well as in some types of stuffing.  Tree nuts and peanuts are common in many desserts such as brownies, cookies, cakes, and pecan pie.  Eggs and milk (i.e., dairy) are also used in many baked goods.  Although pumpkin allergies are not common, pumpkin pie may contain an assortment of ingredients that may trigger a food allergy in susceptible allergic individuals.  Many families incorporate a multitude of ethnic foods in their celebrations.  These cultural foods may not be traditional, but they increase the possibility of other allergenic foods such as fish and shellfish to be the causative agent of an approaching food allergy.  If someone has a serious food allergy, it is sensible for that person to bring their own food rather than eat food in which they are not 100% sure of its ingredients and origin.

The board certified allergists at Black & Kletz Allergy have been diagnosing and managing food allergies, other allergies, and asthma for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Each office has on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please call for an appointment if you would like a consultation with one of our allergists, or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy prides itself in providing quality allergy and asthma care to the Washington, DC, Northern Virginia, and Maryland metropolitan area community.