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Month: December 2021

Lip Allergies

An inflammatory appearance of the lips is termed cheilitis. This inflammation of the lips may cause redness, dryness, and/or scaling on the lips. It can also be associated with swelling, and in severe cases, blisters and/or sores may develop on the lips. Cheilitis can be either acute or chronic in nature. Although most cases of cheilitis are due to sun exposure, allergies involving the lips are quite common. Allergic cheilitis is sometimes referred to as eczematous cheilitis which is also called lip dermatitis.


  • Atopic dermatitis – Usually a genetically determined generalized inflammation of the skin. Can affect the lips causing cheilitis.
  • Irritant contact cheilitis – A reaction of the lips to cosmetics, foods, and/or environmental irritants.
  • Allergic contact cheilitis (ACC) – A delayed hypersensitivity reaction to chemicals which causes an eczema-like reaction on the lips. Allergic sensitization to chemicals found in lipsticks, lip balms, toothpastes, dental materials, medications, metals, foods, and/or nail polish can cause ACC.
  • Contact urticaria – A hive-like reaction over the lips usually caused by certain flavorings in toothpastes, foods, and/or food additives (e.g., preservatives, coloring agents).

Clinical Features:

Both the upper and lower lips are usually involved at the same time. They may appear dry, red, cracked, peeling, fissuring, and/or swollen. There may also be itching, burning, and/or pain of the lips in some individuals. The angles of the mouth may exhibit crusting at the corners. If the angles of the mouth are affected, it is called angular stomatitis or angular cheilitis. In addition, the skin around the mouth may also be red and dry. This involvement of the skin around the mouth is termed perioral dermatitis.


It is important for the board certified allergist to perform a comprehensive history of the onset, duration, and severity of the symptoms, as well as any possible temporal association with exposure to the known triggers in order detect the offending agent responsible for the condition. A complete physical examination is also performed.

When the history and physical examination are not definitive in identifying the causative agent, patch testing may be necessary. This procedure involves the application of the common chemical sensitizers in individual small rectangular patches that are placed on the skin. These patches should remain in constant contact with the skin for 48 hours. Test results are interpreted after the removal of the patches at 48 hours and again between 72 and 96 hours after their application. Redness, swelling, blistering, and/or oozing at the site of the contact of the test agent confirms a sensitivity to that particular chemical.

Contact urticaria may sometimes require prick skin testing with foods and/or chemicals to establish the diagnosis.

The following causative agents are usually identified as the triggers for allergic contact cheilitis:

  • Oral hygiene products (e.g., toothpastes, mouthwash, dental floss)
  • Lipsticks and other lip care products (e.g., lip balm, sunscreen, Chapstick)
  • Nail polish substances
  • Fragrances (e.g., Balsam of Peru)
  • Rubber or latex products
  • Sunscreen
  • Certain foods (e.g., cinnamon, mango)
  • Metals (e.g., nickel, gold, cobalt) – Found in orthodontic devices, musical instruments, etc.
  • Propylene glycol
  • Chronic lip picking and/or lip licking
  • Certain medications (e.g., bacitracin, neomycin)
  • Weather-related conditions (e.g., wind, cold)


Topical anti-inflammatory medications such as corticosteroids or non-steroidal agents such as Elidel and Eucrisa ointments can help relieve the symptoms of lip cheilitis/dermatitis. Non-irritating and fragrance-free emollients containing petrolatum, shea butter, mineral oil, ceramides, and/or sun-protective ingredients, (e.g., zinc oxide, titanium oxide) are useful to keep the lips moisturized.

Strict avoidance of exposure to the offending agent at all times is essential, as desensitization to the contact allergens has not been shown to be effective.

The board certified allergists at Black and Kletz Allergy have been diagnosing and treating allergies and asthma for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We see both pediatric and adult patients. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have on-site parking at each of our 3 locations. Our Washington, DC and McLean, VA offices are Metro accessible. Black & Kletz Allergy offers a free shuttle service between our McLean, VA office and the Spring Hill metro station on the silver line. If you suffer from allergies to your lips or face, please call us to make an appointment. You may also click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy is dedicated in providing the most state-of-the-art allergy treatment in a caring, friendly, and professional environment.

Allergies to Dust

When one thinks of house dust, a picture may come to mind of a room with a whitish colored film of dirt covering the hardwood floors, wooden furniture, and any other visible hard surface in the room. One may also envision house dust scattered in the air which can often be seen with the aid of the light from a window in the room. Does this “dust” that you are envisioning however cause allergies in a typical dust-allergic individual? The answer is not usually. More commonly, the “dust” that typically causes dust allergies is the “dust” that is embedded into carpeting, upholstered furniture, pillows, mattresses, box springs, and blankets. The reason that free-floating dust is less likely to cause allergies is because dust mites, the main dust allergen, tend not to live in the air or on hard surfaces. Dust mites tend to live in bedding (i.e., pillows, mattresses, box springs, blankets), carpeting, and upholstered surfaces. Approximately 33% of dust mite life takes place in bedding. There are from tens of thousands to millions of dust mites that typically live in the average bed. In addition, approximately 100,000 dust mites can live in 1 square yard of carpeting. Dust mites tend to prefer warm and moist environments as opposed to cool and dry conditions.

Dust mites live off of sloughed skin or dander of both humans and animals. When you sleep at night, you shed dead skin and these skin flakes are the food that sustains dust mites. The average person sheds 0.2 to 0.3 ounces of dead skin each week which becomes the fuel that keeps the dust mites alive. As mentioned above, the “dust” one sees from the rays of light near a window in a room is not allergenic because in general, dust mites do not live in free-floating air. It is interesting to note that the “dust” one sees near a well-lit window is mostly made up of dead skin from humans and/or animals.

There are 2 species of dust mites found in the U.S. Their names of these 2 species are Dermatophagoides farina (i.e., North American house dust mite) and Dermatophagoides pteronyssinus (i.e., European house dust mite). As stated previously, dust mites are the main “dust” allergen. It is however a protein in the dust mite feces and a protein in the exoskeleton (i.e., external skeleton) of the dust mites that are the true allergens. Dust mites have 8 legs and are arthropods belonging to the class Arachnida. In that way, they are similar to spiders. Dust mites are between 0.2 to 0.3 mm. in length and are translucent, making them almost invisible to the naked eye.

Dust mites cause allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), and asthma symptoms in sensitized individuals. The classic symptoms of allergic rhinitis may include sneezing, runny nose, nasal congestion, post-nasal drip, sinus congestion, sinus headaches, itchy throat, fatigue, and/or snoring. In addition, individuals with allergic rhinitis are more prone to developing sinus infections. Allergic conjunctivitis symptoms may include itchy eyes, watery eyes, redness of the eyes, and/or puffiness of the eyes. The typical asthma symptoms that one may experience are wheezing, chest tightness, coughing, and/or shortness of breath. Asthma can range in severity from mild intermittent to severe persistent. In some instances, it can be life-threatening. It is thus crucial for individuals with asthma to adhere to a strict plan of action that can be tailored to them by a board certified allergist, like the ones at Black & Kletz Allergy.

The diagnosis of dust mite allergy begins when the allergist takes a comprehensive history from the patient and then follows that up by a complete physical examination. Allergy testing is usually performed using the more common allergy skin tests, however, blood tests can be done in select individuals. Pulmonary function tests are usually performed when asthma symptoms are present. Occasionally a chest X-ray may be indicated.

The treatment of dust mite allergy begins with prophylaxis. Preventing as much exposure to dust mites is highly recommended, although not always attainable. Covering pillows, mattresses, box springs with allergy-proof encasings are a great place to start. Using HEPA filters and changing the filters frequently are also helpful in reducing one’s dust mite exposure.

Treatment usually continues with medications. There are numerous medications that can be utilized in the treatment of allergic rhinitis, allergic conjunctivitis, and asthma. Oral antihistamines, oral decongestants, oral leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular antihistamines, ocular decongestants, ocular mast cell stabilizers, inhaled corticosteroids, and inhaled bronchodilators are the most commonly used medications to treat allergic rhinitis, allergic conjunctivitis, and asthma. Rarely, oral corticosteroids may be used in severe cases of allergies and asthma. It should be noted that allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are very helpful in the treatment of dust mite allergies as well as with the treatment of allergies to molds, pollens, pets, cockroach, and insect stings (e.g., bees, wasps, hornets, yellow jackets, fire ants). Allergy shots are effective in 80-85% of the people who take them. They have been used in the U.S. for more than 100 years and they are usually taken for 3-5 years.

The board certified allergy doctors at Black & Kletz Allergy are always available for our patients to ask any questions that they may have regarding asthma or allergies. We have been diagnosing and treating adult and pediatric patients with dust mite allergies as well as other allergies, including allergic rhinitis, allergic conjunctivitis, asthma, and insect sting allergies for more than 50 years. We have 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you would like to be evaluated today for dust mite allergies or any other type of allergies, please call us today. You may also click Request an Appointment instead and we will respond to your request within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy pride themselves in providing the highest quality asthma and allergy care in the Washington, DC metropolitan area.