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Eyelid Dermatitis

An itchy, red, and scaly rash over the eyelids is a very common presentation of a type of contact allergy. This condition is termed eyelid dermatitis and describes inflammation of the skin over the eyelids. It may be in fact a local manifestation of a generalized disorder called atopic dermatitis (i.e., eczema).

Eyelid dermatitis is usually seen in adults and teenagers and is less common in younger children. Both men and women can have eyelid dermatitis, but women greatly outnumber men in most studies of patients presenting with eyelid dermatitis. Both right and left sides are usually affected and both upper and lower eyelids are generally involved at the same time.


The eyelids are a sensitive site due to the thinness of the skin and the potential increased penetration of allergens and irritant through this thin skin. Frequently, eyelids may be the only site affected by contact dermatitis. Interestingly, eyelid dermatitis may be the only manifestation of contact dermatitis to hair care products, even in the absence of a coexisting eruption on the scalp. Nail care products and other allergens may be transported from the hand to the eyelid area and may cause isolated eyelid dermatitis in the absence of hand dermatitis.

Allergic contact dermatitis – Allergens found to cause allergic contact dermatitis (ACD) on the eyelids may include metals (e.g., nickel, gold), fragrances, preservatives, and/or topical antibiotics.

Gold is a common cause of eyelid dermatitis. Exposure to gold occurs from jewelry on the hands or ears and perhaps is worsened by concurrent use of mineral-based cosmetics or sunscreens. Nail polish, particularly those made from acrylates, is often an overlooked cause. Eye drops containing antibiotics such as gentamycin or neomycin, as well as preservatives are the culprits in many instances. Sensitivity to contact lens solution and/or eye glass frames may also play a role in certain individuals.

Airborne contact dermatitis – Some likely causes may include plant antigens (e.g., ragweed, aster, sunflower, chrysanthemum), wood allergens, plastics, rubber, glues, metals, industrial and agricultural dusts, and/or pesticides.

Protein contact dermatitis – These may include foods, pollen, animal hair, and/ or latex.

Irritant contact dermatitis – Irritants known to cause or exacerbate eyelid dermatitis may include soaps, preservatives, and/or fragrances.

Atopic dermatitis – Eyelid dermatitis may occur in patients with a history of childhood-onset atopic dermatitis and/or other atopic diseases, including asthma and seasonal allergies (i.e., allergic rhinitis, hay fever).

Seborrheic dermatitis – Seborrheic dermatitis is a chronic, relapsing form of dermatitis that has a predilection for nasolabial creases, eyelids, ears, scalp and chest.


Redness, severe itching, burning, and a stinging sensation over the eyelids are the most common symptoms of eyelid dermatitis. The eyelids can also be swollen and excessive fissuring of the skin is frequently visible. In addition, crusting of the secretions may be seen over the eyelashes. Seborrheic dermatitis on the eyelids may appear scaly and waxier than contact dermatitis.

Eyelid dermatitis may wax and wane and sometimes exhibit a seasonal variation. Individuals may notice that airborne irritants, including plants, pollens, dust, and dander, may trigger or exacerbate the disease. Eyelid dermatitis may also flare with hay fever (i.e., allergic rhinitis) or allergic conjunctivitis, possibly related to chronic tearing or mechanical rubbing.


The diagnosis of eyelid dermatitis is made in most cases clinically, based on the characteristic appearance of the eruption, associated symptoms, and clinical history.

Patch testing – Patch testing involves applying appropriately diluted allergens to the skin, usually on the back for convenience, for 48 hours. The patch tests are then read at 48 hours and again at 96 hours, as reactions usually take 48 – 96 hours to develop. Positive reactions produce a patch of dermatitis at the application site of the offending allergen, which will appear as a red and possibly raised, vesicular, and even blistering area.

Any patient with eyelid dermatitis requiring ongoing treatment beyond 4 – 8 weeks should be strongly considered for patch testing to ensure the correct diagnosis. The most frequent sensitizers are nickel sulfate, fragrance mix, balsam of Peru, paraphenylenediamine (PPD), and thiomersal.

If patch testing is negative, or positive reactions are deemed not to be relevant to the current dermatitis, the diagnosis of “irritant” contact dermatitis should be considered.

A skin biopsy may be helpful if the diagnosis is uncertain and, in particular, to rule out connective tissue disease.


Skin care – Conservative initial management of eyelid dermatitis includes gentle skin care and avoidance of fragrances and other known irritants in personal care, hair, and facial skin care products. Bland, fragrance-free emollients, such as petrolatum, may be applied directly to the eyelids.

Avoidance of irritants and allergens – In patients with a confirmed diagnosis of irritant or allergic contact eyelid dermatitis, ongoing avoidance of irritants and allergens is the mainstay of therapy. The use of perfumes and aerosol hair sprays should be avoided.

Topical corticosteroids – As the eyelids exhibit the highest percutaneous absorption of the body, only low-potency topical corticosteroids are safe for short-term use on the eyelids. Note that in the setting of active dermatitis, where the skin barrier is broken, the absorption may be even higher. Low-potency topical corticosteroids can be used twice daily for up to 2 – 4 weeks. Keep in mind that the prolonged use of topical corticosteroids in the periorbital area may induce a number of adverse effects. Even with low-potency topical corticosteroids, the eyelids remain vulnerable to thinning and atrophy.

Topical calcineurin inhibitors – Topical calcineurin inhibitors (e.g., Protopic, Elidel) can be used as an alternative to topical corticosteroids for the treatment of eyelid dermatitis in individuals who require prolonged treatment (i.e., beyond 4 weeks). Topical calcineurin inhibitors are applied twice daily for 2 – 4 weeks or until improvement is noted, and then tapered. The treatment can be resumed if flare-ups occur. The use of topical calcineurin inhibitors can initially be limited by a burning sensation when applied to inflamed skin, which improves with ongoing use.

The board certified allergy doctors at Black & Kletz Allergy treat both adults and children and will answer any questions you have concerning eyelid dermatitis or any other allergic skin disorder. Black & Kletz Allergy has locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location and the Washington, DC and McLean offices are also Metro accessible. There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line. If you would like to make an appointment with an allergist, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been providing quality allergy care to the Washington, DC metropolitan area for more than 50 years.


Sinusitis is a term for an inflammation of the sinus. Most of the time however, it refers to a typical sinus infection. There are of course various causes of sinus infections ranging from infections due to a virus, bacteria, fungus, or parasite. Viral sinus infections are by far the most common sinusitis seen in the community. Bacterial sinus infections are certainly not uncommon and often result from a secondary bacterial infection in someone who had had a viral sinus infection. Fungal and parasitic sinus infections are quite unusual and are more likely to occur in immunocompromised individuals. Sinusitis occurs when fluid enters the sinus cavity which is normally filled with air.

There are 4 major types of sinusitis:

  • Acute sinusitis:  Generally, lasts 4 weeks or less. It typically presents suddenly. It is most often caused by viruses, (e.g., common cold virus), although bacteria and rarely fungi may be responsible for this type of sinusitis. Having a history of allergic rhinitis (i.e., hay fever) is a risk factor
  • Subacute sinusitis:  Generally, lasts between 4 to 12 weeks in duration. It commonly occurs in conjunction with bacterial infections or partially treated infections. Having a history of allergic rhinitis is a risk factor.
  • Chronic sinusitis:  Generally, lasts more than 12 weeks in duration. It commonly occurs in conjunction with bacterial or rarely fungal sinus infections. Partially treated acute or subacute sinus infections may turn into a chronic sinus infection. Having a history of allergic rhinitis is a risk factor.
  • Recurrent sinusitis:  This occurs when a sinus infection occurs 4 or more times in one year.

Each pair of sinuses are named for the bone that they are situated on. The names of the 4 sinuses are maxillary sinuses, ethmoid sinuses, frontal sinuses, and sphenoid sinuses. The maxillary sinuses are located on the cheekbones. The ethmoid sinuses are situated on each side of the upper nose between the eyes. The frontal sinuses are positioned in the forehead region above the eyes. The sphenoid sinuses are located behind the eyes and bridge of the nose.

The classic symptoms of sinusitis may include nasal congestion, sinus pressure, post-nasal drip, sinus pain, facial pain, discolored mucus, headaches, sore throat, malodorous breath, and/or exacerbation of asthma. It should be noted that in patients with chronic sinusitis, just an aggravation of one’s asthma may be the only sign of underlying sinusitis. A decrease in one’s sense of taste and smell, earaches, and/or fatigue may also occur in individuals with chronic sinusitis.

There are numerous risk factors that make someone more prone to acquiring sinusitis. These risk factors are as follows:

  • Allergic rhinitis (i.e., hay fever)
  • Previous upper respiratory infection (URI), usually viral in origin
  • Structural irregularities of the nose/sinuses
  • Nasal polys
  • Smoking/smoke exposure
  • Immunodeficiency (i.e., weakened immune system)


The diagnosis of sinusitis can be made by just doing a comprehensive history and physical examination for the most part. In some instances, a CT scan of the sinuses may be necessary, particularly when trying to diagnose chronic or recurrent sinusitis. Rhinoscopy, (i.e., looking into the nasal passages and sinuses through a thin flexible tube with a fiber-optic light) is sometimes used to visualize the anatomy of the problem. In rare instances, a culture may be taken to rule out a fungus as a causative agent of the sinusitis or to ascertain which antibiotic is necessary to treat a resistant bacterial sinus infection.


Most viral sinusitis cases resolve on their own without treatment. Decongestants and nasal corticosteroids are useful in many cases to provide clinical relief in patients with sinusitis. Rest and fluids are also advised in most situations of sinusitis. Symptomatic relief can sometimes be enhanced by using saline irrigation in the form of a nasal spray or Neti pot. Likewise, breathing in steam from a hot shower is helpful in some individuals. Pain relief can be aided by using Tylenol (i.e., acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Antibiotic therapy may be necessary for some individuals. When implemented. For individuals who are not allergic to penicillin, amoxicillin or Augmentin (i.e., amoxicillin + clavulanic acid) is the antibiotic of choice for most areas of the U.S. The course of an antibiotic is usually 10-14 days for the treatment of acute sinusitis and 3-4 weeks for chronic sinusitis.

It is important to note that many individuals who have sinusitis have underlying allergies. Many people are aware of these allergies, but many are not aware. Individuals who get sinusitis should seek a consultation with a board certified allergist like the ones at Black & Kletz Allergy. By addressing the underlying allergies and controlling them, one is subsequently less likely to continue to experience bouts of sinusitis.

The board certified allergists of Black & Kletz Allergy have had over 50 years of experience dealing with sinusitis, sinus infections, and other sinus-related conditions. Black & Kletz Allergy has 3 office locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area. The allergy specialists at Black & Kletz Allergy diagnose and treat both adults and children with sinus disease, allergies (e.g., hay fever, food allergies, medication allergies), asthma, hives, swelling episodes, insect bites, bee sting allergies, eczema, contact dermatitis, and immunologic problems. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and have on-site parking at each location. 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 us to schedule an appointment or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been striving to provide high quality allergy and asthma care to the residents of the Washington, DC metro area for more than a half a century and we are dedicated to continue delivering state-of-the-art allergy and asthma care in the future.

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.

Respiratory Syncytial Virus (RSV) Infection

Respiratory syncytial virus (RSV) causes annual outbreaks of respiratory illnesses in all age groups.  It is one of the most common illnesses in children.  Though it can occur any time of the year, RSV infections are most common from the late Fall to the early Spring with a peak predominance in February.

Virtually all children get an RSV infection by the time they are 2 years old.  Most of the time, RSV will cause a mild, cold-like illness, however, it may also cause severe illness such as bronchiolitis (i.e., inflammation of the small airways in the lung) and/or pneumonia (i.e., infection of the lungs).

The initial symptoms of RSV usually include a runny nose, nasal congestion, mild fever, cough, and/or occasional wheezing.  Most individuals generally recover fully within a week.  It is important to note that the illness may be more severe in children under the age of 2 with chronic lung disease, congenital heart disease, suppressed immune systems, and neuromuscular disorders. Children who have difficulty swallowing or clearing mucus secretions are at greater risk for developing more severe disease as well.

Approximately 1 or 2 out of every 100 children younger than 6 months of age with RSV infection may need to be hospitalized.  Those who are hospitalized may require oxygen, intubation, and/or mechanical ventilation to help with breathing.  Most affected children improve with this type of supportive care and are usually discharged in a few days.  Recently, a number of studies have established a relationship between infants with severe RSV infections and the subsequent development of asthma later in childhood.  Respiratory syncytial virus is the leading cause of lower respiratory tract (i.e., lungs) infection in children and is a common cause of wheezing in infants and young children.

In adults, RSV infections present as mild cold-like illness with symptoms of runny nose, sore throat, cough, mild fever, achiness, and/or fatigue.  In healthy adults the symptoms usually subside spontaneously within 5 days.

Some adults, however, may have more severe symptoms consistent with a lower respiratory tract infection, such as pneumonia.  Those at high risk for severe illness from RSV include older adults (i.e., especially those 65 years and older), adults with chronic lung or heart disease, and adults with weakened immune systems.  RSV can sometimes also lead to the exacerbation of serious conditions such as asthma, chronic obstructive pulmonary disease (COPD), and/or congestive heart failure.


Clinical symptoms of RSV are nonspecific and can overlap with other viral respiratory infections, as well as some bacterial infections.  Several types of laboratory tests are available for confirming an RSV infection.  These tests may be performed on upper and lower respiratory specimens.
The most commonly used types of RSV clinical laboratory tests are real-time reverse transcriptase-polymerase chain reactions (rRT-PCR), which are more sensitive than cultures and antigen testing.  It should be noted that antigen testing is highly sensitive in children but not sensitive in adults.


RSV spreads just like a common cold virus―from one person to another.  It enters the body through the nose or eyes, usually occurring from direct person-to-person contact with saliva, nasal discharge, unclean hands, or contaminated objects/surfaces.  It should be noted that RSV can survive 30 minutes or more on unwashed hands and up to 6 hours on surfaces such as toys, keyboards, door knobs, etc.


The symptoms of respiratory syncytial virus can appear 2 to 8 days after contact with RSV. The typical symptoms may include a runny nose, nasal congestion sore throat, achiness, fatigue, mild fever, cough, and/or occasional wheezing.  According to the Centers for Disease Control and Prevention (CDC), individuals infected with RSV are usually contagious for 3 to 8 days.


There is no specific treatment to cure the infection but symptomatic relief can be obtained by nasal saline irrigation with gentle suctioning to allow easier breathing and feeding.  A cool-mist humidifier can help break up mucus which may result in easier breathing.  Hydration by means of drinking plenty of fluids is also important when fighting an RSV infection.  Acetaminophen (i.e., Tylenol) and ibuprofen (i.e., Motrin, Advil) may help relieve body aches and fevers.  Antibiotics and corticosteroids are not helpful.  Aspirin should be avoided.]


Frequent hand washing, covering coughs and sneezes, avoiding people who are ill, cleaning and disinfecting surfaces, and staying home when sick will go a long way to help prevent spreading the infection.

A vaccine for RSV is not currently available but intense research is going on to develop one.  A medication named Synagis (i.e., palivizumab)) may reduce the risk of severe RSV infection in some high-risk infants.  It is a monoclonal antibody that is administered by means of an intramuscular injection.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating upper respiratory infections in both adults and children for more than 50 years.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call one of our offices or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  If you suffer from allergies, recurrent upper respiratory infections, asthma, sinus-related symptoms, or have had an RSV infection, we are here to help you manage and alleviate your symptoms.  Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a caring, relaxed,, and professional environment.

Are You Allergic to Turkey on Thanksgiving?

Homemade Sliced Turkey Breast on a Thanksgiving plate

We have all felt it and we have all heard it.  “Turkey on Thanksgiving makes you sleepy!”  If so, is it an allergy to turkey that causes this sleepiness?  Is it just a side effect of something in the turkey that causes this tiredness and lethargy?  Some have blamed the high amounts of the essential amino acid L-tryptophan for the somnolence.  Regardless of what you have heard, the fact is that turkey does not cause sleepiness.  Why then do people tend to feel sleepier on Thanksgiving?

Let’s begin with the fact that there are high amounts of the essential amino acid L-tryptophan in turkey.  But what is L-tryptophan?  L-tryptophan is an essential amino acid that must be acquired from foods we eat since the body does not produce L-tryptophan on its own.  Amino acids are the precursors to proteins.  It takes multiple amino acids to make a protein.  Thus, amino acids are considered the “building blocks” of proteins.  It is also important to note that there are a variety of other foods besides turkey that are rich in L-tryptophan.  Some of these foods include fish, canned tuna, eggs, legumes (e.g., peanuts, lima beans, soybeans), milk, yogurt, seeds (e.g., sesame, sunflower, pumpkin), oats, cheese, chocolate, bread, and some fruits.  It should be noted that turkey and chicken both have similar amounts of L-tryptophan.  Another interesting fact is that the white turkey meat has more L-tryptophan than the dark turkey meat, but with chicken, it is the reverse, as there is more L-tryptophan in dark chicken meat than white chicken meat.

L-tryptophan is needed for the body to produce serotonin, a chemical in the brain that plays a role in one’s mood, as well as one’s pain intolerance.  When serotonin levels are high, one’s mood is elevated and a sense of relaxation ensues.  In addition, one may also have a higher pain tolerance.  Thus, L-tryptophan is thought to have a beneficial effect on memory, learning, mood, and depression.  It may also have beneficial effects on reducing anxiety, seasonal affective disorder, and premenstrual pain although more research is needed to confirm this.

Many people often experience sleepiness and fatigue after eating a Thanksgiving Day meal.  Many attribute this lethargy to the turkey eaten on Thanksgiving.  Many feel that they are having an allergic reaction to turkey due to this somnolence, however, it is not an allergy at all.  Allergies to turkey meat are not common, but a true allergy to turkey can occur in some individuals.  Rather than sleepiness and fatigue, the symptoms of a true turkey allergy more typically may include generalized itching (i.e., pruritus), hives (i.e., urticaria), swelling (i.e., angioedema), abdominal pain, diarrhea, vomiting, wheezing, shortness of breath, feeling faint, and/or a drop in blood pressure.  These individuals should see a board certified allergist for proper diagnosis and treatment which would include an epinephrine self-injectable device (e.g., EpiPen, Auvi-Q, Adrenaclick) for emergency use.  It should be noted that if an individual uses an epinephrine self-injectable device, that individual should go immediately to the closest emergency room.

Even though turkey allergy exists, the vast majority of individuals that experience sleepiness or fatigue after eating a Thanksgiving Day meal most likely get these symptoms from a variety of factors not associated with the turkey.  During Thanksgiving, it is well known that people overeat.  In addition, they tend to overdo it with alcohol consumption.  These 2 factors may easily explain the lethargy and sleepiness many find themselves suffering after a Thanksgiving Day meal.  It is well known that a high carbohydrate, high fat meal can lead to sleepiness and fatigue approximately 1-2 hours after eating.  Alcohol is also known to cause excessive sleepiness.  Thus, the combination of a high carbohydrate, high fat meal with alcohol seems like the perfect storm to cause sleepiness and fatigue.

In order to minimize or prevent any somnolence that may occur during Thanksgiving Day, or any other holiday, try to limit one’s eating and drinking so that it is not excessive.  Try to eat smaller portions and reduce alcoholic consumption.  In addition, try to get enough sleep and have a nice holiday!

The board certified allergists at Black & Kletz Allergy have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area and treat both adults and children with food allergies, food sensitivities, other allergies, asthma, sinus disease, and immunologic disorders.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Black & Kletz Allergy offers on-site parking at each of their 3 office locations and the Washington, DC and McLean, VA offices are also Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call our office or you can click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy has been serving the allergy and asthma needs of the Washington, DC metropolitan area community for more than 50 years and we strive to administer high quality allergy and asthma care in a welcoming professional environment.


Eustachian Tube Dysfunction and Allergies

The Eustachian tube is a small tubular passageway that connects the middle ear with the junction of the back of the nose and upper throat. It is approximately 1.5 inches long and 3 mm. (0.12 inches) in diameter. It is the structure in the ear that pops when one goes to high altitudes or descends deep in the water. The tube helps to regulate pressure in the middle ear, shield the ear from hearing its own body noises, and drain fluid from the middle ear. The Eustachian tube has a valve that opens and closes. If the tube stays open too much, one may get a constant feeling of increased pressure in one’s ear. In addition, one may hear their own body noises such as hearing one’s voice too loudly or hearing one’s own breathing. On the other hand, if the Eustachian tube stays closed, there may be a buildup of fluid which may result in a feeling of increased pressure and/or pain in the ear as well as a decrease in hearing.

Eustachian tube dysfunction occurs when the tube fails to open and gets stuck closed during swallowing or yawning. This results in a difference in the air pressure between the inside and outside of the middle ear.

The most common cause of Eustachian tube dysfunction is an upper respiratory infection (URI) such as the common cold, flu, or a sinus infection. Other causes of Eustachian tube dysfunction may include allergies (i.e., allergic rhinitis), enlarged tonsils/adenoids, nasal polyps, cigarette smoke, pollution, nasal tumors, cleft palate, and/or tumor at base of the skull. Note that the last 3 causes mentioned are fairly rare causes of Eustachian tube dysfunction.

We will focus on allergies as a cause for Eustachian tube dysfunction. Allergic rhinitis (i.e., hay fever) is a very common condition and accounts for a fair amount of Eustachian tube dysfunction. The classic symptoms of allergic rhinitis may include runny nose, nasal congestion, sneezing, post-nasal drip, snoring, itchy eyes, watery eyes, redness of the eyes, sinus pain/pressure, itchy nose, and itchy throat. As a result of a post-nasal drip, some individuals may experience hoarseness and a sore throat. Others may develop asthma symptoms such as chest tightness, coughing, wheezing, and/or shortness of breath.

Still others, however, may develop symptoms of Eustachian tube dysfunction. These symptoms may include clogged ears, hearing loss, increased ear pressure/pain, popping of the ears, vertigo/dizziness, and/or ringing of the ears (i.e., tinnitus). Allergies may cause a narrowing of the Eustachian tube opening or its passageway resulting in the symptoms described above.

The diagnosis of an allergic cause of Eustachian tube dysfunction begins with a comprehensive history and physical examination. If an allergy is suspected, allergy skin testing or blood tests may be performed. A CT scan of the sinuses may be ordered for individuals who present with recurrent or chronic sinus infections.

The management of the underlying allergies in patients with allergy-induced Eustachian tube dysfunction is the goal of treatment. Treating the underlying allergy may help to reduce the swelling in the lining of the Eustachian tube. Nasal corticosteroids are often effective in reducing the symptoms of Eustachian tube dysfunction. Oral or nasal decongestants may also be beneficial. Oral and nasal antihistamines have also proven beneficial in the treatment of allergic rhinitis. Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a very effective tool to treat allergic rhinitis as it works in 80-85% of patients on this therapy.

The board certified allergy doctors at Black & Kletz Allergy have been treating Eustachian tube dysfunction as well as allergies, sinus problems, and asthma. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years and treat both adult and pediatric patients. All 3 offices at Black & Kletz Allergy 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 are concerned that you may have Eustachian tube dysfunction, allergies, sinus problems, asthma, hives, eczema (atopic dermatitis), or immune system problems, please call us to schedule an appointment. You may also click Request an Appointment and we will reply within 24 hours by the next business day. At Black & Kletz Allergy, we strive to improve the quality of life in allergic individuals in a professional and compassionate setting.

Seasonal Flu and Asthma

Viruses cause a variety of illnesses in humans ranging from mild upper respiratory infections (URIs) to life-threatening pulmonary and extra-pulmonary diseases. Rhinoviruses, adenoviruses, respiratory syncytial virus (RSV), coronaviruses, and influenza viruses are the most common viruses infecting the respiratory tract. Among these rhinoviruses, RSV, and influenza viruses are common causes of wheezing in children. Recurrent infections with these viruses may play a role in the development of asthma.

Patients with asthma are more susceptible to contracting infections with the influenza virus. In addition, they are also more likely to develop serious complications from influenza. In fact, more than 75% of acute flare-ups of asthma are triggered by infections from influenza, RSV, or rhinovirus.

Infections typically occur in the United States between October and November with a peak infection rate between January and March. There are 3 strains of influenza viruses that cause human infections; influenza A, influenza B and influenza C.

Influenza A and B are typically associated with seasonal disease but also have been associated with several pandemics during the 20th century. For example, in 1918, the Spanish influenza (i.e., Spanish flu), a strain of H1N1 of influenza A, caused between 50 and 100 million deaths worldwide with a mortality rate of 2.5 to 3%. Most of the deaths occurred in adults between the ages of 20 and 40 years old. In 1957, the Asian influenza or Asian flu of the H2N2 strain of influenza A, caused between 1.5 and 2 million deaths. In 1968, the Hong Kong influenza (i.e., Hong Kong flu), a strain of H3N2 influenza A, caused over 1 million deaths.

Currently circulating influenza A viruses of the H1N1 variety are related to the 2009 H1N1 pandemic that emerged in the Spring of 2009 and caused a flu pandemic.

Influenza infection begins with invasion of the respiratory epithelium by the virus. This site in the respiratory system serves as a place for both viral replication and the resulting host’s immune response. Destruction of normal airway tissue and a pro-inflammatory immune response are the primary causes of symptoms associated with influenza infection.

The immune response of the host causes many of the symptoms associated with a viral respiratory infection and those associated with exacerbations of underlying asthma. Certain individuals seem to be at a higher risk for developing infections in the lower airway (i.e. lungs). For example, age less than 6 months old, second-hand smoke exposure, and genetic factors play a role in increasing the risk of infection. Allergic subjects are also more susceptible to infections due to an impaired immune response.


  • Runny nose, stuffy nose, post-nasal drip
  • Sore throat
  • Cough
  • Fever, chills
  • Achiness
  • Vomiting, diarrhea
  • Fatigue


  • Pneumonia
  • Exacerbation of asthma symptoms
  • Inflammation of the heart muscle
  • Inflammation of the brain


Most cases of influenza are mild and symptoms usually resolve within 7 to 10 days. Symptomatic relief can be given by over-the-counter medications such as Tylenol (i.e., acetaminophen) in order to reduce fevers, chills and/or achiness. Inhaled medications such as albuterol (i.e., ProAir, Ventolin) are given to help relieve asthma-like symptoms which may include wheezing, chest tightness, coughing and/or shortness of breath. Rest and increased oral fluids may hasten the recovery process.

The indications for antiviral medications include patients that are at high risk of influenza-related complications including pregnant women, adults over 65 years of age, immunocompromised individuals, and those with chronic medical conditions such as asthma, chronic obstructive pulmonary disease (COPD), and diabetes. Antiviral medications should be used if an individual requires hospitalization, during severe or complicated infection, and during pregnancy. Many primary care physicians recommend antiviral therapy for other scenarios and individuals should check with their physician to see what they recommend.

Antiviral treatment works the best when begun soon after flu-like symptoms begin.  When treatment is started within 2 days of developing flu-like symptoms, antiviral drugs can reduce fever and flu symptoms and shorten the duration of the illness.  They also may decrease the risk of complications such as ear infections in children, respiratory complications requiring antibiotics, and hospitalizations in adults. Some of the antiviral medications used for the treatment of the flu are as follows:

  • Tamiflu (i.e., oseltamivir) is available as a pill or liquid suspension and is FDA approved for the early treatment of the flu in individuals over the age of 2 weeks.
  • Relenza (i.e., zanamivir) is a powder that is inhaled and approved for the early treatment of the flu in individuals 7 years of age and older.  Relenza is administered using an inhaler device and is not recommended for individuals with breathing problems such as asthma or COPD.)
  • Oseltamivir and zanamivir are given twice a day for 5 days.
  • Xofluza (i.e., baloxavir) is a pill given as a single dose by mouth and is approved for early treatment of flu in people 12 years and older.  Xofluza is not recommended for pregnant women, breastfeeding mothers, and outpatients with complicated or progressive illness.
  • Rapivab (i.e., peramivir) is given intravenously by a primary care physician and is approved for the early treatment of flu in individuals 6 months of age and older.


Staying home as much as possible and avoiding contact with others will reduce the risk of acquiring an influenza infection.

Routine annual influenza vaccination (i.e., flu shots) is recommended for all persons 6 months of age and older.  Many types of flu vaccines are licensed by the FDA this year with varying indications based on one’s age group and health status.  Please see the following link for more information.


The board certified allergists at Black & Kletz Allergy treats both adults and children and will gladly answer any questions you have concerning the flu as well as any allergy/immunology topic. Black & Kletz Allergy has 3 offices in the Washington, DC, northern Virginia, and Maryland metropolitan area with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location and our Washington, DC and McLean offices are also Metro accessible. There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line. If you would like to make an appointment with an allergy specialist, please call us. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been providing quality allergy, asthma, sinus, and immunological services to the DC metro area for more than 5 decades