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Category Archives: ALLERGIES

Can Sleep Disorders be Due to Allergies?

A top allergist Arlington, VA trusts examines the correlation between allergies and sleep disorders
Sleep disorders affect about 30% of the population.  Several sleep disorders have been linked to allergies.  People who suffer from hay fever (allergic rhinitis) are more than twice as likely to have insomnia as those individuals who do not have hay fever.  They are also more than twice as likely to have problems falling asleep.  A little more than one-third of individuals with hay fever complain of insomnia.  Almost two-thirds of these same allergic people complain that they do not get enough sleep.  For comparison, only one-sixth of individuals without allergies say they have insomnia and one-quarter of individuals without allergies say that do not get enough sleep.  The severity of the sleep disorders also increased as the severity of the allergies increased, showing a direct proportional relationship.  Sleep disorders are linked to sleepiness during the day, fatigue, depression, decreased ability to learn, decreased memory, decreased productivity at school and/or work, and a decreased quality of life.  Interestingly, allergic rhinitis has been linked to many of the same symptoms.  The combination of allergic rhinitis and a sleep disorder can have deleterious effects on these individuals.

Obstructive sleep apnea is a sleep disorder that is caused by repeated interrupted breathing which does not allow an individual to get enough “deep” sleep that is required to rejuvenate the body.  As a result, excessive daytime sleepiness or falling asleep at inappropriate times is the hallmark of this condition.  It is often caused by one’s tongue sliding back in the throat, in combination with a relaxed airway which changes shape to a more oval (rather than round) shape which gives way to less “room” for air to be able to get to the lungs from the nose or mouth.  This combination of things often causes the individual to snore.  People with obstructive sleep apnea are unable to breathe in air due the blockage caused by a tongue that is blocking the airway on top of an already relaxed smaller diameter airway.  These individuals literally stop breathing for typically 20 to 60 seconds.  When this occurs, there is an “emergency” sensor called the carotid body near the carotid arteries in one’s neck, that detects the lowering of the oxygen and rise in carbon dioxide in the blood.  This triggers the awakening center in one’s brain and the individual awakens for a few seconds allowing them to unknowingly move their tongue and re-form their throat shape to the normal awakened state.  Breathing is then reestablished.  This cycle in people with obstructive sleep apnea occurs many times per hour.  It can occur greater than 50 times per hour, resulting in a lack of restful sleep.  Obstructive sleep apnea has been linked to allergic rhinitis.  People with allergic rhinitis often have nasal congestion which causes the upper airway to narrow.  Individuals with hay fever also are more prone to sinus infections.  Most people with sinus infections also have nasal congestion as part of their symptoms.  The upper airway narrowing that occurs due to nasal congestion increases the likelihood of snoring and obstructive sleep apnea.  Obstructive sleep apnea should not be taken lightly as some of the complications of obstructive sleep apnea include heart disease, stroke, increased risk for motor vehicle accidents, and sexual dysfunction.

If you snore, experience insomnia, have difficulty falling asleep, and/or have daytime sleepiness, the board certified allergists at Black & Kletz Allergy can order a sleep study as well as diagnose and treat you for allergic rhinitis, if applicable.  We treat both adults and children and have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All our offices have on-site parking and our offices in Washington, DC and McLean are Metro accessible.  We offer a free shuttle between our McLean office and the Spring Hill metro station.  If you have a sleep disorder and/or hay fever symptoms, please call us for an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy strives to provide quality allergy, asthma, sinus disease, hives, and immunologic care to the Washington, DC metro area community in a caring and professional manner as we have done for more than 50 years.

Over-The-Counter Allergy Medications and Their Possible Side Effects

Any Arlington allergist can tell you: millions of allergy sufferers reach for over-the-counter (OTC) allergy medications daily to try to get relief from their allergy symptoms. There are numerous medications available and they come in a variety of routes of administration. The medicines come in the forms of tablets, capsules, syrups, powders, nasal sprays, eye drops, creams, ointments, and inhalers.

Most OTC medications use additional ingredients, referred to as inactive ingredients, which may include preservatives, coatings, dyes, lubricants, sweeteners, flavoring agents, and binding materials. Not all inactive ingredients are always inactive. Alcohol is added to some OTC medications and may be inactive or active. Alcohol is often found in OTC cough syrups which many allergy patients use. Some individuals have allergic reactions and/or untoward side effects to some of these inactive ingredients. Common inactive ingredients that cause reactions for some individuals include: aspartame, benzoates, benzyl alcohol, sulfites, benzoates, lactose, oleic acid, propylene glycol, saccharin, sorbitan trioleate, and soy lecithin. There are over 450 inactive ingredients used in OTC medications.

Many individuals can also have allergic reactions and/or unwanted side effects from the active drug found in OTC allergy medications. The active drug is the drug that is meant to “work” on the symptoms. An allergic reaction to a drug can occur with any drug and usually involves symptoms that may include: hives (urticaria)itching (pruritus)swelling (angioedema), rashes, abdominal discomfort, nausea, vomiting, wheezing, shortness of breath, throat closing sensation, chest tightness, itchy eyes, watery eyes, redness of the eyes, itchy throat, and anaphylaxis (a life-threatening systemic allergic reaction).

OTC allergy medications can be even more confusing since many of them contain more than one active drug. An example of a single drug medication is Claritin, which contains loratadine, whereas an example of a medication that has 2 drugs is Claritin-D, which contains both loratadine and pseudoephedrine. There are many OTC allergy medications that contain more than 3 drugs in a single pill. To the average consumer, whose knowledge of the field of medicine is rudimentary, this can present a potentially serious problem. In the example used above with Claritin and Claritin-D, any allergist in Arlington will agree that a person with high blood pressure (hypertension) and/or heart disease should not take the Claritin-D because the active ingredient, pseudoephedrine, can elevate one’s blood pressure and increase their heart rate. It should also not be taken in individuals with an enlarged prostate, glaucoma, kidney disease, and/or overactive thyroid (hyperthyroidism). In a healthy person, it usually is not a problem; however, in patients with the diseases listed above, it can potentially be devastating.

Another potential problem with using OTC allergy medications involves the interactions they may have with other medications that the individual may be taking. These other medications may be prescribed or they may interact with other OTC medications. Certain medications may diminish the efficacy of other medicines causing them not to work as well as they were intended. On the other hand, certain medicines can have the opposite effect and increase the effect of another medicine making it potentially dangerous as well. An example of the latter would be an individual with attention deficit hyperactivity disorder (ADHD) who takes the medication Adderall (mixture of the salts of amphetamine and dextroamphetamine) with the OTC medication pseudoephedrine (e.g., Sudafed). The pseudoephedrine could potentiate the effect of the Adderall or vice versa. Therefore, an understanding of pharmacology is recommended for self-medicating.

Drugs tend to be classified in “classes.” For example, beta blockers, angiotensin inhibitors, and calcium channel blockers are 3 common classes of high blood pressure medications. Likewise, penicillins, macrolides, and quinolones are 3 common classes of antibiotics. Individuals who are allergic to a drug in a particular “class” of medications tend to be more likely to have an allergy to another drug in that same “class.” For example, someone who is allergic to amoxicillin is more likely to be allergic to another penicillin derivative such as ampicillin. An individual that has a known allergy to a drug may take an OTC allergy medication that may contain an active or inactive ingredient that may be in the same “class” as that drug. The person may not have checked the ingredients in the OTC medicine, may not have known that the OTC medicine was in the same “class,” or more likely, did not even know about cross-reactions to medications within “classes.” A good example of this would be when someone takes a sinus relief allergy OTC medication that contains ibuprofen. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) which is also known under the brand names Advil, Motrin, Nuprin, as well as many other names. That individual may have known that he/she was allergic to naproxen (e.g., Naprosyn, Aleve, Anaprox) but did not know to avoid that “class” of medications, namely NSAIDS’s or he/she did not know that the generic name for Advil was ibuprofen.

In addition to the above reasons to be careful when using OTC allergy medications, one must recognize that there are side effects that are not allergic in nature, but still affect average people in different ways. It is fairly common for many OTC allergy medications to cause drowsiness. There are typically warnings on the sides of the boxes or bottles, but one may become extremely drowsy to a medication whereas someone else may have no drowsiness to the same dose of the same medication. Still others may have a paradoxical effect where it causes them to feel “hyper” and “agitated” like the feeling of too much caffeine (which by the way, is also used in a great deal of OTC allergy and sinus medications).

Even though OTC allergy medications can be beneficial, one must use caution when using them. There are other side effects not listed in this article, but this article is meant to warn people about the possibility of having potentially serious reactions from OTC allergy and sinus medications. If you have allergies and need advice on any type of medication whether OTC or prescribed, please feel free to make an appointment for a consultation with our board certified Arlington allergists at Black & Kletz Allergy. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All our offices have on-site parking and the Washington, DC and McLean offices are Metro accessible. There is a free shuttle that brings patients back and forth between our McLean office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment and we will respond within 24 hours on the next business day. We treat both adults and children and have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years.

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:


  • 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.


  • 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.


  • 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


  • About 80% of postmenopausal woman have flushing associated with sweating.


  • 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.


  • High levels of circulating histamine released from excessive numbers of mast cells in one’s body causes flushing, fainting, and shortness of breath.


  • 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?

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.

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.