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Category Archives: HAY FEVER

Allergy Shots – A Brief Overview

Allergy shots are synonymous with other terms such as allergy immunotherapy, allergy injections, allergy desensitization, and allergy hyposensitization. The allergy shots Gainesville, VA residents rely upon are the same allergy shots that have been given in the U.S. for over 100 years. They have been an important method of preventing and/or diminishing allergy symptoms in tens of millions of individuals over the last century.

Allergy shots can be given to almost any person and are given to any individual over the age of 2. Usually, however, most children do not begin allergy injections earlier than 4 years of age. They can be given to children, teenagers, adults, and the elderly. They can be continued in a pregnant individual as well as in a person who is nursing, as long as it is confirmed by the patient’s obstetrician and/or pediatrician of the nursing baby.

Allergy injections are given to patients with allergic rhinitis (i.e., hay fever)allergic conjunctivitisasthma, and venom hypersensitivity (i.e., allergy to stings of bees, wasps, hornets, yellow jackets, and/or bites from fire ants). The idea behind them is to get to the root of the problem, as opposed to treating the symptoms of allergic rhinitis, allergic conjunctivitis, and asthma. By receiving allergy injections, one’s body develops antibodies that help prevent the allergen (e.g., dust mites, molds, pollens, pets, cockroaches, venom) from causing the unwanted allergy and/or asthma symptoms.

Allergy immunotherapy is useful and may be considered when one is allergic to substances that cannot be avoided. They are also used in individuals that have failed over the counter therapy and/or prescription medications. There are other individuals that do not want to take medications on a daily basis. Others have very severe symptoms and develop secondary problems (e.g., sinus infections, ear infections, bronchitis, asthma) from untreated or sub-par treatment from medications. Many people cannot deal with the side effects of many of the allergy medications. Still others would like to treat the cause of the allergy rather than just treat the symptoms of allergy and/or asthma.

During allergy immunotherapy, very small doses of the allergens that the individual is allergic to are administered subcutaneously (i.e., just under the skin into the fat) of the arm(s) either once a week or twice a week, depending on the patient’s choice. Obviously, if the individual receives the injections more frequently (i.e., twice a week vs. once a week), he or she will get through the build-up process twice as fast. Each dose is increased in strength over the build-up period which at Black & Kletz Allergy is usually 18 doses. Therefore, the maintenance dose (i.e., top dose) is reached in 9 or 18 weeks depending if the individual gets his or her build-up shots twice a week or once a week respectively. Once the maintenance dose is reached, the individual can spread out the frequency of the injections to up to every 4 weeks. Note that many people get their shots more frequently throughout the year depending on their “bad” seasons, such as Spring and Fall which in the Washington, DC, Northern Virginia, and Maryland metropolitan area is very common. Others need their injections more frequently throughout the year since they have perennial symptoms which may require them to get the injections more frequently, depending on their severity of allergy and/or asthma symptoms. The average length of time someone is on the allergy shots Gainesville, VA residents receive from Black & Kletz Allergy ranges between 3-5 years. It is important to note that allergy shots to venoms have a different build-up and maintenance schedule.

The effectiveness of allergy injections is excellent. They have been shown work in 80-85% of individuals taking them. Venom immunotherapy is effective in over 90% of patients receiving them. Allergy injections may also prevent the development of asthma in children with allergic rhinitis. They help to prevent the inflammation that occurs in a typical allergic encounter. Normally when an individual is exposed to a known allergen, many chemicals such as histamine and leukotrienes are released into the bloodstream of the patient. These chemicals are responsible for producing the miserable symptoms of allergies, and in addition, cause inflammation to occur. The allergy shots Gainesville, VA patients receive help the body naturally produce antibodies that will help prevent this process from occurring and thus the individual suffers much less or not at all and has much less or no development of allergic inflammation.

There are essentially no side effects of allergy shots, however there are two risks. The first being the chance of having a local reaction at the site of the injection which may include localized itchiness, redness and/or swelling. The second risk is that of a systemic reaction such as developing generalized itching, hives, swelling, wheezing, abdominal cramps, drop in blood pressure, which potentially can be serious. For that reason, although very rare to occur, it is important to wait 30 minutes in our office after an allergy injection, so that we could treat you with epinephrine and/or Benadryl if necessary. Despite the rarity of a systemic reaction, it can occur and it is necessary to wait the 30 minutes after an injection. A longer wait time is needed for individuals receiving venom immunotherapy.

In summary, allergy shots are a very effective treatment modality for individuals with allergic rhinitis, allergic conjunctivitis, asthma, and/or venom hypersensitivity. As mentioned above, they have been given in the U.S. for over a century and can be given to all ages from young children to the elderly. The board certified allergists at Black & Kletz Allergy have been administering allergy shots for over 50 years. We have one office location in Washington, DC and 2 offices in Northern Virginia with one office in McLean, VA (Tysons Corner, VA) and another in Manassas, VA. We have on-site parking at all 3 office locations and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line. If you suffer from allergies, asthma, sinus problems, hives, swelling episodes, and/or immunological conditions, please call our office to schedule an appointment or you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy prides ourselves in providing high quality allergy and asthma care in a professional, inviting, and friendly environment.

Hay Fever in the Fall

September may be the month to consult an allergy specialist Centreville VA patients turn to, as ragweed pollen counts peak and wreak havoc in allergic individuals in the Washington, DC, Northern Virginia, and Maryland metropolitan area including the following cities in Northern Virginia: McLean, VA, Tysons Corner, VA, Vienna, VA, Fairfax, VA, Arlington, VA, Great Falls, VA, Falls Church, VA, Annandale, VA, Alexandria, VA, Reston, VA, Herndon, VA, Sterling, VA, Oakton, VA, Burke, VA, Manassas, VA, Centreville, VA, Chantilly, VA, Gainesville, VA, Haymarket, VA, Warrenton, VA, Springfield, VA, Dumfries, VA, Culpeper, VA, Ashburn, VA, Leesburg, VA, Purcellville, VA. Ragweed also affects the surrounding Maryland cities such as Bethesda, MD, Chevy Chase, MD, Potomac, MD, Great Falls, MD, Gaithersburg, MD, Rockville, MD, Darnestown, MD, Germantown, MD, Olney, MD, Silver Spring, MD, Wheaton, MD, College Park, MD, Hyattsville, MD, Beltsville, MD, Bowie, MD, Clinton, MD, Annapolis, MD, Columbia, MD, and Baltimore, MD. In the DC metropolitan area, ragweed begins to pollinate in mid-September and ends at the first frost which is usually at the end of October.

What is Ragweed?
As an allergy specialist Centreville, VA has to offer might attest, ragweed is a tough and hardy soft-stemmed weed that can grow well along roadsides, riverbanks, vacant lots, and fields. It belongs to a genus called Ambrosia and there are 17 different species of ragweed. The height of the plants generally range from about 3 inches to 12 feet.

The plants mature in mid-Summer and produce small flowers. Warmth, decreased humidity, and active breezes after sunrise help create the ideal environment for ragweed flowers to release their pollen. Each individual plant can release up to one billion pollen grains. Though most of the released pollen stays in the general area, some grains can travel as many as 500 miles in dry and windy conditions. This helps explain why pollen counts are usually lowest on rainy days and cool mornings. Individual plants pollinate only for one season but the seeds survive in the soil from year to year producing fresh crops each year. Over the past decade, the EPA has noticed a prolonged ragweed season in the Washington, DC area. Climate changes and increased carbon dioxide levels in the atmosphere may play a role in this prolongation of the ragweed season.

How Does it Cause Allergies?
Though ragweed pollen is generally harmless, in a genetically susceptible individual, the immune system can mistake it as potentially dangerous invader and mount a defensive attack. This process triggers antigen (ragweed) vs. antibody (immunoglobulin) reactions on exposure, resulting in the release of chemical mediators like histamine which are responsible for the classic annoying hay fever and/or asthma symptoms. An estimated 15% of all Americans are sensitive to ragweed. As an allergy specialist in Centreville VA may explain, the risk of developing sensitivity is higher in people with other types of allergic disorders like eczema (i.e., atopic dermatitis) and asthma and in those with a family history of similar disorders.

What are the Symptoms?

  • Itchy nose, eyes, throat, and ears
  • Watery and/or red eyes
  • Runny nose, nasal congestion, and/or post-nasal drip
  • Sneezing
  • Post nasal drip and/or throat irritation
  • Cough, chest tightness, wheezing, and/or shortness of breath
  • Sinus pressure and/or headaches
  • Fatigue
  • Snoring
  • Clogging and/or popping of the ears

Though “hay fever” is the term commonly in vogue, “seasonal allergic rhinitis” is a more accurate description of the condition.

Oral allergy syndrome (i.e., Pollen-food allergy syndrome) is a condition where one experiences itching of the lips, mouth, and/or throat after eating fresh fruits and/or vegetables. The cause of the phenomenon is a cross-reactivity between similar proteins in the pollen and the fruits and/or vegetables. Ragweed pollen typically cross-reacts with melons, bananas, cucumbers, avocados, kiwi, and zucchini.

How is it Diagnosed?
An allergy specialist Centreville, VA residents turn to for help will take a thorough history and physical examination. A simple allergy skin test can be performed by applying the diluted allergen (ragweed) to the surface of the skin. A raised, itchy, red bump after 15 to 20 minutes at the site of application confirms sensitivity to the allergen. Alternatively, a blood test can also be done.

What Can Be Done to Minimize the Symptoms?

  • Keeping track of pollen counts and avoiding outdoor activities to the possible extent on high pollen days.
  • Keeping the windows closed in homes and automobiles and running air-conditioning.
  • Changing clothes and showering before going to bed.

If the symptoms are bothersome in spite of environmental control, several medications like antihistamines, nasal sprays, eye drops, and inhalers may be needed. Keep in mind that most medications only mask the symptoms without treating the underlying cause and can cause undesirable side effects. Many individuals also become tolerant to an antihistamine and what had helped initially becomes ineffective.

Allergen immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization) is a process of increasing tolerance to the allergens by exposing the immune system to gradually increasing the concentrations of the antigen at regular intervals. This process has the potential to offer long-term benefit to many people who experience bothersome symptoms every year. Allergy shots are effective in 80-85% of individuals and have been used in the U.S. for over 100 years.

A Centreville, VA allergy specialist at Black & Kletz Allergy can treat both adults and children with ragweed allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have convenient offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA that all offer on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle between the McLean, VA office and the Springhill metro station on the silver line. Please call us for an appointment or alternatively you can click Request an Appointment and we will respond within 24 hours by the next business day. We can also answer your questions and concerns about other allergic and immunologic disorders, since we have been providing allergy, asthma, and immunology care to the local community for over 50 years. If you’re looking for an allergy specialist Centreville, VA patients recommend, turn to a board certified allergist at Black & Kletz Allergy.

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.

Tree Pollen Allergies in the Washington, DC Metropolitan Area

Spring is rapidly approaching in the Washington, DC metropolitan area and that means many people will be suffering from hay fever (allergic rhinitis).   In the early Spring, tree pollen is mainly responsible for the symptoms that cause hay fever.

There are of course molds in the air simultaneously, but they are always present in Washington.  In the DC area, trees usually begin to pollinate at the end of February, peak in mid- to late-April and continue to pollinate through late May and occasionally through early June.  Some of the first trees to pollinate in this area include cedar, maple, elm, alder, birch, and poplar.  Later in the season, the predominant tree that causes problems for individuals with tree pollen allergies is the oak tree.  Other tress that pollinate in this later time frame include hickory, walnut, and pine.

It is interesting to note that, in general, people are not allergic to flowering trees (i.e., cherry tree, dogwood tree).  Many people think they are allergic to flowering trees because they develop allergy symptoms when these trees are in bloom, however, it is usually not due to these trees, but due to other non-flowering trees that happen to pollinate at the same time.  Nature is behind this sleight of hand trickery.  Flowering trees have pollen that is fairly heavy in weight.  Since the pollen is heavy, it is not easily wind-disbursed and as a result, individuals do not breathe in the pollen and thus do not become sensitized to these pollens.  The flowers are present in order to attract insects such as bees.  When the bee lands on the flower, the pollen sticks to the abdomen of the bee.  The bee will then fly to another flower of another tree and the pollen will intermingle with that flower.  It is by this method that cross-pollination is achieved, made possible by the aid of the bees.  Non-flowering trees such as cedar, maple, elm, alder, birch, poplar, oak, hickory, walnut, etc. have very light weight pollen.  These pollens are easily wind-disbursed.  It is these wind-disbursed tree pollens that individuals breathe in and become sensitized to, that are the cause of hay fever symptoms in sensitized people.  It just so happens that people develop their hay fever symptoms at the same time when the flowering trees bloom.  People then associate these flowering trees with their symptoms and blame their symptoms on the wrong trees.

The symptoms of tree pollen allergies are the classic symptoms of hay fever.  They can include any or all of the following:  runny nose, stuffy nose, post-nasal drip (which can lead to a sore throat, hoarseness, and/or cough), sneezing, itchy eyes, watery eyes, red eyes, puffy eyes, itchy nose, itchy throat, sinus pressure and/or pain, wheezing, chest tightness, cough, and/or shortness of breath.

The following are some measures that can be taken to reduce one’s exposure to the tree pollen in the Spring besides living in a “plastic bubble:” It is advisable to keep one’s windows and sunroof closed.  It is advisable to turn on the air conditioner and change air filters regularly (about once a month).  Use the re-circulate feature in the car so that the air is not coming into the vehicle from the outside.  Choose an automobile that has a filter in its air conditioning unit, if possible.  Avoid yard work and mowing lawns.  If a person needs to do yard work, wear a filtration face mask in order to diminish exposure to the pollen.  If one goes outdoors, shower, wash one’s hair, and change one’s clothing upon returning home to decrease pollen exposure.  Wash your pets regularly and avoid close contact with a pet that goes outdoors during the pollen season since they carry tree pollen on their coats.  Monitor pollen counts daily.  Click Today’s Pollen Count to view the daily pollen count.  Stay indoors wherever possible when the pollen count is high (generally on dry warmer days).  Note that rain washes pollen from the air causing pollen counts to be lower on wet cooler days.  Avoid drying clothes outdoors when the pollen count is elevated.  Avoid contact lenses which may trap pollen in one’s eyes.  Since pollen is released in the early mornings, try to avoid exercising during this time.

The diagnosis and treatment of tree pollen allergies begins with a thorough history and physical examination by a board certified allergist.  Our board certified allergists in both adult and pediatric allergy at Black & Kletz Allergy have had more than 50 years of experience diagnosing and treating tree pollen allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  After the history and physical examination, allergy testing is usually done by skin testing, or in some cases, by blood tests to confirm if the patient is in fact allergic to trees.  Once confirmed, there are a multitude of treatment options to alleviate the annoying symptoms of tree pollen allergies.  In addition to pollen avoidance measures in the above paragraph, the treatment of tree pollen allergies includes medications which can include oral medications (tablets, capsules, syrups, granules, etc.), nasal sprays, eye drops, and/or lung inhalers.  If there are additional environmental allergens that are found in a particular person which correlate with his/her symptoms during a different time of the year (Fall, Winter, etc.), then allergy shots (also referred to as “allergy immunotherapy” or “allergy desensitization”) may be a great way to treat the pollen allergy.  They are extremely effective and have been available for over 100 years.

If you would like a consultation for your hay fever symptoms, please do not hesitate to call Black & Kletz Allergy to make an appointment.  Alternatively, you can click Request an Appointment and we will get back in touch with you within 24 hours of the next business day.  We have 3 convenient locations in the Washington, DC metropolitan area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  There is parking at each location and the Washington, DC and McLean, VA locations are accessible by using the Metro.  Whether your hay fever symptoms are seasonal or perennial, we would be happy to help you.


As Winter approaches, people with dust, mold, and pet allergies tend to suffer more than those with pollen allergies.  Pollen levels in the mid-Atlantic region (Washington, DC, Virginia, Maryland, etc.) become immeasurable once the first frost occurs.  The first frost usually occurs by November in our region of the country.  Therefore, when people experience the typical allergy symptoms during the late Fall and Winter months, dust mites and/or molds are generally the culprits.  Keep in mind that there are other causes of these symptoms, namely the common cold, flu (influenza), or other upper respiratory tract infection (i.e., sinus infection, bronchitis).  How does one know the difference between winter allergies, a “cold,” the “flu” or other type of upper respiratory tract infection?


Winter Allergies – the same symptoms as seasonal allergies and can include all or some of the following:  runny nose, nasal congestion, post-nasal drip, sore throat, cough, sneezing, itchy nose, itchy eyes, watery eyes, red eyes, itchy throat, fatigue, sinus headaches, wheezing, and shortness of breath.

Common Cold – can include all or some of the above symptoms, but in addition may contain achiness, fever, and chills, although discolored nasal discharge and a fever do not occur in most cases of the common cold.

“Flu” (also referred to as influenza) – can include all or some of the symptoms of the common cold, but unlike a “cold,” there is usually severe achiness and/or headache, and a fever is almost always present.

Note:  For the flu season of 2014-2015, one must be cognizant of the recent Ebola epidemic in Western Africa.  If a person develops “flu-like” symptoms and has traveled to Western Africa and/or if they have been in contact with someone infected with the Ebola virus in the last 21 days, he or she must assume that they could have Ebola and should contact the CDC (Centers for Disease Control) and local county and state health agencies for guidance about seeking medical care at an appropriate hospital.  If one cannot get in touch with the CDC or local health agency, they should go immediately to closest emergency room.

Sinus Infection (also referred to as sinusitis) – can include all or some of the symptoms of the common cold, but unlike a “cold,” there usually is discolored nasal discharge, sinus pain and/or pain that radiates to the teeth.


Winter Allergies – Dust mites; Molds: Pets; Cockroaches

Common Cold – Viruses [Rhinoviruses, Coronaviruses, Parainfluenza viruses, and Respiratory syncytial virus (RSV) are the most common ones]; Note that there are many more viruses that cause the common cold. “Flu” – Viruses (Influenza virus types A, B, and/or C)

Sinus Infection – Viruses, Bacteria, and/or Fungi (Most are caused by viruses)

HOW ARE THESE CONDITIONS DIAGNOSED? Besides a thorough history of your symptoms and a physical examination, the following also help our physicians distinguish between the 4 common conditions below:

Winter Allergies – An experienced allergist can perform blood and/or skin tests to evaluate if you have a true allergy to one of the many allergens that can cause winter allergy symptoms.  When symptoms last longer than 1-2 weeks or there is a history of recurring symptoms every Winter or perennial (year-round) symptoms, allergies should be a top concern.

Common Cold – Typically the symptoms last less than 1 week in duration and resolve on their own.

“Flu” – A fever is the hallmark of this condition.  The flu can be very serious particularly in the elderly.  There are rapid influenza diagnostic tests that can identify the flu in about 30 minutes.  These require that the physician to wipe the inside of the back of one’s throat or nose with a swab and then send it for testing.  They are not 100% accurate however.

Sinus Infection – The symptoms may begin as a result of an individual being exposed to an allergen, virus, and/or bacteria.  A thorough history together with a complete examination of the ears, nose, mouth, and throat can usually identify a sinus infection in the majority of patients.  Further diagnostic studies such as a CT scan of the sinuses may be necessary in some individuals.  When there is recurrent sinus infections, the diagnosis of chronic sinusitis and/or an immunologic disorder should be investigated by an experienced allergist.


Winter Allergies – There are many allergy medications that can be used which include tablets, syrups, nasal sprays, and/or allergy shots (allergy immunotherapy or allergy injections).

Common Cold – Usually self-limited and generally does not require treatment except to help relieve symptoms with medications and nasal sprays.

“Flu” – Usually self-limited and generally does not require treatment except to help relieve symptoms with medications and nasal sprays.  Occasionally a severe case or a case in the elderly may need hospital care of complications from the flu which can include dehydration, pneumonia, and other more severe complications. Antiviral flu medications can be taken to reduce the duration and severity of the flu. These medications work best if they are taken within the first 48 hours of the beginning of symptoms, however they can still be effective if taken later.

Sinus Infection – May need to be treated with antibiotics if it persists or is recurrent.  Other medications may also be used if needed to help alleviate the symptoms with tablets, syrups, and/or nasal sprays.


Winter Allergies – Avoidance of dust mites, molds, and pet exposure.  Allergy medications and/or allergy shots (allergy immunotherapy or allergy injections).

Common Cold – Washing of hands; good hygiene; avoidance of crowded areas.

“Flu” – Flu vaccination (unless one has a reason not to take it such as egg allergy, previous reaction to the flu vaccine or the preservative used in the flu vaccine, etc.).  In addition, one should avoid exposure to people with the flu.  They should also practice good hygiene, avoid crowded areas during the flu season, wash their hands, etc.

Sinus Infection – Control allergies; washing of hands, good hygiene; avoidance of crowded areas.

As one can see from the information above, it may not be so easy for the average person to distinguish the difference between Winter allergies, the common cold, the flu, and a sinus infection.  Many of the symptoms are the same, similar, and/or overlap.  The board certified allergists at Black & Kletz Allergy have the expertise to help diagnose the correct ailment and more importantly, treat your problem.  We have 3 office locations in the Washington, DC metro and Virginia areas and we will be happy to schedule a visit for you at your earliest convenience.

Mold Allergies

As the temperatures are dropping and the leaves are starting to “fall”, the ragweed and other weed pollen counts are also gradually decreasing, but the mold spores will be a significant trigger of asthma and allergy symptoms in the coming few months for sensitized individuals.

Mold is a fungus which can cause bothersome symptoms in a few different ways:

  1. Allergic Reaction:  Though all of us are exposed to molds, only some of us develop “sensitivity” to them determined by our genetic composition.  When a genetically predisposed individual inhales spores from molds, his/her immune system considers them as foreign invaders and manufactures antibodies in an attempt to fight them.  These antibodies memorize the particular spores and “attack” them when they are exposed to them again.  This reaction causes certain chemicals like histamine to be released into the tissues which cause the typical symptoms of sneezing, stuffy/runny nose, itchy/watery eyes, etc. (Note: If your vision is seriously impaired, it may be a sign on something more severe, and you may wish to consult with a LASIK surgeon in Washington DC.)
  2. Irritant Reaction:  Molds can release substances called volatile organic compounds (VOC’s) which can irritate skin and mucus membranes inside the mouth, nose and eyes resulting in burning sensation, watery eyes, runny nose, scratchy throat and cough.
  3. Toxic Reaction:  Mycotoxins, produced by certain types of molds, in addition to causing irritant symptoms can also lead to flu-like symptoms, fatigue, headache, dizziness, and shortness of breath.
  4. Infection:  Though skin lesions are the most common infectious manifestation, different types of molds also can cause respiratory, gastrointestinal, and neurological disorders.

Molds are found in both indoor and outdoor environments and thrive in high humidity.  Moist and decaying leaves on the ground, which tend to peak in the Fall, form a substrate for the mold growth.  Damp basements, leaky faucets, wet shower curtains, and wet bathroom tiles also encourage proliferation of molds.  Though many mold overgrowths are visible, their spores are microscopic and are air-borne.  The most common types of molds that cause human suffering are alternariahormodendrumcladosporium and penicillium.

Most people sensitive to mold spores only exhibit “hay fever”- like symptoms involving the eyes, nose, mouth, and throat.  Less commonly, molds also play a role in more serious conditions like:

  1. Allergic Asthma:  In sensitized individuals with a history of asthma, mold spores can induce sudden and severe flare-ups of asthma symptoms which may require emergency treatments and/or cause an increase in the number or dose of controller medications.
  2. Allergic Bronchopulmonary Aspergillosis (ABPA):  It is a hypersensitive reaction to a particular type of mold called aspergillus in the lungs of patients with persistent asthma or cystic fibrosis.
  3. Allergic Fungal Sinusitis:  A chronic inflammatory response of the membranes and tissues inside the sinus cavities can be caused by certain types of molds in susceptible people.

Diagnosis:  Mold allergies can be detected either by skin testing or by measuring the amount of specific IgE antibodies in a blood sample by a clinical laboratory.  Skin testing is a more sensitive test and is the preferred method used by allergists.  A detailed history of the symptoms and their possible triggers in the environment followed by a focused physical examination will help the allergist in determining the type of testing needed to confirm the diagnosis.

Treatment:  The first principle in the management of any allergic disorder is to identify the possible triggering and aggravating factors in the environment and to avoid exposure to them to the extent possible.  To reduce exposure to the mold spores, the following measures can be quite useful:

  1. As dampness encourages mold growth, indoor humidity levels should be kept below 50 percent. Avoiding water leaks and running a dehumidifier in damp and musty areas of the house can also inhibit mold proliferation.
  2. Installing HEPA filters in HVAC systems and changing them periodically will reduce indoor spore counts by trapping them before fresh air is circulated.
  3. Adequate ventilation of the bathrooms either by running the exhaust fan or opening the windows will reduce mold growth.  Keep in mind that by opening the windows, outdoor molds may enter one’s home which can be counterintuitive.
  4. Proper care of indoor plants such as removing the dead leaves and avoiding standing water can be helpful.
  5. Wearing a face mask to cover the nose and the mouth before raking leaves and cutting grass will reduce exposure to molds substantially.
  6. Mold spore counts are usually higher at nights when the atmosphere is cool and damp.  Closing the windows will keep the outdoor molds from entering inside one’s home.

Medications like ocular, nasal, and oral antihistamines as well as nasal and inhaled anti-inflammatory drugs can relieve the misery of symptoms to a certain extent.  When environmental control measures and medications do not help enough or when the side effects of the drugs are bothersome, a desensitization process (i.e, allergy shots or allergy immunotherapy), which induces tolerance to the offending allergens, can be a long term solution which is highly efficacious.

The board certified physicians and staff at Black & Kletz Allergy have the training, expertise, and decades of experience in the diagnosis and treatment of adults and children with mold and other allergies in a professional, caring, and patient-friendly environment in the Washington, DC, Maryland, and Northern Virginia area.

Ragweed Allergies – What Are They and Do You Have Them?

As summer draws to a close and schools reopen across our region, most of us look forward to cooler days and fall colors. But if you are one of several million Americans who suffer from “Hay Fever” (“seasonal allergic rhinitis,” as it is more accurately named) to ragweed, the rising levels of pollen from ragweed are sure to increase your misery due to your allergic reaction to these pollen grains.

Though many weeds like Pigweed, Mugwort/Sagebrush, Cocklebur, and Russian thistle pollinate in the fall, Ragweed (species Ambrosia) is the most common and predominant allergen in our geographical area. Each plant can produce up to one billion pollen grains per season, and these can remain airborne for several days and travel hundreds of miles from the site of origin. In the Washington, DC metropolitan area, the ragweed pollen usually starts appearing in the air in mid-August. The pollen counts gradually increase and peak in early September and subside after the first frost which is usually in late October. Many scientists believe that rising temperatures and an increase in atmospheric carbon dioxide (CO2) levels may prolong the ragweed season.

When a person who has been previously sensitized to a particular pollen is exposed to that pollen in the air, the proteins trigger specialized cells in the immune system to release excessive levels of histamine and other chemical mediators which are responsible for various allergic symptoms, some of which are listed below:

  • Excessive sneezing
  • Itchy, red, puffy, watery eyes
  • Persistent runny nose
  • Nasal stuffiness, blockage, or congestion
  • Itchy throat and post-nasal drip leading to a dry cough
  • In asthmatic individuals, the pollen can also induce flare-ups of wheezing, chest tightness, cough and/or breathing difficulty.

In ragweed sensitive people, eating fresh fruits and vegetables like melons (cantaloupe, honeydew, watermelon, etc.), cucumber, zucchini, kiwi, and bananas may cause itching and tingling of mouth, tongue, and throat. This condition is called “pollen-food allergy syndrome” or “oral allergy syndrome” and is due to cross-reacting proteins in the pollen and fresh fruits.

A few avoidance measures can reduce the exposure to pollen and the suffering:

  • Minimize outdoor activities in the early morning hours when the pollen counts tend to be the highest.
  • Keep the windows at home and in automobiles closed and use air-conditioning.
  • Shower to remove pollen from the skin and hair after coming indoors and wash clothing.
  • Nasal irrigation can wash the pollen and irritants from nasal passages.

If the symptoms are bothersome, several medications like antihistamines (available in pills, liquid, nose sprays and eye drops), decongestants (pills and liquid), and corticosteroids (nasal sprays, pills, liquid), either alone or in combination may offer considerable relief. To be optimally effective, the medicines are best started a few days before the onset of the active season. For many people with moderate to severe sensitivity, allergy immunotherapy (also referred to as “allergy shots,” will cause a desensitization to that pollen, which in this case is ragweed pollen) will offer the most effective long-term relief from the symptoms and can reduce or eliminate the need for medications.

The physicians and Washington, DC allergy doctors at Black and Kletz Allergy practice in DC and northern Virginia have several decades of experience and expertise in managing ragweed sensitive patients and are committed to provide the most up to date and evidence based treatment options in a patient-friendly environment.

Hay Fever in the Washington, DC Area

Hay Fever in the DC area is manifested by tree and grass pollens in the Spring and ragweed pollen in the Fall.  More specifically, the tree pollen usually begins to pollinate towards the end of February each year and continue pollinating into May or even early June.  Grass pollen usually begins to pollinate in May and the peak of it is usually over by early July, but it still is present into August.  Ragweed pollinates usually beginning in mid-August and ends with the first frost which is usually in late October.  There are other weeds that cause hay fever in the DC area which are present throughout the Spring, Summer, and Fall.  The medical name for hay fever is “allergic rhinitis.”

Also read: What Is Hay Fever?

Another important allergen that affects many individuals in the Washington, DC area is mold.  People are exposed to mold spores and become sensitized to them, the same way that pollen causes sensitization in allergic patients.  Washington, DC was built on a swamp and therefore tends to always have mold in the air.  Mold tends to like damp and humid climates such as the DC area, however, some molds can exist and flourish in dry climates, even the desert.  Of course, molds are both an outdoor and indoor allergen and is found indoors primarily in basements, kitchens, and bathrooms which tend to be more damp.  The symptoms of hay fever may include nasal congestion, runny nose, sneezing, itchy nose, throat and/or eyes, watery eyes, red eyes, post nasal drip, sinus headaches, and/or fatigue. These symptoms are most bothersome after outdoor activities and many people feel that they are forced to isolate themselves indoors for several weeks when the weather is nice, resulting in a significant negative impact on their quality of life.  Many patients with asthma also experience cough, wheezing, chest tightness, and/or breathing difficulty on exposure to pollen.  These flare-ups can also cause sleep disturbances, unscheduled emergency visits to health care providers, and loss of work and school days.

Pollen counts are the highest on warm, dry, and windy days and are directly proportional to the “misery index” of the people who have been previously sensitized to the pollen. They also tend to be higher in the mornings and decrease temporarily after it rains.  Individuals that are sensitized to pollens have specific antibodies (called IgE antibodies) which interact with the antigen in the pollen, causing histamine and other chemicals to be released.  It is these chemicals that cause the symptoms of hay fever.  To alleviate hay fever symptoms, a few common sense precautions can help reduce the amount of exposure to pollen.  These precautions include closing the windows in homes and automobiles, keeping the sunroof closed in automobiles, minimizing outdoor activities on warm and windy days, and taking a shower after being outdoors.  Over the counter antihistamine medications can offer some relief from symptoms in mildly sensitized individuals but are not very helpful in people who have long term severe sensitivities to these pollens.  For people who continue to be symptomatic, however, more effective treatment options like prescription medications and/or allergy desensitization (immunotherapy) procedures offer long term relief, greatly improving the quality of life and increasing productivity.

Board certified allergists are physicians who have received advanced training in treating hay fever, asthma, and sinus conditions.  Black and Kletz Allergy practice has over five decades of experience in evaluating and treating hay fever in the DC area.  Feel free to contact us to schedule an appointment if you are experiencing hay fever or any other allergic or immunologic symptoms.