Honey to Treat Allergies?
May 5, 2026 | Black & Kletz Allergy
Many people have heard that eating local honey helps treat seasonal allergies, commonly referred to as hay fever (i.e., allergic rhinitis), but is it true? Many beekeepers also agree with this concept, but again, is it true? This belief has been present for many decades. The theory makes some sense, but the answer is no, local honey does not help treat or prevent seasonal allergies.
The hypothesis is based on the fact that when a bee lands on a flowering plant or tree, its abdomen becomes full of pollen because the pollen adheres to the bee’s abdomen just by contact. Likewise, when the bee makes honey from the nectar of a plant, the pollen that was on its abdomen becomes incorporated into the honey. Processed honey, that is common in grocery stores, is usually pasteurized and heavily filtered. This store-bought honey is processed to delay crystallization, so that it stays liquid longer. As a result of the processing, the pollen becomes filtered out of the honey and thus the pollen is not present in the honey. Local honey or “raw” honey, on the other hand, is not pasteurized and may be minimally filtered, allowing tiny bits of pollen, wax, and natural enzymes to remain in the honey. Local or raw honey often crystallizes faster, which is normal and a sign it has not been overprocessed. The theory is that by eating the local pollens that are in the local honey, an individual will develop a “tolerance” or “resistance” to the pollens that are in that local or raw honey. By consuming the local honey, the person is building up their resistance to those pollens which, in turn, would lead to less allergic symptoms or perhaps no allergy symptoms when exposed to these local pollens. In theory, this sounds good, but in fact, there are multiple flaws in this concept which are as follows:
The first and most important fault in this idea is that patients who have seasonal allergies in the Springtime in the Washington, DC, Northern Virginia, and Maryland metropolitan area have allergies to non-flowering plants and trees (e.g., birch, hickory, beech, cedar, maple, elm, ash, oak trees), not generally flowing plants and trees (e.g., cherry trees, forsythia bushes, redbud trees, Bradford pear trees, dogwood trees). The explanation for this is rather simple. The pollen from flowering trees and plants tend to be heavy in weight and thus are not wind-dispersed. Since the pollen is heavy, through evolution, these types of trees and plants had to develop flowers in order to attract bees so that they could cross-pollinate and thus reproduce. After the bees are attracted to a flower, they land on a flower and the pollen then sticks on their abdomens. The bees then fly to another same-species flowering plant or tree and when they land on these flowers, the pollen on their abdomen gets transferred to this new flower and thus cross-pollination occurs. The fact that the pollen is heavy and not wind-dispersed means that people do not breathe in the pollen and thus do not become allergic or sensitized to these pollens. Unlike flowering plants and trees, the non-flowering tree pollens are light in weight and are wind-dispersed. Since they are wind-dispersed, they are able to cause sensitization and thus allergy symptoms may occur to select allergic-prone individuals who inhale these pollens in everyday life. This translates into the fact that eating local honey (which is composed of flowering tree pollens) will not reduce one’s allergies in the Spring because it does not contain the correct types of non-flowering pollens that are the cause of seasonal allergies.
The second fault in this theory is that there is no standardization from one batch of local honey to another. The amount of pollen in local honey is not consistent between different bottles of honey from the same beekeeper yet from different beekeepers. The idea of allergy immunotherapy (i.e., allergen desensitization, allergy hyposensitization) is to give a very small tolerable dose to an allergic individual and slowly increase the dose over time, so that the individual can become tolerant to that allergen (e.g., tree pollen). In raw, local honey, there is no measurement of the amount or type of pollen in any jar of honey, so immunity cannot be attained through this method.
The third fault in this thinking is that there are no published scientific papers documenting any advantage in using local honey to treat allergies. There are a handful of studies that are flawed in the manner that the studies were done. In others, the number of participants in the studies were too small to make a good statistical correlation between the consumption of local honey and its beneficial effects on allergies. The use of honey to treat allergies is also not recommended by either the American Academy of Allergy, Asthma & Immunology or the American College of Allergy, Asthma & Immunology.
Honey does have some advantages, however. It is sometimes recommended to help relieve coughs and sore throats, and of course, it tastes good! It is rich in antioxidants, has a lower glycemic index than sugar, it can be used for a quick energy boost, it may help heal burns and wounds, and it may help in digestion. It is also interesting to point out that honey is antibacterial and does not spoil. This is thought to occur because organisms cannot survive long enough within a jar of honey due to the very low moisture that exists in a jar of honey and thus does not have the chance to spoil.
So overall, honey has its merits, but treating allergies is not one of them. If you suffer from allergies, please contact Black & Kletz Allergy so that you can see one of our board certified allergy specialists in the Washington, DC metro area. After a comprehensive history and physical examination, allergy testing may be performed, and the appropriate avoidance measures will be discussed. Depending upon the results, medications and/or allergy shots (i.e., allergy immunotherapy, allergy desensitization) may be recommended. Allergy injections have been proven to be effective in 80-85% of patients undergoing this course of treatment and they have been given in the United States for over 100 years. Unlike eating local honey, there is abundant research and medical publications demonstrating the efficacy and benefits of allergy immunotherapy when administered in the appropriate manner.
The board certified allergy doctors at Black and Kletz Allergy have been diagnosing and treating allergies and asthma for more than 5 decades in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We see and treat 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, asthma, sinus problems, hives, or immunological disorders, please call us to schedule 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 to providing the most state-of-the-art allergy treatment in a warm, friendly, and professional atmosphere.Breastfeeding with Allergies and Asthma
April 24, 2026 | Black & Kletz Allergy
More than 300 million people globally suffer from asthma, while allergic rhinitis (i.e., hay fever) and other allergic diseases, such as atopic dermatitis (i.e., eczema) and food allergies, affect between 10 and 30% of the worldwide population. The rapid rise in the prevalence of these diseases recorded over the last few decades, and their negative impacts on health-related quality of life, has stressed the need to recognize the environmental and modifiable risk factors associated with the development of these conditions. In the last decade or so, research has been directed on both prenatal and postnatal modifiable factors for allergic disease prevention, as these factors can affect the immune system in an important phase of its development. Breastfeeding seems to be one of the most significant postnatal factors that drives the development of the immune system in newborns and infants. Human milk has been shown to defend against early respiratory infections. Exclusive breastfeeding for at least the first 6 months of life continuing up to 2 years of age has been considered the gold standard for infant feeding.
Food Allergy:
Exclusive breastfeeding for the first 4 months of life may reduce the risk of IgE-mediated food allergies among infants, according to study results published in Annals of Allergy, Asthma and Immunology.
Exclusive breastfed infants had lower odds for egg, sesame, and peanut allergies. Infants exposed to cow’s milk in the nursery and later were breastfed exclusively had higher odds of developing cow’s milk allergies.
Certain infants who had delayed exposure to sesame had increased odds for developing sesame allergies. These findings support the expansion of early allergen introduction guidelines to include sesame, in addition to peanut and egg.
Asthma:
A recently published article in the Journal of Allergy and Clinical Immunology shed light on the relationship between the breastfeeding of infants and their subsequent development of asthma.
Exclusive breastfeeding has consistently been associated with a modest reduction in childhood asthma risk. However, this inverse relationship between breastfeeding and asthma is dependent on the length of time of breastfeeding and the type of asthma diagnosed in later childhood or adolescence.
Duration of breastfeeding:
- Shorter exclusive breastfeeding (e.g., < 2 months) tends to be associated with higher asthma/wheezing prevalence.
- Longer exclusive breastfeeding (e.g., > 4–6 months) tends to show progressively lower odds of preschool/early-childhood asthma outcomes.
- Associations with “any breastfeeding” (exclusive + partial) are generally weaker and more heterogeneous than with exclusive breastfeeding duration.
- Persistent asthma (lower risk)
- Early transient wheezing/asthma (weaker/borderline effects)
- Little to no association with late-onset asthma (adolescent/adult onset)
- Longer exclusive breastfeeding has also been linked with a small reduction in IgE sensitization measured repeatedly from childhood into young adulthood.
- Breastfeeding may reduce early-life lower respiratory infections that drive wheezing/asthma diagnoses in early childhood.
- Parental atopy/asthma, smoking, socioeconomic factors, childcare exposure, early infections, and/or environmental exposures may influence both breastfeeding duration and asthma development.
- Infants who develop early wheezing or eczema may prompt feeding changes indicating reverse causality.
- A few studies suggest a potentially stronger protective association after vaginal delivery than cesarean, plausibly via microbiome-related pathways.
Springtime Asthma
April 9, 2026 | Black & Kletz Allergy
When most people think of Springtime allergies, they think of people with nasal congestion, runny noses, post-nasal drip, itchy eyes, watery eyes, redness of the eyes, itchy throat, and sneezing. This description is of someone who has hay fever (i.e., allergic rhinitis). For the most part, this visualization is correct, however, many individuals also have or only have asthma symptoms in the Spring. These unlucky people may experience wheezing, chest tightness, coughing, and/or shortness of breath in the Spring. Some of these individuals only develop asthma symptoms in the Spring, while others have asthma symptoms all year round but have increased symptoms in the Spring.
Why do some people develop asthma symptoms in the Spring? What is it that is causing these flare-ups? In the Washington, DC, Northern Virginia, and Maryland metropolitan area, the trees usually begin to pollinate in late February. They reach a peak in late April and taper off in late May. Grass pollen usually begins to pollinate in May, reaches a peak in June and tapers off in early August. Depending on whether an individual is allergic to trees or grasses will determine when this person experiences asthma symptoms. It should be noted that it is usually the ugly trees and not the pretty flowering trees that cause patients to exhibit allergy or asthma symptoms. The pollens from ugly trees (e.g. birch, maple, oak) are light in weight and thus dispersed by the wind to reproduce. As a result, individuals breathe in the pollen causing a certain percentage to become sensitized to the pollen. When this occurs, the patient may experience hay fever and/or asthma symptoms when they are exposed to these pollens. On the other hand, the pollens of the pretty flowering trees are heavier in weight and thus unable to reproduce by relying on the wind alone. Adaptation in nature created the symbiotic relationship with bees to help these trees reproduce. Bees are attracted to the pretty and scented flowers. They land on the flowers and unknowingly coolect pollen from the flowers which attaches to their abdomens. When they land on another flower, there is an exchange of pollen and as a result, reproduction occurs.
Asthma is a chronic inflammatory disorder affecting the lower respiratory tract. The lower respiratory tract is made up of the muscular tubes that carry air in and out of the lungs as well as the tissues in the lungs where the exchange of gas occurs. The inflammation found in people with asthma is usually linked with inflammation of the upper respiratory tract (e.g., nose, sinuses). As mentioned before, the main symptoms of asthma may include chest tightness, wheezing, coughing, and/or shortness of breath. The frequency of these symptoms differs depending on the seriousness of the asthma. The symptoms can be sporadic or constant. The severity is categorized as either mild, moderate, or severe. Asthma usually begins in childhood, although it can also be diagnosed for the first time in adulthood. The course of asthma is variable. The symptoms can be mild, moderate, severe, frequent, infrequent, intermittent, and/or persistent at various times throughout one’s life. Although the underlying cause for most cases of asthma is genetic, many external factors such as the environment play a crucial role in the severity, frequency, and course of the disease. These external factors typically trigger or cause exacerbations of asthma in most patients.
In the Spring, there are however many other factors that can cause asthma symptoms in sensitive persons. Most of the following factors are ubiquitous and not only present in the Spring, however they still may cause increased asthma symptoms that may be recognized in the Spring. Mold is often the culprit in mold-sensitive individuals. In the Washington, DC metro region, due to its weather and the fact that Washington, DC was built on a swamp, makes this area more humid and thus prone to more mold growth. Combine that with the added rain that the area gets in the Spring and it becomes a lightning rod for mold sufferers. In addition to molds, other environmental allergens (e.g., dust mites, pet dander, cockroach) are still around in the Spring and thus likely to cause asthma symptoms. Excessive humidity, dry air, smoke, cold air, pollution, chemical aerosol sprays, colognes, perfumes, fragrances, and other strong odors may irritate the airways of the lungs and result in the exacerbation of asthma. As these “irritants” cannot be “desensitized” by traditional allergy immunotherapy since they are technically not caused by allergens, avoidance is the key to decreasing the risks of more severe asthma when irritants are the trigger. Occupational asthma can also occur at any time of the year and may affect bakers, farmers, hairstylists, seafood processors, painters, carpenters, pharmaceutical workers, welders, chemical manufacturers, textile workers, food processors, animal handlers, adhesive handlers, and metal workers. Occupational asthma may be caused by the inhalation of harmful fumes, gases, chemicals, plastics, dust, dyes, metals, animal proteins, enzymes, and/or other particulates. Exertion can also play a role, particularly in the Spring. Many asthmatics do worse with exercise and given that there is pollen in the air at this time of the year, the pollen can make it worse. Just as the tree and grass pollen can cause nasal symptoms by direst contact, it can do the same for the mucosal linings of the airways and lungs. Another common trigger for asthma are infections. Upper respiratory tract infections (URIs) and lower respiratory tract infections may be responsible for causing exacerbations of one’s asthma and may occur at any time of the year. A variety of viruses such as rhinoviruses, coronaviruses, adenoviruses, and myxoviruses, are well-known to aggravate asthma.
The diagnosis and treatment of asthma begin with the allergy specialist performing a comprehensive history and physical examination. The diagnosis is further established by doing a pulmonary function test. Occasionally a chest X-ray may be needed to rule out other respiratory conditions. Allergy skin testing or allergy blood testing is often performed since both indoor and outdoor aeroallergens are often a trigger in many asthmatic patients. The treatment of asthma begins with prevention. It is desirable for an asthmatic patient to attempt to evade triggers that are recognized to cause or worsen their asthma symptoms. Medications are used in the treatment of asthma in most asthmatic individuals. Every asthma patient should have a short-acting beta2 agonist rescue medication [e.g., albuterol (ProAir, Proventil, Ventolin), levalbuterol (Xopenex), pirbuterol (Maxair), albuterol/budesonide (AirSupra)] to use if symptoms develop or to use prophylactically before exposure to a known trigger such as pets, exercise, etc. In addition, many patients will need other medications to control their asthma symptoms. Other medications used to manage asthma may include, inhaled corticosteroids, inhaled long-acting beta2 agonists, oral phosphodiesterase inhibitors, oral leukotrienes, oral beta2 agonists, and biologicals [e.g., Xolair (omalizumab), Fasenra (benralizumab), Tezpire (tezepelumab), Nucala (mepolizumab), Dupixent (dupilumab)]. Allergy injections (i.e., allergy immunotherapy, allergy shots, allergy desensitization, allergy hyposensitization) may also be helpful in the treatment of asthma as it helps decrease and prevent allergic triggers such as tree pollens, grass pollens, dust mites, molds, pets, and cockroaches. It is important to note that the treatment of asthma is individualized and differs with each individual depending on the frequency and severity of the patient’s symptoms as well as their allergic profile.
The board certified allergists at Black & Kletz Allergy have 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. The allergy specialists of Black & Kletz Allergy diagnose and treat both adult and pediatric and patients. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy have been helping patients with asthma, hay fever, sinus disease, hives, eczema, insect sting allergies, food allergies, medication allergies, and immunological disorders for more than 50 years. If you are bothered by allergies, it is our goal to improve your quality of life by decreasing or preventing your annoying allergy symptoms.
Tree Pollen Allergy Update
March 18, 2026 | Black & Kletz Allergy
Well, it is this time of the year again. The time when pollen-allergic individuals are happy for the nicer weather, but often dread its consequences. For some, the relentless release of tree pollen causes a wide variety of annoying symptoms to occur, which is typical in the Spring in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Is also time for many individuals to seek care from a McLean allergist.
In the Washington DC area, trees begin to pollinate in February, reach a peak in April, and taper off in May, although some trees pollinate throughout the late Spring to the early Summer. Certain trees (e.g., maple, elm, juniper. alder) pollinate in the early Spring and certain trees (e.g. oak, birch, pine, sycamore) pollinate in the later Spring. One can always ask their McLean allergist for the exact timing of particular trees, if interested.
A question that many individuals living in the Washington, DC metropolitan area always ask is, what causes the yellowish coating of the cars that occurs every Spring? The answer is pine trees. It just so happens that pine tree pollen is very large in size and heavy, so it tends to land on surfaces. As a result, pine tree pollen is not very allergenic because it is too heavy to float in the air. Ironically however, oak tree pollen is highly allergenic and it is released at the same time pine tree pollen is released. Unlike pine tree pollen, oak tree pollen is small in size which allows the pollen grains to enter the nose and sinuses easily, triggering immune and allergic reactions. Oak tree pollen is one of the main culprits for causing allergies in our area. In fact, oak trees are the major tree in our area that seems to produce the most amount of allergic symptoms in patients. The Washington area has millions of oak trees in its forests and neighborhoods. They are one of the dominant native trees in the Mid-Atlantic region. When the pine trees release pollen all at once, it creates that famous yellow Spring haze, but the pine tree pollen is generally not causing allergic symptoms in most of the allergy sufferers. Simultaneously however, the oak trees are also releasing their pollen which does bother tree pollen-sensitive individuals causing them to have the classic hay fever (i.e., allergic rhinitis) symptoms. To put this in perspective, a single large oak tree can release billions of pollen grains in one season. This fact gives an insight as to why so many people at this time of year seek a McLean allergist to help relieve these bothersome symptoms that result from exposure to tree pollens in allergic individuals.
Washington, DC tends to have more tree pollen than many cities in the United States. This occurs for several different reasons. The Mid-Atlantic originally had dense oak–hickory forests. Even today, much of the area around DC (i.e., Maryland and Northern Virginia) still has large tree coverage. The major tree pollens (e.g., maple, hickory, sycamore, birch, oak) are wind-pollinated, which means they release a lot of pollen into the air. In fact, Washington was designed with large green spaces and tree-lined streets. The parks (i.e., Rock Creek Park, National Mall, and Arboretum) plus the neighborhood trees create a huge urban canopy. Roughly 35–40% of the city is covered by tree canopy, which is very high for a major city. It is thus understandable that many tree pollen-sensitive individuals often look for a McLean allergist in the Spring in order to diagnose and treat the unwanted symptoms that result from being exposed to so much tree pollen.
In addition to the numerous trees in Washington, DC, landscapers in the 20th century preferred male trees because they do not produce fruit or seeds that could fall on the sidewalks of the nation’s capital. The problem is that male trees produce all the pollen. While being a good choice for the aesthetics of the city, it unfortunately was not a good decision for tree pollen-allergic individuals. Also, Washington, DC’s warm and early Springs, windy days, and dry periods all tend to be the perfect combination of factors or the “perfect storm” to produce very intense pollen seasons.
The characteristic allergic symptoms experienced by allergy sufferers may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, sinus headaches, snoring, itchy eyes, watery eyes, and/or redness of the eyes. Individuals with asthma may develop a worsening of their asthma. These individuals may complain of chest tightness, wheezing, coughing, and/or shortness of breath. Patients with moderate to severe signs or symptoms of the pollen allergies should see a McLean allergist for diagnosis and treatment.
The diagnosis of allergic rhinitis (i.e., hay fever) and/or allergic conjunctivitis (i.e., eye allergies) begins with the McLean allergist obtaining a comprehensive history and physical examination. Allergy skin testing, and/or occasionally allergy blood testing, is usually performed in order to determine if and how allergic a patient is to a specific aeroallergen. A board certified McLean allergist would be the person to see if one lives in the vicinity. If our McLean office is not convenient, Black & Kletz Allergy has another office locations on K Street in Washington, DC, as well as an office in Manassas, VA.
The treatment of allergic rhinitis and allergic conjunctivitis mainly consists of avoiding the allergen, if possible and using medications designed to treat allergies. Medications may include antihistamines, decongestants, leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, nasal mast cell stabilizers, ocular antihistamines, and/or ocular mast cell stabilizers. In addition to medications, allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is very efficacious. It typically helps about 80-85% of individuals who take them. The average length of time on allergy immunotherapy is approximately 3-5 years. Seeing a board certified McLean allergist like the ones at Black & Kletz Allergy may be beneficial because they can diagnose and treat these maddening allergy symptoms in order for you to have a better quality of life.
The board certified allergists at Black & Kletz Allergy will promptly answer any questions you may have regarding tree pollen allergies and asthma. Our allergists have been diagnosing and treating seasonal allergies as well as all other types of allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. We have 3 convenient locations in the DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. There is on-site parking at each location and both 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. To schedule an appointment, please call us at any one of our 3 locations. Alternatively, you can 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 up-to-date diagnostic and treatment modalities in the field of allergy, asthma, and immunology.
Chronic Rhinosinusitis With Nasal Polyps
March 10, 2026 | Black & Kletz Allergy
Chronic rhinosinusitis (i.e., long-standing inflammation of the tissues inside the nasal cavity and sinuses inside the facial bones) is one of the most common medical conditions, affecting approximately 12% of the population. In roughly 20% of these patients, there is an association with nasal polyps and the condition is thus named “chronic rhinosinusitis with nasal polyps.”
Nasal polyps are soft tissue growths that form on the lining of the nasal passages and inside the sinuses (i.e., air-filled cavities within the facial bones). Nasal polyps are painless and non-cancerous. They are usually in the shape of teardrops and glisten like moist grapes. Polyps develop when the mucus membranes are chronically inflamed and swell up over a long period of time.
When the polyps grow large, they can obstruct the nasal passages and cause breathing difficulties. They can also block the free passage of secretions from the sinuses into the nose. This blockage predisposes individuals with nasal polyps to sinus infections.
Any condition which results in chronic inflammation inside the nose and sinuses may lead to polyp formation. Some of these conditions are as follows:
- Allergic rhinitis
- Chronic sinusitis
- Aspirin sensitivity
- Asthma
- Cystic fibrosis
- Eosinophilic disorders
- Allergic fungal sinusitis
- Nasal congestion
- Runny nose
- Post-nasal drip
- Diminished sense of taste and smell
- Facial pressure/headaches
- Snoring
- Endoscopic examination of nose
- Imaging studies such as Xrays and CT scans
- Allergy tests
- Sweat chloride test for cystic fibrosis
- Eosinophil count in the peripheral blood
- Measurement of biomarkers such as periostin
- Long-term (i.e., chronic sinusitis) or repeated sinus infections
- Nosebleeds (i.e., epistaxis)
- Asthma exacerbations
- Obstructive sleep apnea
- Double vision (i.e., diplopia)
Post-Nasal Drip
February 11, 2026 | Black & Kletz Allergy
A common complaint among patients is the need to clear their throats frequently in an attempt to get relief from a feeling of “irritation” in their throats. This feeling is often termed “post-nasal drip,” implying excessive secretions from the upper respiratory tract draining down the back of the throat.
All because the feeling of a post-nasal drip is present, there are many other conditions or processes that may result in the sensation of throat irritation. Post-nasal drip is primarily a subjective complaint with no definitive objective diagnostic criteria.
It should be pointed out that a chronic cough is one of the most bothersome symptoms triggered by a post-nasal drip, however, hoarseness, bad breath, and sore throat are other common manifestations of a post-nasal drip.
There are many conditions that predispose an individual to a post-nasal drip and some of them are listed below:
- Allergic rhinitis (Hay fever): The inflamed nasal mucus membranes secrete excessive mucus in patients with allergies.
- Non-allergic rhinitis: Some examples of this condition include gustatory rhinitis (i.e., related to eating where eating any food may trigger a runny nose or post-nasal drip), neurologic rhinitis, and rhinitis caused by other irritants such as smoke, strong scents (e.g., perfumes, cleaning solutions), changes in barometric pressure, changes in temperatures).
- Nasal polyps: The increased surface area of the mucus membranes from excessive tissue growth of the nasal polyp results in oversecretion of mucus.
- Ciliary dyskinesia: Dysfunction or reduced activity of the ciliary (hair-like) structures which promote normal drainage of secretions.
- Cystic fibrosis: A genetically determined condition which causes abundant thick mucus production.
- Heightened body awareness or hypersensitivity
- Upper respiratory tract infections: May cause ciliary damage and thus prolonged symptoms.
- Chronic rhinosinusitis: Typically caused by viral, bacterial, or fungal infections.
- Laryngopharyngeal reflux (LPR): Gastroesophageal reflux disease (GERD)-related disorder usually resulting in a sore throat and/or hoarseness.
- Comprehensive history and physical examination
- Allergy skin testing or allergy blood testing
- Rhinoscopy: A direct visualization procedure of the tissues in the nose and the back of the throat that can be done in the office. It is when the physician puts a thin long tube up one’s nose in order to look in the nose, throat, and vocal cords. Rhinoscopy identifies posterior nasal secretions but has a limited sensitivity and specificity. Patient-reported frequency and severity of symptoms do not always correlate with the abnormalities detected by rhinoscopy.
- Fluorescent particle tracking: May show slower mucociliary clearance and more viscous mucus.
- The Sinonasal Outcome Test (SNOT) is used to measure symptom severity. It is a subjective 0-5 scale where patients report bothersome symptoms, including postnasal drip.
- Associated symptoms may include nasal congestion, poor sense of smell and taste, facial pressure, and/or difficulty in sleeping
- Chronic rhinosinusitis: Functional endoscopic sinus surgery, posterior nasal nerve ablation, etc.
- Allergic rhinitis: Antihistamine (e.g., azelastine, olopatadine), corticosteroid (e.g., fluticasone, mometasone, budesonide), and anticholinergic (e.g., ipratropium bromide) nasal sprays, oral antihistamines (e.g., loratadine, desloratadine, fexofenadine, cetirizine, levocetirizine), and/or allergen immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) to environmental allergens. Allergy shots are effective in 80-85% of patients. The average length allergy immunotherapy treatment is typically 3-5 years.
- A humidifier or steam inhalation (as occurs in a hot shower)
- Keeping well-hydrated: Keeps the mucus thinner.
- Sleep on propped up pillows, to keep the mucus from collecting at the back of the throat
- Nasal irrigation: Available over-the-counter saline preparations
- Oral decongestant: Such as pseudoephedrine (e.g., Sudafed)
- Mucolytic agents: Medications that thin out mucus such as Guaifenesin (e.g., Mucinex)
- Gastroesophageal reflux disease (GERD): Lifestyle modifications may help to reduce acid secretion. Proton pump inhibitors (e.g., pantoprazole, omeprazole, esomeprazole, lansoprazole, rabeprazole, dexlansoprazole) may help alleviate symptoms.
- Biologics: Medications such as omalizumab (i.e., Xolair) and dupilumab (i.e., Dupixent) show moderate efficacy.
Update on Mast Cell Activation Syndrome (MCAS)
February 3, 2026 | Black & Kletz Allergy
Mast cell activation syndrome (MCAS) is caused by episodic abnormal release of chemical mediators stored in the granules of mast cells which may affect any organ system. The organ systems most affected tend to involve the skin, gastrointestinal tract, nervous system, and cardiovascular system primarily. Although the prevalence of mast cell activation syndrome varies a lot depending on the source, it is pretty clear that the prevalence has been increasing over recent 5-10 years, particularly since the coronavirus pandemic. The syndrome tends to affect women more than men.
What is a mast cell?
A mast cell is a type of specialized white blood cell that serves as the “alarm system” for the immune system. Unlike normal white blood cells which circulate in the bloodstream, mast cells are found in the connective tissues of the body, especially in areas that interface with the external environment, such as the skin, gastrointestinal tract, and lungs. Mast cells use their receptors on their surface to detect “intruders” such as allergens, bacteria, viruses, and/or parasites. When a mast cell notices a threat, it "degranulates,” a procedure where it quickly bursts open hundreds of tiny sacs (i.e., granules) which in turn releases chemical mediators that were stored in those granules. As a result, chemical mediators (i.e., histamine, heparin, tryptase, cytokines) signal other immune cells to rush to the area. They cause blood vessels to expand, leading to flushing and swelling, as well as muscles to contract, causing coughing or gastrointestinal tract symptoms, in order to help flush out the threat.
What does each chemical mediator do?
As mentioned above, the key chemical mediators released from mast cells and their primary effect are as follows:
- Histamine - Increases blood flow and causes itching, swelling, and mucus production.
- Heparin - Prevents blood clotting to keep blood flowing to the affected area.
- Tryptase - An enzyme used as a marker for mast cell activity; It helps break down tissue to allow immune cells to move.
- Cytokines - Small proteins that recruit other immune cells and signal the body to create more white blood cells.
- Emotional and Physical Stress – Emotional trauma or anxiety and physical stressors such as pain, major surgery, and/or lack of sleep.
- Environmental Factors – Extreme heat, extreme cold, sudden changes in temperature, high humidity, and/or sunlight.
- Food and Drink – High histamine foods: Alcohol (especially beer and red wine), fermented foods (e.g., aged cheeses, soy sauce, sauerkraut, kombucha), chocolate, tomatoes, citrus fruits, pineapples, kiwi, bananas, strawberries, papayas, plums, spinach, eggplant, peanuts, walnuts, cashews, chickpeas, cured meats, food additives (e.g., MSG, artificial dyes), ketchup, mustard, and/or shellfish
- Odors and Chemicals - Fragrances (i.e., perfumes, colognes), cigarette smoke, cleaning supplies, pesticides, and/or "new car" or "new carpet" smells.
- Physical Stimuli - Friction or vibration on the skin (i.e., rubbing, tight clothing), and/or intense exercise.
- Hormonal Changes - Fluctuations in estrogen levels (i.e., estrogen treatment, menstruation, pregnancy, menopause)
- Infections - Bacterial, viral, or fungal infections (e.g., COVID-19, influenza, strep. infection).
- Insect Bites/Stings - Venom from bee, wasp, yellow jacket, hornet, and/or fire ant stings
- Medications - Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Motrin, Advil), naproxen (e.g., Aleve, Naprosyn), opioids (e.g., codeine, morphine), aspirin, certain antibiotics, and/or contrast dyes used in medical imaging (e.g., IV radiocontrast dye)
Asthma in the Winter Updated 2026
January 22, 2026 | Black & Kletz Allergy
It is Winter in the Washington, DC, Northern, VA, and Maryland metropolitan area which generally means cold and dry weather. Individuals with asthma may be affected more than the usual person during the Winter because the cold weather is a common trigger of asthma. An asthma doctor DC residents trust is important to the health of anyone in the metro area with asthma. At Black & Kletz Allergy, we have asthma doctors DC locals have used for decades to help them with their treatment of allergies and asthma.
In addition to cold air, upper respiratory tract infections (URIs) are a very common asthma trigger in many asthmatics. The infectious agents can be viral, bacterial, or fungal in origin. During the Winter months, it is extremely common to be exposed to a variety of infections. Viruses such as influenza (i.e., flu), respiratory syncytial virus (RSV), COVID-19, rhinovirus, adenovirus, human metapneumovirus (hMPV), and parainfluenza are fairly prevalent. Interestingly, it is not the cold weather that makes individuals more susceptible to these viruses. Instead, when it is cold outside, people tend to spend more time indoors with each other, and as a result, the close proximity to other individuals allows for easier transmission of viruses from one person to another.
Upper respiratory viruses cause airway inflammation, increased mucus production, and constriction of the bronchial tubes which usually leads to an exacerbation of an individual’s asthma symptoms. The classic symptoms that result are wheezing, chest tightness, coughing, and/or shortness of breath. In many asthma patients, pneumonia may occur. An asthma doctor DC inhabitants trust, such as the board certified allergists at Black & Kletz Allergy, should be notified when a patient has an exacerbation of one’s asthma. It should be noted that asthmatic airways are already inflamed and sensitive, making them more prone to swelling. Upper respiratory infections with viruses such as rhinovirus RSV, influenza, parainfluenza, adenovirus, human metapneumovirus or coronavirus can damage the airway lining, trigger immune responses, and/or worsen bronchial hyperresponsiveness, resulting in breathing difficulties and requiring more short-acting, quick-relief asthma rescue medication such as albuterol (e.g., Proventil, Ventolin, ProAir), levalbuterol (e.g., Xopenex), or albuterol/budesonide (e.g., AirSupra).
Certain environmental allergens also play an important role in how bothersome someone’s asthma may be. During the Winters in the DC metro area, indoor allergens (i.e., dust mites, molds, pets, cockroach) and some outdoor allergens (i.e., molds) are common aggravators of asthma. Individuals that are sensitive to these environmental allergens may experience worsening of their asthma and/or allergic rhinitis (i.e., hay fever) symptoms.
Dust mites tend to be an important trigger, particularly to inner city children. The dust mites are typically found in bedding (e.g., pillows, mattresses, box springs), carpeting, and upholstered furniture to name a few. It is advisable for patients to cover their bedroom pillows, mattress, and box spring with allergy-proof encasings. These encasings usually zip up over the pillows, mattress, and box spring. An asthma doctor DC residents admire will help the patient avoid dust mites with different options.
Unlike dust mites, mold is found both indoors and outdoors. Mold is ubiquitous and may trigger an asthma exacerbation in mold-sensitive individuals. In buildings, mold typically is found in moist and damp areas such as bathrooms, kitchens, and basements. Using a dehumidifier may help reduce the amount of mold present inside one’s home. Molds that are outdoors are more difficult to control, however, avoiding mowing the lawn, raking the leaves, and other activities where mold exposure is high are recommended. Again, an allergy or asthma doctor DC locals find helpful will steer one in the right direction.
Pets’ saliva and dander are found mostly indoors, and they may be a significant trigger to someone’s asthma. Pet allergies tend to be worse during the Winter because people’s homes tend to be closed up more during this time causing the pet allergen to be more prevalent. It is prudent to avoid direct contact with a pet if the person is sensitive to that type of pet. Touching one’s eyes may cause itching, watery, puffiness, and/or redness of the eyes in pet-allergic individuals. An asthma doctor DC residents trust would also advise for that person to avoid having that pet go in their bedroom, so there is a “safe” space in their home.
Cockroaches are also mostly an indoor allergen. Cockroach allergies are quite common in big cities, such as Washington, D.C. Many homes, condos, apartments, public buildings, and restaurants in inner cities are infested with cockroaches, even though they may not be visible during the day to most people. It is vital to make sure that traces of food are not left on floors and counters, as this invites cockroaches. There is also a clear association between cockroach allergy and childhood asthma in inner city populations. In addition to asthma, cockroach allergies may cause allergic rhinitis (i.e., hay fever) and/or allergic conjunctivitis (i.e., eye allergies) in sensitive allergic individuals. An allergy or asthma doctor DC inhabitants have confidence in will recommend being as clean as possible to try to avoid having cockroaches in one’s home.
Other than avoiding all the allergens mentioned above that are common during the Winter, there are various medications that can be utilized by allergy and asthma doctors DC locals trust to treat dust mites, mold, pet, and cockroach allergies. In addition to various antihistamines, decongestants, nasal sprays, and allergy eye drops, allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization) are a very effective tool that board certified allergists use to treat people with these allergies. Allergy shots are efficacious in 80-85% of the individuals that take them. Allergy immunotherapy has been used in the U.S. to treat asthma and allergies for more than a century. The typical length of therapy is 3-5 years.
The board certified allergy doctors at Black & Kletz Allergy have been diagnosing and treating asthma and allergies for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Our offices are conveniently located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Each office has on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please call for an appointment if you would like a consultation with one of our allergists, or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy prides itself in providing quality allergy and asthma care to the Washington, DC metropolitan area community.
Update on Alpha-Gal Syndrome
January 16, 2026 | Black & Kletz Allergy
Alpha-gal syndrome is an allergic condition caused by a sensitivity to a carbohydrate known as galactose-alpha-1,3-galactose (i.e., alpha-gal). This molecule is found on the cells of non-primate mammals (i.e., beef, pork, lamb, venison, etc.). This condition is mainly thought to develop after tick bites. The regional distribution of alpha-gal syndrome corresponds with specific tick species populations (e.g., the lone star tick). Alpha-gal syndrome is also called mammalian meat allergy.
In the United States, the prevalence of lone start ticks and alpha-gal syndrome is highest in the Southeast region. Overall, the prevalence of alpha-gal syndrome is thought to be rising, with current estimates suggesting that up to 450,000 cases have occurred in the U.S. since 2010. It was first diagnosed in Virginia.
Other organisms besides ticks have been implicated in the potential induction of alpha-gal sensitization and clinical reactivity. One study demonstrated a correlation between alpha-gal-specific IgE antibody levels and exposure to an intestinal parasite called Ascaris lumbricoides (i.e., round worm). Moreover, some data suggest that bee and wasp stings may also contribute to the production of alpha-gal-specific IgE, particularly in beekeeping populations.
Besides muscle and organ meats, dairy products have also been implicated in triggering reactions. Additionally, gelatin, (commonly derived from the connective tissue, bones, and hides of mammals), often retains the alpha-gal epitope and is frequently used in products such as gummy candies, marshmallows, and gelatin desserts.
Individuals with blood group B appear partially protected against sensitization. This protection is likely due to structural similarities between the blood group B antigen and alpha-gal, resulting in the reduced immunologic recognition in B or AB individuals.
Cofactors such as exercise, alcohol, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (i.e., Advil, Motrin) and naproxen (i.e., Aleve, Naprosyn) are frequently reported to enhance the likelihood, timing, and/or severity of the reactions. These cofactors may amplify allergic responses by increasing the gastrointestinal absorption of alpha-gal and/or lowering the reaction threshold.
Alpha-gal syndrome differs from the common IgE antibody-mediated food (e.g., nuts, peanuts, fish, shellfish) allergy in 2 important aspects. In a typical food allergy scenario, the individual is sensitized to a particular protein, whereas in alpha-gal syndrome, the individual reacts to a carbohydrate in meats and/or mammalian products. Usually, common food-triggered allergic reactions may cause symptoms within an hour after ingestion, however, clinical manifestations from alpha-gal syndrome are typically delayed, characteristically beginning 2 to 8 hours after exposure to the mammalian product.
The classical manifestations of alpha-gal syndrome may include generalized itching (i.e., pruritus), hives (i.e., urticaria), and/or soft tissue swelling (i.e., angioedema) of the lips, tongue, eyelids, etc. In more severe cases, difficulty in swallowing, shortness of breath, wheezing, and/or life-threatening anaphylaxis may ensue. Gastrointestinal symptoms such as abdominal pain, cramping, nausea, vomiting, and/or diarrhea are also common. The gastrointestinal symptoms are more common in children and may be the sole presenting symptom(s).
The diagnosis rests on a comprehensive history, focusing on symptom timing, dietary exposures, and any history of tick bites. The most commonly used diagnostic test is the measurement of the specific IgE antibody to alpha-gal in a blood sample. A level above 0.1 IU/mL is considered positive and diagnostic. The IgE antibody to alpha-gal testing is the preferred method since skin food prick testing to mammalian meats can be negative in those found to have a positive IgE against alpha-gal. It should be noted that most people with a detectable IgE to alpha-gal will also have detectable IgE to extracts from mammalian meats such as beef, pork, lamb, venison, etc.
If the clinical suspicion for mammalian meat allergy remains high but the initial serum IgE to alpha-gal is negative, then skin prick and serum IgE testing to beef, pork, and lamb may be considered, as this may be helpful with diagnosing other non-alpha-gal forms of meat allergy. As an aside, if the patient primarily reacts to pork, checking for sensitivity to cat via skin prick or serum IgE testing may be warranted to rule out pork-cat syndrome, which is due to cross-reactivity between cat and pork serum albumin.
In order to prevent the development of acute reactions, the core management principle of alpha-gal syndrome is to avoid mammalian meat and associated visceral organs. The mammalian meats usually implicated are beef, pork, lamb and venison, though all non-primate mammalian meat can be causative. Ingestion of meat or products from bison, buffalo, whale, rabbit, horse, goat, and other mammals should also be avoided. Additionally, it is important to highlight to patients that mammalian fats used in cooking (i.e., lard, tallow, casings derived from pork which can be used in poultry-based sausages) are also to be avoided.
Many patients with alpha-gal syndrome will be able to tolerate dairy products. However, if the reactions continue while avoiding meats, dairy products and gelatin-containing foods/medications should also be avoided.
The treatment of reactions depends on the clinical manifestations. Antihistamines may be helpful in treating itching and rashes, but more severe systemic reactions such as anaphylaxis need to be treated with an epinephrine auto-injector (e.g., EpiPen, Auvi-Q, Adrenaclick) or an epinephrine-containing nasal spray such as Neffy. Some reactions may also require intravenous hydration, albuterol inhalation, and/or oxygen supplementation. It should be noted that if an individual uses their epinephrine auto-injector device or their epinephrine-containing nasal spray, they should go immediately to the closest emergency room.
As tick bites have been associated with the development of alpha-gal syndrome, a reasonable prevention tactic is obviously to circumvent sensitization through the avoidance of tick bites. There is data showing that the higher the number of tick bites, the higher the alpha-gal IgE levels, highlighting the importance of avoiding subsequent tick bites after sensitization. Avoiding wooded areas, treating gear with the insecticide permethrin, and using insect repellants will reduce the likelihood of a tick bite. Full body checks should be performed after outdoor activities, and if ticks are found, they should be removed with a fine tipped tweezer.
Some patients with alpha-gal syndrome will be able to tolerate meat again with continued avoidance of recurrent tick bites. In order to determine when and if that person can again tolerate meat, serial monitoring of alpha-gal IgE levels and oral meat challenges may be performed in order to assess the readiness of that individual to consume meat.
The board certified allergists at Black & Kletz Allergy have been diagnosing alpha-gal syndrome for many years. At Black & Kletz Allergy, we treat both adult and pediatric patients. We have 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. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you think that you have an allergy or sensitivity to meat, we are here to help diagnose your problem and help differentiate whether your symptoms are a meat allergy, meat sensitivity, or alpha-gal syndrome. Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a relaxed, compassionate, and professional environment.
Allergic to Penicillin Update
December 16, 2025 | Black & Kletz Allergy
Adverse reactions to medications are very common. Among the drugs associated with immediate hypersensitivity reactions (i.e., IgE antibody-mediated allergic reactions), penicillins are the most commonly observed.
Penicillin allergy is reported in approximately 7 to 10% of the community population and it occurs in up to 20% of hospitalized patients. However, more than 90% of these patients do not have true penicillin allergy, which can be ruled out with the help of a standardized testing procedure. These patients are mislabeled as having a penicillin allergy which can be deleterious to them as penicillins will be avoided in the future for often less effective and more costly alternative antibiotics.
There are 3 common causes for this high rate of false positive penicillin allergy reports:
- Mislabeling of a side effect (i.e., gastrointestinal upset) as an “allergy”
- Coincidental event (i.e., headache or rash due to an underlying infection)
- Loss of true sensitivity over time with avoidance of penicillins
- Skin prick testing with a small amount of diluted penicillin antigens, that are commercially prepared testing reagents, with negative and positive controls.
- If the prick tests are negative after 20 minutes, a tiny quantity of the antigen is injected into the superficial layers of the skin (i.e., intradermal skin test).
- If the intradermal skin test in the second stage above is also negative after 20 more minutes, the patient will be given 250 mg. of amoxicillin by mouth (i.e., oral challenge) and will be closely monitored for 90 minutes.
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