It’s Fall Allergy Season Again

August 7, 2026 | Black & Kletz Allergy

As summer fades and crisp autumn air begins to roll in, many people look forward to pumpkin spice lattes, colorful foliage, football games, and cooler temperatures. But for millions of Americans, Fall also marks the return of an unwelcome seasonal visitor - Fall allergies. If you find yourself sneezing more often, rubbing your itchy eyes, or constantly reaching for tissues as the leaves begin to change, you are not alone. Fall allergies affect millions of people every year and can make even the most beautiful season feel miserable. Understanding what causes Fall allergies and knowing how to manage them can help you enjoy everything autumn has to offer. What Causes Fall Allergies? Unlike Spring allergies, which are primarily triggered by tree and grass pollens, Fall allergies are usually caused by ragweed pollen. Ragweed is a common flowering weed that begins releasing its pollen in the late Summer and continues well into the Fall until the first hard frost. Typically, in the Washington, DC, Northern Virginia, and Maryland metropolitan area, ragweed begins around August 15 and ends at the end of October. What's surprising is that a single ragweed plant can produce up to one billion pollen grains in a single season. These lightweight pollen grains can travel hundreds of miles via the wind, meaning that one doesn't have to live near ragweed plants in order to experience allergy symptoms. In addition to ragweed, other common Fall allergy triggers include: Mold spores - Thrive in damp leaves, compost piles, and wet grass Dust mites – Is stirred up when heating systems are turned on Pet dander - Especially as people spend more time indoors Other weeds – Pigweed, mugwort, plantain, cocklebur, lamb’s quarters These allergens can trigger an immune response that leads to inflammation and uncomfortable allergy symptoms. Common Symptoms of Fall Allergies Fall allergy symptoms can easily be mistaken for the common cold. Typically, allergies generally do not cause a fever and often last much longer than a typical viral illness. Common Fall allergy symptoms may include: Sneezing Runny nose Nasal congestion Post-nasal drip Itchy nose, eyes, ears, and/or throat Watery eyes Red eyes Coughing Sinus pressure or headaches Fatigue Asthmatics may also notice worsening symptoms during allergy season, including chest tightness, wheezing, coughing, and/or shortness of breath. Why Fall Allergies Seem Worse Some Years If your allergies seem more severe than usual, you are not imagining it. Weather patterns can have a significant impact on pollen levels. Warm days followed by cool nights create ideal conditions for ragweed pollen production. Dry, windy days spread pollen farther through the air, while rainy days often provide temporary relief by washing the pollen away. However, damp weather can also encourage mold growth, creating another allergy trigger. Climate changes and longer growing seasons have also extended ragweed seasons in many parts of the country, causing allergy sufferers to experience symptoms for weeks longer than they did in previous decades. How to Reduce Your Exposure While you cannot eliminate pollen entirely, you can take sensible steps to reduce your exposure. Stay Informed Check daily pollen forecasts during allergy season. They are available on our Black & Kletz Allergy website under Today’s Pollen Count at the top of our homepage. On days when pollen counts are especially high, consider limiting outdoor activities, particularly during the morning hours when pollen levels often peak. Keep Windows Closed As refreshing as cool autumn air can be, keeping your home's windows closed helps prevent pollen from entering your living space. Use air conditioning when possible and be sure to replace air filters regularly. Shower After Spending Time Outdoors Pollen sticks to your hair, skin, and clothing. Taking a shower and changing into clean clothes after outdoor activities can prevent allergens from spreading throughout one’s home and onto one’s bedding. Clean Your Home Regularly Vacuum carpets and upholstered furniture using a vacuum equipped with a HEPA filter. Dust surfaces frequently and wash bedding weekly in hot water to reduce allergens such as dust mites. Wear a Mask for Yard Work Raking leaves, mowing the lawn, and gardening can stir up large amounts of pollen and mold spores. Wearing a properly fitted mask during outdoor chores and activities may help reduce one’s exposure. Finding Relief Many inpiduals find relief with over-the-counter allergy medications. Antihistamines may help reduce sneezing, itching, and runny noses, while nasal corticosteroid sprays are often effective for treating inflammation and nasal congestion. Saline nasal rinses can also help flush allergens from the nasal passages. If your symptoms persist despite treatment, interfere with your daily activities, or trigger asthma exacerbations, it is time to consult an allergy specialist like the ones at Black & Kletz Allergy. Our board certified allergists can help identify your specific allergy triggers and recommend treatments such as prescription medications or allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization). Don't Confuse Allergies with a Cold Because many symptoms overlap, it may be difficult to determine whether one is dealing with allergies or a “cold.” A “cold” usually develops gradually. It often is associated with body aches or fever and generally resolves within 1 to 2 weeks. Allergy symptoms, on the other hand, often begin shortly after exposure to allergens, typically involve intense itching, and may continue for weeks or even months as long as the allergen exposure persists. Enjoy Fall Without the Sneezing Fall is one of the most enjoyable seasons of the year. From apple orchards and pumpkin patches to hiking trails covered in brilliant autumn colors, there is no shortage of ways to enjoy the season. Fortunately, allergies do not have to keep you sidelined indoors. By understanding your triggers, monitoring pollen levels, practicing good allergy prevention habits, and seeking appropriate treatment, when necessary, you can significantly lessen your symptoms and make the most of the season. So, as the leaves begin to fall and sweater weather arrives, do not let seasonal allergies steal your enjoyment. With a little preparation and the right care, you can breathe easier and fully embrace everything autumn has to offer. Black & Kletz Allergy has 3 convenient locations in the Washington, DC metro area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking. The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment, and we will reply within 24 hours by the next business day. The board certified allergists of Black & Kletz Allergy are eager to help you with your Fall allergies. In addition, we also diagnose and treat all types of allergic conditions including allergic rhinitis (i.e., hay fever), asthma, allergic conjunctivitis (i.e., eye allergies), hives (i.e., urticaria), swelling episodes (i.e., angioedema), sinus problems, eosinophilic conditions, food allergies, medication allergies, insect sting allergies, mast cell activation syndrome (MCAS), eczema (i.e., atopic dermatitis), and immune deficiencies. We have been serving the residents of the Washington, DC metro area for more than 50 years. The allergy specialists at Black & Kletz Allergy are dedicated to providing excellent state-of-the-art care to you in a pleasant and attentive atmosphere.

Immunity and Allergy

July 24, 2026 | Black & Kletz Allergy

We have an immune system primarily to defend and protect us from invaders such as bacteria, viruses, fungi, parasites, and tumors.  The cells and tissues that make up the immune system, are spread out throughout our bodies, rather than being in a single organ.  These cells are concentrated in the lymph nodes, bone marrow, and in the thymus, a small gland in the neck.  They also circulate in the bloodstream. There are 3 major ways that the immune system can malfunction causing diseases and disorders. Deficiency: A properly working immune system is essential for maintaining normal function of various organs.  The immune system has 2 principal components, humoral immunity and cellular immunity.  They both work in tandem to fight external invaders.  They also act as an internal surveillance system in order to detect and attempt to eliminate threats such as cancers. The humoral immune system is comprised of proteins called antibodies (i.e., immunoglobulins) and the cellular immune system is mediated by a type of white blood cell called lymphocytes.  Either the reduction in the numbers of antibodies and lymphocytes or the impairment of their function can lead to a defective defense mechanism and lead to frequent infections and/or tumors. Immune deficiency disorders may be primary (i.e., present from birth) or acquired (i.e., later in life).  Primary immunodeficiencies are usually caused by genetic defects that affect the development or function of the immune system.  People are born with these defects, although the symptoms may not appear until later in life.  Some of these conditions are very serious and incompatible with life and others need life-long treatments with immunoglobulin supplementation on a regular basis to ward off frequent and severe infections.  Secondary immunodeficiencies develop because something damages or suppresses an otherwise normal immune system.  Secondary immunodeficiencies can be caused by treatments with medications such as corticosteroids, chemotherapy, and/or immunosuppressants.  Certain viral infections may also lead to acquired immunodeficiencies.  HIV causing AIDS is an example of how a viral infection may lead to a secondary immunodeficiency. Malnutrition, some cancers, aging, chronic diseases (i.e., kidney failure, diabetes mellitus) may also cause secondary immunodeficiencies.  Unlike primary immunodeficiencies, many secondary immunodeficiencies improve if the underlying cause is treated or removed. Autoimmunity: Instead of identifying and attacking the external threats, sometimes the immune system turns against our own organs, resulting in their dysfunction. Systemic lupus erythematosus (SLE) is a common example of such an autoimmune phenomenon.  Autoimmunity also plays a role in many conditions such as rheumatoid arthritis, Type I diabetes mellitus, thyroid conditions (e.g., Graves’ disease, Hashimoto’s thyroiditis), inflammatory bowel disease (e.g., Crohn’s disease, chronic ulcerative colitis, celiac disease) and neurological disorders (e.g., multiple sclerosis, myasthenia gravis). Autoimmune disorders are diagnosed by measuring the levels of “autoantibodies’ in the blood.  Though many of these diseases are not curable, they can be treated with anti-inflammatory drugs to reduce the symptoms and preserve the function of the organs. Allergy: Allergic diseases are usually a result of mistaken identity.  In an allergic reaction, the immune system considers normally innocuous substances such as pollens, foods, insects, and certain medications as potentially harmful, and it then mounts a defensive attack against them!  The underlying causes for this phenomenon are not clearly understood, but genetic abnormalities are thought to predispose certain individuals to these disorders. The manifestations of allergy can vary depending on the organs affected. Allergens in the air we breathe such as dust mites, mold spores, and pollens (e.g., trees, grasses, weeds) primarily affect the respiratory tract.  Upper respiratory symptoms, referred to as allergic rhinitis (i.e., hay fever) may negatively impact the quality of life and lower respiratory involvement may lead to more severe conditions such as asthma. Milk, wheat, soy, nuts, and seafood are the most common foods that cause allergic reactions.  The symptoms of food allergies usually involve the gastrointestinal tract and the skin (e.g., eczema, hives, swelling episodes), but allergic reactions to foods can also lead to a severe systemic and generalized reaction known as anaphylaxis. Honey bees, yellow jackets, hornets, wasps, and fire ants are the common insects that may cause severe allergic reactions.  Penicillin and sulfa are the most common medications that may cause allergic reactions, though any drug can theoretically cause an allergic reaction.  Sensitivity to insect venoms and medications can also result in life-threatening reactions such as anaphylaxis.  Any patient with a history of having a systemic reaction to a food, venomous insect, or any product, should always carry an epinephrine-containing auto-injectable device such as an EpiPen, Auvi-Q, Adrenaclick or an epinephrine containing nasal spray such as Neffy.  It should be noted that if a patient uses the epinephrine-containing auto-injectable device, they should go immediately to the closest emergency room. The diagnosis of an allergic disorder begins with a comprehensive history and physical examination followed by confirmatory allergic skin test and/or blood tests. The treatment of an allergic condition usually involves:

• Avoidance of the offending allergen
• Medications to control inflammation and to reduce symptoms
• Epinephrine auto-injectors or nasal sprays for emergency use immediately after the first sign of a systemic reaction.
•  Allergy immunotherapy (i.e., allergy desensitization, allergy hyposensitization, allergy shots, allergy injections) to build up a tolerance to the allergens in order to reduce the risk of future reactions and minimize symptoms and the need for medications in the long run.

The board certified allergists at Black & Kletz Allergy are here for you if you are concerned that you may have allergies or an immune problem.  We have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  The McLean, VA office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line.  If you suffer from any allergies, asthma, or immune disorder, please call us to schedule an appointment.  Alternatively, you can click Request an Appointment and we will respond to you within 24 hours by the next business day.  Black & Kletz Allergy has been providing excellent allergy and asthma care in the Washington, DC metro area for more than 50 years and we look forward to helping you.

Exercise and Allergies Update

July 22, 2026 | Black & Kletz Allergy

Dietary Guidelines for Infants and Children

June 22, 2026 | Black & Kletz Allergy

Feeding an infant, toddler, and child in today’s ever-increasing complicated world has never been more challenging. To make it more difficult, food allergies and food sensitivities seem to be everywhere. It seems as though there is so much talk about food allergies/sensitivities now, whereas it was hardly discussed 30-40 years ago. Now, you seem to always hear about things like peanut allergies, tree nut allergies, shellfish allergies, fish allergies, wheat allergies, egg allergies, milk allergies, soy allergies, sesame allergies, alpha-gal (mammalian meat allergy), gluten sensitivity, lactose deficiency, low FODMAP diets, low histamine diets, and so on. What’s going on? What are the right foods to give your child? When should some foods be given? Below are some dietary guidelines for some common questions that parents have regarding what type of foods should be given to their children and when:

• Breast milk provides ideal nutrition for infants. Studies reveal that exclusive breast feeding at least until the age of 6 months of age significantly reduces the risk of developing food allergies in later life. When breast milk is not available, an iron-fortified infant formula is an alternative.
• Breast feeding can be continued as long as mutually desired by mother and child. If supplemented by infant formula, it can be discontinued at 12 months of age and whole milk can be started.
• All breastfed infants should receive a daily oral vitamin D supplement of 400 IU begin shortly after birth, unless they are also receiving adequate quantities of vitamin-fortified formula. Some infants also need iron supplementation. One should first check with the pediatrician before any supplementation.
• Solid foods may be started around 6 months of age, but breast milk or infant formula should be the main source of nutrition until 1 year of age.
• If the infant has severe eczema he or she may be at a higher risk for peanut and other food allergies. In those children, peanut products should be introduced at approximately 4 months of age, in order to reduce the chances of developing a peanut allergy. This can be done by mixing a small amount of peanut butter with bread milk or formula and feeding it with a spoon.
• For those infants presenting with eczema of a mild or moderate nature, incorporate peanut products into their diet at approximately 6 months of age.
• Potentially allergenic foods such as nut butters, eggs, shellfish, and wheat should be introduced at about 6 months of age, beginning with a very small quantity and increasing the quantity as tolerated.
• A diverse range of nutrient-dense foods in appropriate textures are recommended. Some of these foods include meat, poultry, and seafood, vegetables, fruits, full-fat yogurt and cheese, whole grains, legumes, and nut- or seed-containing foods.
• Highly processed foods such as processed meats, (e.g., hot dogs, bacon, deli meats, sugary drinks, and packaged sweets (e.g., cookies, cakes, pastries, candy bars). Note that processed meats are high in sodium and chemical preservatives.
• Avoid sugary foods such as fruit juices, sweetened teas, and sodas in children less than the age of 2 years old.
• Never give cow’s milk before 12 months of age since it strains immature infant kidneys and lacks the necessary iron.
• Never give honey before 12 months of age due to botulism risk.
• Never give unpasteurized juices before 12 months of age since they pose high risks of bacterial foodborne illness.
• Never give canned foods with high sodium before 12 months of age because it can overload an infant's developing kidneys.

Signs that a child is developmentally ready to begin eating food:

• Sits up alone or with support
• Can control their head and neck
• Tries to grasp small objects, such as toys or food
• Brings objects to their mouth
• Opens their mouth when food is offered
• Moves food from the front to the back of their tongue in preparation to swallow
• Swallows food instead of pushing it back out onto their chin

A new food should be offered multiple times. It may take 8 to 10 exposures to a food before the child is ready to accept the food. Many children do not want to try new foods and prefer to eat only the foods that they enjoy the most. Some children will not eat vegetables. Other children have issues with the consistency of foods and will not eat anything that is soft or slimy. Each child is different and parents must be able to navigate all of the issues that may come along in order to make sure that their child gets the nourishment, vitamins, and variety that makes for a healthy and enjoyable diet.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating food allergies and food sensitivities for many years. We also help with dietary guidelines for our pediatric patients. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years and treat both pediatric and adult and patients. All 3 offices at Black & Kletz Allergy offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you are concerned that your child may have food allergies or food sensitivities or any other type of allergy, asthma, or immunologic condition, please call us to schedule an appointment. You may also click Request an Appointment and we will reply within 24 hours by the next business day. At Black & Kletz Allergy, we strive to improve the quality of life in allergic individuals in a professional and compassionate environment.

Uncommon and Unusual Allergies

June 10, 2026 | Black & Kletz Allergy

In the Washington, DC, Maryland, and Northern Virginia metropolitan area, most people are familiar with the manifestations of hay fever (i.e., allergic rhinitis) since our Spring and Fall seasons are notorious for causing plenty of misery to many of the area’s inhabitants.  Most people are also familiar with the most common food allergies (e.g., peanut, tree nut, milk, soy, egg, wheat, fish, and shellfish) from either knowing individuals with these allergies or having heard or read about food allergy situations that have arisen either locally or nationally.  Likewise, most are aware of allergic conditions that affect the skin such as hives, (i.e., urticaria), eczema, (i.e., atopic dermatitis), and allergic contact dermatitis (e.g., poison ivy, poison oak, poison sumac, cosmetic allergy).  Medication allergies are also not a surprise to anyone.  One must understand that in addition to these common allergies, there are a number of allergies that are uncommon and/or unusual that are very interesting.  It is some of these more uncommon and unusual allergies that we will explore in the following discussion. Uncommon and unusual allergies can be categorized into 2 groups: Unusual/Uncommon Non-Food Allergies and Unusual/Uncommon Food Allergies.  Below is a list of some unusual or uncommon allergies that are seen by Black & Kletz Allergy in the Washington, DC metro area: Unusual/Uncommon Non-Food Allergies: Exercise:   Exercise may trigger generalized itching (i.e., pruritus), hives, (i.e., urticaria), swelling (i.e., angioedema), asthma, and/or anaphylaxis, depending on the individual.  These conditions are also referred to as exercise-induced pruritus, exercise-induced urticaria, exercise-induced angioedema, exercise-induced asthma, and exercise-induced anaphylaxis respectively.   In some cases, a patient may need to exercise in the cold air for the symptoms to occur.   In other individuals, a specific food must be eaten a few hours before exercise in order for there to be an allergic reaction.  This is referred to as food-dependent-exercise-induced urticaria.  An example of food-dependent-exercise-induced urticaria is a person who can eat wheat without problems and they can exercise without problems.  However, if they eat wheat within 2 hours before exercise, they will develop hives.  Individuals with these conditions should never exercise alone and if they exercise, they should always stop exercising at the first sign or symptom of their allergy. Scratches:  Some individuals have a disorder called dermatographism where a simple scratch or pressure on the skin will trigger the affected area to develop hives in a linear pattern to match the scratch.  The name of this condition is dermatographism.  The word itself means “skin writing” so it is possible to write a word on the person’s skin just by writing the word using a fingernail on the skin.  Approximately 3-5 minutes later, the word is visible on the skin in a reddish and raised fashion, reminiscent of a hive. Cold:   Cold temperatures can be a trigger for some individuals to develop generalized itching, hives, swelling, asthma, and/or anaphylaxis.  The names of the corresponding conditions are cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, cold-induced asthma, and cold-induced anaphylaxis respectively.  These individuals should avoid exposure to the cold, if possible. Latex:  Latex or natural rubber allergies can range from a mild irritation of the skin to a severe anaphylactic reaction.  Common latex products include latex gloves, condoms, balloons, adhesive bandages, dental dams, tires, waistbands, and pacifiers.  Curiously, there are similar proteins in natural rubber latex and certain foods (e.g., bananas, chestnuts, avocados, papayas, kiwis), so cross-reactivity to these foods can also occur. Sex:  Some people have a condition termed seminal fluid hypersensitivity where they become allergic to the seminal fluid of their partner.  It is an allergy to a specific man’s seminal fluid and not necessarily to all men. The symptoms can vary from having minimal irritation of the skin, to hives, to a life-threatening systemic reaction known as anaphylaxis.  Symptoms can be prevented by using condoms. In patients with this condition who would like to conceive, in vitro fertilization is needed to minimize risk to the allergic individual. Cold:  Cold temperatures can be a trigger for some patients to develop generalized itching, hives, swelling, asthma, and/or anaphylaxis.  The names of the corresponding conditions are cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, cold-induced asthma, and cold-induced anaphylaxis respectively.  Similar to exercise above, these patients should avoid the cold, if possible. Sunlight:  A small number of the population have a sensitivity to sunlight.  These individuals may develop an itchy skin, rash, hives, nausea, and/or headache.  Solar urticaria is a disorder where hives form upon exposure to sunlight. Money:  Yes, unfortunately it is true.  People with a nickel allergy may develop allergic contact dermatitis from handling coins.  Metal allergy is not that uncommon, but having reactions to holding coins is fairly uncommon.  Clearly, the disorder is more widespread in people who handle money more often such as cashiers and bank tellers. Unusual/Uncommon Food Allergies: Mammalian Meat (Alpha-gal):  Some people that are bitten by a Lone Star tick may develop a meat allergy due to the development of an antibody to a carbohydrate named galactose-alpha-1,3-galactose (i.e., alpha-gal).  This carbohydrate is found on all mammalian meat (e.g., beef, lamb, pork, venison, whale).  When a person with the alpha-gal antibody consumes mammalian meat, the meat triggers the release of a chemical named histamine.  It is the histamine that causes the allergic symptoms which typically appear 4-8 hours after ingesting the meat.  Symptoms may comprise of generalized itching, hives, and/or swelling. Raw Fruits/Vegetables:  Pollen fruit syndrome or pollen/food-associated syndrome or oral allergy syndrome is a condition where an allergic reaction in the mouth occurs usually causing itching in certain allergic individuals that have certain pollen allergies.  2 examples of this condition include:  1) Birch tree allergies and reactions to raw apples, cherries, apricots, plums, peaches, pears, celery, avocados, carrots, and/or kiwi.  2) Ragweed allergies and reactions to raw bananas, melons, zucchini, and/or cucumbers.  In pollen fruit syndrome, the raw fruit or vegetable looks similar structurally to the pollen and the body “thinks” that the food is the pollen and thus an allergic reaction (e.g., itchy mouth, itchy throat) ensues.  Interestingly, if the food is cooked and/or processed, the person can generally tolerate the food without any symptoms. Gelatin:  Some people are allergic to gelatin; although this allergy is rare.  Gelatin is a protein that is formed when connective tissue from animals is boiled.  Some people are allergic to this protein and when exposed, they can have an allergic reaction that may also be rather severe.  Gelatin may be found in some of the following:  Jell-O, frostings, chewy candies, pâtés, capsule medications, yogurts, low-fat sour creams, and in some vaccinations such as some influenza (flu) shots, MMR, and chickenpox.  As a quick rule of thumb, if is jiggly, gummy, or set into a firm gel, there is a good chance it contains gelatin unless it is specifically labeled vegetarian or vegan. Hot Dogs and Deli Meats:  Hot dogs and numerous deli meats are highly processed foods that contain many additives including nitrites and nitrates.  An allergic reaction after consuming these processed meats may be due to any of these additional ingredients.  It is thought however that nitrite and nitrate additives are generally the cause in most cases. Wine:  Certain people are hypersensitive to sulfating agents used in processing certain foods, beverages, and drugs.  Sulfur dioxide and numerous forms of inorganic sulfites that release sulfur dioxide when used as food ingredients are known collectively as sulfating agents.  The preservative sulfite is used in the manufacturing of wine and other foods.  Some people, particularly asthmatics, are sensitive to sulfites and should avoid certain foods that may contain sulfites such as salad bars, soups, gravies, sauces, wine vinegar, processed meats, and dried or frozen canned fruits/vegetables. Chamomile Tea:  Chamomile is associated to ragweed and some ragweed-sensitive individuals may also react to chamomile tea and chamomile lotions.  Symptoms can range from allergic rhinitis symptoms to anaphylactic shock, although it is rare to have such a severe reaction. Water:  Yes, people can actually be allergic to water.  It is rather rare, however, there are some people who have a disorder termed aquagenic urticaria.  If one has this problem, contact with water may cause itching and hives.  Unfortunately, there is no ideal treatment for this disorder at the present time. The board certified allergists and immunologists at Black & Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our allergy specialists have been treating uncommon and unusual allergies for many years.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  If you or someone you know has or appears to have an allergic condition, please make an appointment so that we may help you.  Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  The allergy doctors at Black & Kletz Allergy have been treating both adults and children in the Washington, DC metropolitan area for allergies, asthma, sinus disease, and immunologic disorders for more than 5 decades and we would be happy to provide allergy relief for you in a caring and professional environment.

Update on Eosinophilic Esophagitis

May 28, 2026 | Black & Kletz Allergy

Eosinophilic esophagitis (EoE) is an illness caused by long-standing inflammation of the esophagus, the muscular tube that carries food from the mouth to the stomach. Eosinophilic esophagitis may occur as a result of an allergy to certain foods or a food trigger, which are not the same for all individuals.  It occurs when eosinophils (i.e., a certain type of white blood cell) accumulates in the esophagus, causing irritation and scarring of the esophagus.  Some patients with eosinophilic esophagitis will also have other areas of the digestive tract affected with increased eosinophils, including the stomach, small intestine, and/or large intestine (i.e., colon).  Eosinophilic infiltration of other parts of the gastrointestinal system, (i.e., stomach, small intestine, large intestine) is rare but more likely to occur in children. Eosinophilic esophagitis can affect all age groups, beginning in infancy.  More males are affected than females.  It is estimated to occur in 1 out of 1,700 people.  Certain families may have an inherited tendency to develop eosinophilic esophagitis as it is thought to result from a combination of genetic, immune, and environmental factors. Many patients with eosinophilic esophagitis also have food and/or environmental allergies.  Individuals with eosinophilic esophagitis commonly have other allergic diseases, such as allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), asthma, or eczema (i.e., atopic dermatitis). While the exact cause of eosinophilic esophagitis is not known at this point, the general belief is that it is typically caused by an immune response to specific foods. The classic symptoms described by patients with eosinophilic esophagitis typically include trouble swallowing, heartburn, and/or a feeling that food is getting stuck in the throat.  Many individuals also exhibit adaptive or coping behaviors that they naturally developed as a way to be more comfortable with the symptoms that they have lived with, not knowing what is causing their symptoms.  Doctors have described this change in eating behavior by the acronym IMPACT:

• Imbibe fluids - Ingesting fluids with meals to help food go down.
• Modify foods – Cutting food into tiny pieces, softening it, pureeing it.
• Prolong mealtimes - Taking unusually long to eat.
• Avoid hard texture foods - Avoiding bread, steak, dry rice, dense meats, raw vegetables, etc.
• Chew excessively - Over-chewing to prevent food getting stuck.
• Turn away tablets/pills - Avoiding pills because they feel difficult to swallow.

Below are the highlights of the most recently updated guidelines:

• The diagnosis of eosinophilic esophagitis is done by checking for symptoms of esophageal dysfunction, such as trouble swallowing or regurgitating food, finding 15 or more eosinophils per high powered field in the esophageal tissue samples taken during biopsy, and ruling out other possible conditions.
• The recommendation is to use a standard scoring system during every endoscopy and to take at least 6 tissue samples (i.e., biopsies) from at least 2 parts of the esophagus to be examined under a microscope.
• In the treatment of eosinophilic esophagitis, guidelines support the use of medical therapy including proton pump inhibitors (PPIs) or swallowed topical steroids.
• A trial of elimination of 1 or 2 foods from the diet (dairy and/or wheat) while closely monitoring symptoms.
• If patients do not respond to these approaches, the biologic Dupixent (i.e., dupilumab) may be used.
• For children with eosinophilic esophagitis and feeding difficulties, a feeding therapist or dietitian to help with therapy is recommended.
• Continue to monitor symptoms and perform endoscopies with biopsies so that the tissue samples can be examined under a microscope.

The guidelines emphasize the importance of addressing both the inflammation and any scarring or narrowing of the esophagus when treating and monitoring patients with eosinophilic esophagitis. If you think that you may have eosinophilic esophagitis, or any other type of allergy, the board certified allergy doctors at Black & Kletz Allergy would be happy to help you.  We have 3 convenient offices in the Washington, DC metropolitan area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking.  Our Washington, DC and McLean, VA locations are Metro accessible.  There is also a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  Please call us for an appointment.  Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy have been treating both children and adults in the DC metro area for eosinophilic disorders, allergies, asthma, sinus disease, and immunologic disorders for more than 5 decades.  We strive to provide top-of-the-line allergy relief in a thoughtful and professional environment.

Honey to Treat Allergies?

May 5, 2026 | Black & Kletz Allergy

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.

Types of asthma: When asthma is separated into longitudinal phenotypes, longer exclusive breastfeeding shows the clearest association with:

• Persistent asthma (lower risk)
• Early transient wheezing/asthma (weaker/borderline effects)
• Little to no association with late-onset asthma (adolescent/adult onset)

Relationship to atopy / IgE sensitization:

• 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.

Confounding by familial/host factors:

• 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.

Take home message: Extended periods of exclusive breastfeeding (i.e., approximately 4 months or longer) are linked to a slightly reduced chance of childhood asthma. This protective effect is most evident for asthma that emerges in the first 10 years of life, as well as for persistent asthma, while the evidence is less conclusive for asthma with a later onset. It is interesting note that in 1936, Grulee and Sanford noted a significantly lower incidence of atopic dermatitis (i.e., eczema) in breastfed infants compared with formula-fed infants. Since then, the protective role of breastfeeding in the development of allergies has been in the forefront of allergy research, eventually leading to physicians recommending breastfeeding to new mothers. The board certified allergy specialists at Black & Kletz Allergy will readily respond to your needs for further information in dealing with the subject of breastfeeding and allergies and/or asthma.  The allergists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We offer on-site parking at all of our offices and our 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 inquire about an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond to you within 24 hours by the next business day.  Black & Kletz Allergy treats both adults and children and we strive to provide the best and most current diagnostic and treatment techniques in the Washington, DC metropolitan area, as we have done for more than 5 decades.

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.