Category Archives: COMMON COLD

Respiratory Infections and Asthma

As we enter into the “cold and flu” season, children and adults with a history of asthma may experience an increase in the frequency and severity of their asthma symptoms triggered by these infections.

Most of us have to contend with a few upper respiratory infections (e.g., cold, flu, sinusitis) each year. Viruses are the usual culprits and the rhinovirus is the most common virus causing upper respiratoryinfections in all age groups.  Respiratory syncytial virus (RSV) usually affects the upper and lowerrespiratory tracts in infants and young children.

Upper respiratory tract infections are usually mild self-limited illnesses in otherwise healthy children and adults.  The common symptoms of nasal congestion, runny nose, post-nasal drip, sneezing, sore throat, achiness, and an occasional dry cough may last for about a week.  However, in individuals with a history of asthma, these infections can trigger a flare-up of their asthma by causing wheezing, coughing, chest tightness, and/or shortness of breath.  Once the asthma symptoms are triggered, they can linger for several days to weeks, even after recovery from the infection.

Viral infections also can predispose one to secondary bacterial infections which can lead to complications like sinus infections causing discolored nasal discharge, facial (sinus) pressure and pain, persistent mucus drainage into throat, and coughing.  Fever, chills, night sweats, fatigue, coughing up discolored sputum, and/or soreness in the chest while breathing, may be indicative of pneumonia. A few precautions may help prevent or alleviate respiratory infections and reduce the risk of asthma exacerbations:

  1. Viruses causing respiratory infections are highly contagious.  Avoid contact with others with active infections can minimize the risk of contracting the illness.
  2. Wash hands frequently with soap and water.  This will eliminate most germs causing infections. Hand sanitizers are useful while traveling.
  3. Refrain from touching one’s eyes, nose, and mouth which can minimize the germs from entering into the body.
  4. An annual influenza vaccine (i.e., flu shot) is highly recommended in all children (above 6 months of age) and adults with asthma.  FluMist (the flu nasal spray vaccine) is not indicated in asthmatics and only approved for use in persons 2 through 49 years of age.
  5. Many children and adults also benefit immensely from a pneumonia vaccine to prevent bacterial infections from pneumococcus, a type of bacteria that causes respiratory tract infections.  The two most common vaccines available are Prevnar 13 and Pneumovax.  It is important to check with your primary care physician to check for documentation of what type of pneumonia shot you may have had and when it was administered.  Depending on this information, your physician will recommend which type of pneumonia vaccine may be needed and when it should be given.  The age of the patient, underlying diseases, and history of previous vaccinations all will play a role in determining what, when, and if the vaccine is needed.
  6. Rest, drinking plenty of fluids, and the use of certain over the counter medications may alleviate some of the symptoms.
  7. Prescription antiviral medications [i.e., Tamiflu (oseltamivir), Relenza (zanamivir), Rapivab (peramivir)] can reduce the duration of the flu and they may also decrease the risk of an increase in asthma symptoms.
  8. Monitoring peak flows is helpful in predicting asthma exacerbations.
  9. If the infection ends up triggering asthma symptoms, one should begin using a rescue inhaler or nebulized medications at regular intervals for symptom relief.
  10. Either initiating the preventative controller medications or increasing their doses at the onset of cold or flu symptoms, (as directed by the physician), may be useful in preventing or reducing the severity of asthma flare-ups triggered by viral infections.

The board certified allergists of Black & Kletz Allergy have been treating adult and pediatric patients with asthma for over 5 decades.  We are very familiar with upper respiratory tract infections as well as other triggers that cause asthma exacerbations.  In addition, we also treat all kinds of upper respiratory infections.  Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have convenient offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our offices in Washington, DC and McLean, VA are Metro accessible with free shuttle service between the Spring Hill metro station and our McLean office.  All 3 locations offer on-site parking.  To make an appointment, please call us, or alternatively you can click Request an Appointment and we will respond within 24 hours on the next business day.  The allergy doctors at Black & Kletz Allergy strive to manage your asthma to your utmost satisfaction in a professional caring environment.

The “Cold” of Winter Has Effect on Allergy and Asthma Patients

The onset of winter in the Washington DC metro area has brought two cold-related health problems to the forefront.

The first one concerns many people with respiratory disorders like asthma and COPD (Chronic Obstructive Pulmonary Disease).  Cold dry air is a known irritant to the respiratory passages and can trigger an increase in the frequency and severity of respiratory symptoms like coughing, wheezing, and shortness of breath. In addition, respiratory infections, especially caused by viruses, are more prevalent during the winter months.  Influenza (the “flu”) is just one of the many viral infections which are notorious in aggravating asthma and pulmonary-related conditions.

Avoiding exposure to the cold air, in addition to minimizing the chance of developing a viral upper respiratory tract infection by frequent hand washing and covering one’s sneezes and coughs, can help prevent flare-ups in people with breathing difficulties such as asthma and COPD.  People with persistent asthma (defined by any asthma symptom which occurs more often than twice a week during the daytime and/or more often than twice a month during the nighttime) need to use their controller medications on a daily basis as prescribed, in order to reduce the chances of exacerbating their asthma.  Controller medications may include inhaled corticosteroids, long-acting beta agonists, leukotriene antagonists, and/or theophylline.  In more severe asthmatics that meet certain criteria, a humanized antibody called Xolair (omalizumab), may also be prescribed in order to help prevent asthma exacerbations.

The second issue concerns people with a history of a specific type of “hives” called “cold-induced urticaria.”  Though there are usually multiple triggers for hives (urticaria), exposure to colder temperatures can result in giant hives over exposed skin in susceptible individuals.  The condition can be very serious in selected patients and is usually diagnosed in our office by an “ice cube test,” where an ice cube is placed on the forearm of the patient for 10 to 15 minutes and then removed.  When the skin re-warms in a few minutes, an elevated red wheal or hive in the shape of the ice cube confirms this disorder.  In rare instances, this condition is also associated with some systemic diseases and blood tests for cold agglutinins and cryoglobulins may be appropriate.  Treatment begins with avoiding the cold when possible.  In addition, various medications can be used to help prevent the hives and/or anaphylaxis that can occur in people with this condition.

The board certified allergists at Black and Kletz Allergy are experts in cold-related respiratory and skin disorders.  Please call any one of our 3 office locations in Washington, DC, McLean, VA (Tysons Corner, VA) or Manassas, VA if you need further information or are in need of an evaluation and advice regarding any of the cold-related disorders above or other cold-related disorder not mentioned above.


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


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

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

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

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

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


Winter Allergies – Dust mites; Molds: Pets; Cockroaches

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

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

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

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

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

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

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


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

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

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

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


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

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

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

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

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

Summertime Sickness: Sinus Infection vs. the Common Cold

As the tree and grass pollen season is winding down in the Washington DC area, “summer colds” are playing a bigger role in symptoms that include stuffy nose, runny nose, eye irritation, sore throat, and cough in many people.

Also read: Sinus Infection vs. Cold: Symptoms & Treatment Options

The common cold is caused by a viral infection of the upper respiratory tract passages.  Different strains of viruses are responsible for these infections in different seasons.   Whereas rhinoviruses cause most of the colds in the winter, enteroviruses are more prevalent in summer.

The symptoms usually begin as sneezing spells followed by nasal congestion, runny nose, and a redness and burning sensation of the eyes.  More serious eye problems, may be better handled by a Washington DC ophthalmologist. They are usually followed by a sore throat, occasional dry cough, and fatigue.  Many individuals also experience headaches and a mild fever. The illness may last for 5 to 7 days and usually resolves by itself.

Though, no medication is needed to eradicate the infection, the symptoms can be relieved and the person can be made to feel more comfortable by taking some of the following steps:

  1. Irrigating the nasal cavity with a saline spray and over-the-counter (OTC) oral decongestants to unclog the nostrils and help breathe easier.  (Note that  individuals with high blood pressure, heart problems, prostate conditions, and other various diseases should not use decongestants)
  2. Though the OTC nasal decongestant sprays can give quicker relief, if they are used more than 3 days continuously, they can cause “rebound” congestion when their effect wears off.   This can lead to a habituation and dependency and is called “rhinitis medicamentosa.”   Therefore, never use an OTC nasal decongestant such as Afrin (oxymetazoline) or Neosynephrine (phenylephrine) more than 3 days.
  3. OTC pain medications like acetaminophen and ibuprofen to relieve headache, achiness, and/or fever.
  4. Gargling with warm salt water and using throat lozenges to soothe the throat irritation.
  5. Get rest and drink plenty of oral fluids while the immune system is fighting the virus.

However, in some instances the upper respiratory infections can also progress to involve the linings inside the sinuses.  (Sinuses are air-filled cavities within the facial bones and are present behind the forehead, around the eyes, and behind the cheek bones).  This complication can not only prolong the duration of the illness, but can also result in additional symptoms such as fever, facial pain/tenderness, persistent thick and discolored nasal secretions, post-nasal drip, and/or frequent productive coughing, which are symptoms consistent with a sinus infection.  People with a history of asthma may also experience aggravation of their breathing problems and the more frequent need for their rescue medications.

If the symptoms are persisting in spite of the OTC medications and comfort measures (especially if the symptoms last more than 1 week), it is time to consult your Manassas, VA sinus problem doctor for evaluation and treatment. Black & Kletz Allergy’s Washington, DC specialists will help you beat your summer allergies for good.

Sinus Infection vs. Cold: Symptoms & Treatment Options

When we have frequent nasal congestion, runny noses, sneezing fits, and itchy, red, watery eyes, the common dilemma arises:   Is it a sinus infection vs. a cold?  How do I treat either?

Sinus Infection vs. Cold:  Differences
The “common cold” refers to an infection caused by germs like viruses affecting the upper respiratory passages.  It causes inflammation of the tissues inside the nose and surrounding areas (Infectious Rhinitis).  It usually begins with nasal congestion, runny nose, and sneezing.  The nasal secretions are usually clear to start with but can turn into light yellow after a few days.  One can also have a sore throat, cough, and mild fever.  Most symptoms usually subside after about a week without any treatment, though the cough can linger for a few weeks.  This condition is more frequent in winter months and common in children who attend daycare and preschool, due to repeated exposure to viruses.  Adults usually get less frequent “colds” because their more mature immune systems can resist and fight more effectively.

“Allergic Rhinitis,” on the other hand, is the inflammation of the nose and eyes (conjunctivitis) caused by exposure to allergens like dust mites, animal dander, mold spores and various pollens in a susceptible individual.  The symptoms of a sinus infection are somewhat similar to “common colds,” but itching can be more prominent and fever is usually not present.  One important differentiating feature is that the symptoms usually do not remit after a few days but can persist either throughout a particular season or throughout the year depending on the specific triggering agents.  In more severe cases, the condition can have a substantial impact on the quality of life and productivity.  Allergic sensitivity can also play a role in the causation of repeated ear infections and contribute to lower airway disorders like asthma.

Sinus Infection vs. Cold:  Similarities
Both Infectious and Allergic rhinitis can also lead to a “sinus infection or sinusitis” where the lining and tissues inside the sinuses (hollow cavities inside the facial bones) are inflamed.  This can result in facial pressure and/or pain, headache, fatigue, fever, discolored secretions, persistent post nasal drip or drainage, sore throat, and cough.  The condition can be caused either by viruses (which do not need antibiotics) or less frequently by bacteria, especially if the symptoms last for several weeks.

Allergic Rhinitis and Allergic Conjunctivitis, not relieved by simple over the counter (OTC) remedies, require thorough evaluation and management by qualified allergists, who can offer long lasting symptom relief, prevent complications, and improve the quality of life in these individuals.  If you have any additional sinus infection vs. cold questions, please contact the allergists at Black & Kletz Allergy.