Itchy, Runny Nose? Watery Eyes? Keep Reading.


Many of you have experienced these symptoms: Itchy, runny nose. Sneezing and watery eyes. Are you suffering from Allergic Rhinitis? How is Allergic Rhinitis diagnosed? And how is it treated? I have created a handout, available to my patients, entitled, “Understanding Allergic Rhinitis”. It has been published in its entirety below for your reference.

Allergic Rhinitis refers to a group of symptoms that affect the nose. Allergy signs and symptoms include: itchy nose, eyes or throat, runny nose, sneezing, watery eyes, cough, clogged ears, headache, dark circles and/or puffiness under the eyes and fatigue. Other symptoms associated with Allergic Rhinitis include impaired sleep, increased irritability and recurrent sore throat. It is estimated that Allergic Rhinitis affects 40-50 million people a year. Allergic Rhinitis can be a trigger for asthma and predisposes patients to chronic sinus infections or ear infections. Allergic Rhinitis is the fifth most costly condition in the United States, trailing only hypertension, heart disease, mental illness and arthritis.


Symptoms of Allergic Rhinitis are caused when an allergen you are allergic to is inhaled. This causes an inflammatory response, the release of histamine, and the symptoms outlined above. Allergic Rhinitis can be seasonal due to spring and fall pollens, or year-long due to dust mites, animal dander, cockroaches or mold. Non-Allergic Rhinitis can mimic Allergic Rhinitis, but it is caused by irritants such as smoke, air pollution, exhaust fumes, fragrances, paint fumes, and the like. A diagnosis is made on the basis of patient history, a physical exam and testing. Skin testing is the most common method of allergy testing. If for some reason the patient cannot get skin testing, a blood test known as IgE Rast can also be done. Other tests that can be helpful include a Complete Blood Count (CBC) with differential, to assess the serum-eosinophil cationic protein level (S-ECP). The serum-eosinophil cationic protein level (S-ECP) has been promoted as a biomarker of asthma that reflects the degree of bronchial eosinophilic inflammation.


Lifestyle and environmental controls are the cornerstones of treatment. Identifying the proper triggers is helpful in outlining the proper treatment strategy.

Pollens: Keep windows closed and use air conditioning in the summer. Don’t hang clothing outdoors. Pollen may cling to towels and sheets, worsening symptoms. Usually allergy symptoms are worse between 5 a.m. and 10 a.m. You may want to consider wearing a pollen mask (NIOSH 95 filter rating) while working outdoors.

Mold: Keep water away from the house; use a dehumidifier to keep household humidity around 40%.

Dust Mites: Use dust mite covers, minimize exposure to carpets and heavy drapes, and minimize exposure to stuffed animals. Keep household humidity low, as outlined above.

Irritants: Avoid exposure.


Saline Irrigation: Saline irrigation can be helpful in combination with medications, or alone, if symptoms are mild. We recommend using a ceramic Neti Pot, as plastic containers are a wonderful surface for growing layers of bacteria and biofilms. We suggest combining 1/4 teaspoon of salt and 1/4 teaspoon of baking soda with 4-8 ounces of distilled water. Gentle irrigation improves mucociliary clearance which helps prevent infection.

Nasal Steroids: Nasal corticosteroids are the most effective treatment for Allergic Rhinitis. They work best when used continuously, as directed by your physician. When the patient is asymptomatic, dosages can be reduced. Nasal steroids are considered very safe. If symptoms are strictly seasonal, using nasal steroids on an intermittent basis may be recommended.

Antihistamines: Antihistamines can be taken by mouth, and are generally supplied without a prescription. Some antihistamines can cause drowsiness and impair one’s ability to operate machinery or drive a motor vehicle. Antihistamine nasal sprays can also be effective in the treatment of allergies.

Decongestants: Occasionally, decongestants may be helpful in reducing symptoms such as nasal stuffiness. However, decongestants can also exacerbate hypertension or cause heart palpitations. Nasal decongestants should not be used for more than 3 consecutive days.

Leukotriene Inhibitors: These medications are generally recommended for patients with nasal polyps. Examples are Singulair and Zyflo.

Allergic Rhinitis can cause symptoms independently, or can be a precipitating cause for other diseases such as asthma or vocal cord dysfunction. Most symptoms of Allergic Rhinitis can be treated effectively. Depending on the severity of symptoms, a variety of treatment strategies can be recommended to effectively treat allergies, as well as concomitant illness. If you are experiencing symptoms similar to those of Allergic Rhinitis, I encourage you to make an appointment with our office, Annapolis Allergy & Health Enhancement Center, to obtain a proper diagnosis and treatment plan.




Simple 5K Training Plan For Beginners

With the weather finally warming up, now is an excellent time to take your exercise regime outside. Why not give a 5K a try? The following article provides some great tips for preparing for a 5K! Ready to commit? Here’s a link to 5K races throughout Maryland this Spring:

Sunny Sleevez


Want to shake off the winter woes and shape up for summer? Try signing up for a 5k.
Running a 5K is a great goal for beginners. A lot of excitement and motivation can be generated by participating. But the best part is that even if you’re a couch potato, you can participate in a 5K event with just a couple of months training.
Creating the schedule
First things first, you need to have a clearly laid-out schedule. Running experts have created an easy, eight-week schedule for beginners to help them prepare for the 5K event.
Mondays and Fridays should be rest days, which is very critical for injury prevention and recovery. Sticking to your rest days is also important to prevent you from getting burned out from daily running.
Tuesday, Thursday and Saturday should be the normal running schedule. After warm-up exercises, you should start running at a comfortable…

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Understanding Obesity


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I do not know anyone obese who actually enjoys being overweight. Obesity is a difficult condition to overcome because there is more to treating this condition than simply eating in moderation and exercising. Understanding what causes obesity is the first step in reversing the process and preventing diseases such as diabetes and heart disease. I have created a handout, available to my patients, entitled, “Understanding Obesity”. Below is an excerpt from this handout as well as links to other helpful resources:

Without question, the biggest problem with our diet is sugar. It used to be that we consumed relatively small amounts of sugar. As Americans, we now consume approximately 150 pounds sugar a year; up 100 pounds from approximately 10 years ago. Sugar can be found in two forms: sucrose and high fructose corn syrup. Both include one molecule of glucose and one molecule of fructose. Because of the high cost of sucrose (cane sugar) it was used very sparingly in the past. For example, in the early 1900s, the average Coca-Cola bottle contained 6 ½ ounces of soda. With the advent of high fructose corn syrup, sugar became much cheaper. Now a canned soft drink contains 12 ounces of soda, and a bottled soft drink from the vending machine contains 20 ounces. Perhaps the biggest offenders are sports drinks because they are marketed as being healthy. In essence they are nothing more than a fat factory for our bodies.

Glucose is an energy source which all of our cells use. Excess glucose is broken down into glycogen in our liver which is non-toxic. Fructose on the other hand cannot be taken up by cells and is metabolized directly in the liver. Fructose does not contribute to energy formation and is metabolized directly to fat. We recommend that you look at labels very carefully and do not eat products that contain more than 3 grams of sugar per serving. Because cells do not use fructose for energy there is no feedback mechanism in the brain to tell us to stop eating…and so we don’t. This promotes the cycle of obesity.


People who switched from a conventional diet to a Mediterranean diet lowered their risk for death from all causes by 50%. In addition, there was an 80% reduction in heart disease, a 75% reduction in colon cancer, as well as decreased risk for reoccurrence of breast cancer. Avoid sugar, particularly fructose and high fructose corn syrup. It makes us fat and contributes to the development of diabetes, heart disease, and hypertension as well as other diseases. Make vegetables and legumes the mainstays of your diet. Believe it or not our cells talk to each other. By eating the proper nutrients, we get proper cell to cell communication. Make exercise a part of your daily routine. Try and keep your daily total calories in a reasonable range.


Annapolis Allergy & Health Enhancement Center

Why Sugar is So Bad For Us

Components of a Mediterranean Diet

Characteristics of Long Lived Cultures



One Patient’s Experience: The 8 Week Lifestyle Challenge

One of my patients recently shared her “inspirations” and “experiences” upon completion of the 8 Week Lifestyle Challenge. What I found to be most interesting was her mindset throughout the challenge. She remained positive, embraced trying new things, encouraged herself daily and did not set unrealistic expectations. I believe this set the stage for her success. I am posting her comments here in the hope that some of you can benefit from her experiences. Congrats, C!

I am a participant in the 8 Week Lifestyle Challenge! I officially started this challenge on January 28, 2014.  I followed the directions and wrote down my inspirations to be successful.


  • I can do all things through Christ which strengthen me when I am not strong.
  • I want to eat to live…not eat to destroy my body anymore.
  • Many foods are available to me but that doesn’t mean I have to eat all of them. Good foods are good for the body but the wrong foods are not.  Think, girl, before you put it in your mouth! Moderation!
  • You know you have to drink water today. Really? Yes! And you have to just walk away from the sodas and juices. They will hurt your body. You can do it. Exhale and keep it moving.
  • Don’t look at trying to lose 30, 50 or 75 lbs. because you won’t do it. Just look at 8 weeks. When you finish the first 8 weeks, take a two-day break and do another 8 weeks until you accomplish your goal.


  • I introduce myself to vegetables that I have never eaten before like swiss chard, spaghetti squash, rutabagas & turnip greens.  Wait a minute, I am now eating hummus too. Right.
  • I learned how to prepare my food differently.
  • I have to be honest….I used honey instead of white sugar. Don’t shoot me.
  • I started walking, bending and stretching during commercials.
  • My favorite muffin is blueberry. There was a blueberry muffin on the counter at my office; I heard it calling my name.  I walked over and told the blueberry muffin,  “You are delicious, however you are not good for me.”
  • Was this challenge easy for me? No, but I am determined to achieve my goals and turn my life and health around.  Fortunately, I can reverse my weight and health conditions by following the 8 Week Lifestyle Challenge.
  • I thoroughly enjoyed the deep breathing exercises. My pain levels are not as intense anymore and I experience less stress.
  • I am breathing better when I walk through a store, from my car to my building, etc.
  • Wait a minute. Now my pants are too big for me?! Yes!
  • Guess what? I lost 17 lbs. This was the best news I could ever receive on my 59th birthday.  Yes, I am still smiling and dancing. I got my mind made up and I won’t turn back.
  • My friends asked me what diet I was on. “Well, it is not a diet.” I said.  “It is a Lifestyle Challenge from Dr. Bernstein’s office.”

If you are reading this right now, trust me, live a long and healthy life by giving  the 8 Week Lifestyle Challenge a chance.  Love ya. -C

The 11 Best Asthma Health Blogs

Winners were selected by Tracy Rosecrans. The following article was written by Robin Madell for

Asthma is a chronic lung condition that causes chest tightness, wheezing, coughing, and shortness of breath. Many of those who suffer from asthma are children. However, people of any age can have asthma. Click through the 11 Best Asthma Health Blogs of the year for information and insights about living with and managing asthma.


Understanding Asthma


The key to diagnosing and treating asthma properly is conducting a thorough review of the patient’s symptoms, lifestyle and current medical conditions. Additional tests, such as using a flow-volume loop can help narrow down a diagnosis.

To help my patients better understand asthma, I have created a handout, available in my office, to provide further education on this condition. Below is an excerpt taken from this handout:

Historically, we were taught that depending on the severity of asthma, treating our patients with a stepwise approach to more medications was advised. Recently, this approach has changed to what I believe is a more thoughtful and scientific approach. Currently it is recommended that a thorough patient evaluation should be done to look for triggers or concomitant factors that may make control of asthma difficult. These may include allergic factors such as allergic rhinitis or subacute bacterial infections such as mycoplasma, which may not be apparent on x-ray. Conditions such as acid reflux disease can also exacerbate your asthma symptoms. Moreover, sometimes diseases like vocal cord dysfunction, which is an upper airway problem, can mimic the symptoms of asthma. In this case, the vocal cords paradoxically close while breathing in, when normally they open. Simple tests conducted in our office such as a flow-volume loop can help differentiate between conditions.

After the problem is identified, appropriate interventions can be made which allow for more effective treatment of one’s asthma, and the use of less medications in the long run. Further medical research has also led to a change in what types of controller medications we should be using. Recent data suggests that inhaled, long-acting corticosteroids that are smaller in size may be more helpful in treating the small airways disease that is associated with asthma then some of the larger molecule inhaled steroids. Additionally, data has become more convincing for the use of a new technology looking at inhaled nitric oxide levels. This can help predict which patients are likely to respond to inhaled corticosteroids and it is another tool, besides spirometry, that allows us to monitor the effectiveness of our treatment recommendations.

If you or someone you love is experiencing symptoms that you believe are asthma-related, make an appointment with your physician or contact our office  to learn more about this condition. When properly diagnosed and treated, asthma symptoms can be managed with relative ease.

If you would like to learn more about asthma or Dr. Bernstein, use the following links:

Annapolis Allergy & Health: Patient Education

More about Dr. Bernstein

Asthma Education Videos


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‘Pre-Hypertension’ Associated with an Increased Risk of Stroke


We all know that people with hypertension (blood pressure of 140/90 and above) are at an increased risk of stroke but a new study shows that those with ‘pre-hypertension’ (blood pressure readings between 120/80 – 139/89) should take action now to reduce those numbers. The study, conducted by Chinese researchers, found that people with prehypertension have a significantly increased risk of stroke.

“We want the public to understand that you need to do something” when blood pressure rises, even before it reaches hypertensive levels, says Ralph Sacco, a spokesman for the American Heart Association and a neurologist at the University of Miami.

“Lifestyle modification is the No. 1 recommended approach,” Sacco says. It should come as no surprise that losing weight, exercising and eating a diet high in fruits and vegetables all go a long way to lower blood pressure and reduce one’s risk of stroke.

For those of you who participated in our 8 Week Lifestyle Challenge, you learned new ways to eat, exercise more and manage stress, all of which play a role in reducing your risk of stroke. Remember, the full list of recommendations, complete with a grocery shopping guide are always available on our practice’s website.

Here’s to Your Improved Health!


How to Fit Exercise Into Your Lunch Break


For many of us, life during the day is largely spent in a chair at a desk. The sedentary nature of our jobs can lead to negative effects on our bodies; many of us develop poor posture and back and neck pain as a result of long hours spent at a desk.

Enter your lunch break. Most of us get one of these. Some of us only get 15 minutes, while others of us may have the luxury of an hour. Regardless of the specific duration, you can incorporate exercise into your midday break. Here’s how:

Make the Time!

  • Bring your lunch to work. If your lunch is already in your work space, you don’t have to travel anywhere to obtain food, freeing up more time for exercise.
  • If you have a short lunch break, consider eating your lunch slowly over time while you work and reserve your break time for exercise.

Bring on the Exercise!

  • Keep a good pair of athletic shoes at work. Don’t rely on yourself to remember to bring them each day. Your morning routine is likely busy enough. Instead, simply keep a pair of sneakers at your office so they are always there when you need them.
  • If you are fortunate enough to have your own office, you have privacy, and many more options for exercise. Consider keeping a set of dumbbells in your office and complete 3 rounds of 10 reps of bicep curls or tricep kickbacks.
  • Wall squats are another easy way to get some exercise into your work day. Simply find a wall, place your back against it, and slide down into a squat position, keeping your back firmly pressed to the wall. Hold the pose for 30 seconds.
  • A lot of offices have stairs. Spend 10 minutes of your day walking up and down stairs. Challenge yourself and work up to increasing your speed as you climb over time.

With a little creativity, you can easily find ways to enjoy your lunch AND get a little exercise in your day too!

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Walking Toward Improved Fitness


Even those of us with some physical ailments are able to walk. And most of us do it everyday. We walk to the mailbox to get our mail. We walk to the bus stop to pick up our kids. We walk through the grocery store to pick out the evening meal. We walk Fido to make sure he gets his exercise for the day. Did you ever think of taking yourself for a walk?

A person of virtually any fitness level can enjoy a good walk. It’s easy, inexpensive (only a good pair of sneakers is required) and you can do it anywhere. Cold and snowy day? Take your walk in the local mall. Warmer temperatures and no precipitation? Take your walk outdoors. You choose your own destination, your own pace and how long or short your walk will be. The best part of walking? At any pace, in any location, for any distance, it is still exercise.

For those of you who want to begin walking for exercise, set a small goal to start, keeping in mind your own fitness level and limitations. An example of a small goal is the following: I will walk at a moderate pace for 15 minutes on Monday, Wednesday and Friday of this week. Try to vary where your walks take place to avoid boredom. If Monday is a busy day for you, take your walk in your neighborhood or around your office building. If you have more time on Wednesday, take your walk in a local park. If it rains on Friday, take your walk on a treadmill at the gym, in the mall, or in your place of employment. Again, the beauty of walking as a form of exercise is that you can do it anywhere.

For those of you who are already on the move, perhaps now is the time to push yourself further. Choose a walking trail or path that includes hills. Pick up your pace and keep track of your mileage to set new goals. Bring arm weights along on your walk and incorporate exercises with small weights into your walking routine. You will be surprised at how these small changes can really boos your walking workout.

This weekend in Annapolis, we will finally be enjoying a break from the freezing cold temperatures this winter has brought to our area. With the exception of a 40 degree Sunday, the temperature will be IN THE 50s, Saturday, Monday and Tuesday!  Let’s go on a walk!


Anne Arundel County Parks & Trails

Family-Friendly Outdoor Trails 

4 Ways to Boost Your Walking Workout

Top 10 Best Walking Shoes 

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8 Tips to Tame Winter Allergies By


The article below was originally published on Whether it’s summer, spring, or winter allergies stuffing you up, you can do a lot to manage — or prevent — allergy symptoms, including:

Avoid Allergens. The first and best treatment for winter allergies is to avoid what you’re allergic to. For example, stay indoors when the wind is whipping up damp leaves in the yard, and keep indoor allergens to a minimum by mopping, sweeping, and dusting often.

Wash Away Allergens. Washing your hands and face frequently reduces the number of allergens you carry — and spread. When allergy symptoms are intense, take a shower; it removes allergens from your hair and encourages you to change the clothes that allergens may be clinging to. A bonus: The steam of a hot bath or shower may relieve allergy symptoms like sinus congestion.

Wash Bedding Often. Most bedrooms are havens for pet dander and dust mites. You can keep these and other allergens down by washing your sheets, pillowcases, and blankets in hot water. A weekly wash is great, but twice a month is fine, too.

And Get Better Bedding. Look for bedding that’s specially designed to be less permeable to allergens like dust mites. You can start your search online with the term “allergy bedding.”

Try a Saline Solution. Irrigation with saltwater is a great home remedy to relieve the nasal congestion that may be part and parcel of winter allergies. Look for saline at most drugstores, or make your own by mixing in a squirt bottle one teaspoon of non-iodized salt to eight ounces of water.

Get More Moisture. When you’re blowing your nose all the time and the thermostat is cranked up, it’s easy to get dehydrated. Pump up the fluids by carrying around a water bottle, eating more water-rich fruits and veggies, or enjoying hot tea. A side benefit to hot drinks: their steam may reduce nasal congestion.

The Air Needs Moisture, Too. It’s an indoor balancing act: Too little moisture in the air may irritate nose and throat; too much encourages mold and mildew growth. Costing as little as $5, a hygrometer — a humidity monitor — can help you track the moisture in your house and adjust with a humidifier/dehumidifier accordingly. Aim for humidity no lower than 30% and no higher than 50%.

Take Allergy Medication. Allergy meds can relieve symptoms like itchy eyes and nasal congestion, yet over-the-counter or prescription drugs won’t do you much good if you don’t use them right. Managing winter allergies is easier if you take medication before symptoms appear, and if you remember that taking more medicine doesn’t lead to fewer symptoms. Follow label directions carefully and you should get the relief you crave. You’re not alone with winter allergies. More than 40 million Americans are allergy-prone year-round. If you aren’t getting the relief you need with lifestyle changes or over-the-counter medication, it may be time to talk to an allergist.

To read about the Top Triggers for Winter Allergies, Click Here.


Asriani Chiu, MD, associate professor of pediatrics and medicine (allergy/immunology); program director, allergy/immunology fellowship program, Medical College of Wisconsin.

Steven H. Cohen, MD, FAAAAI, associate clinical professor, Medical College of Wisconsin. American Academy of Allergy, Asthma and Immunology: “Allergies vs. Colds,””Preparing Your Home For Battle: Fighting Indoor Allergies.”

Alan Goldsobel, MD, spokesman, American Academy of Allergy, Asthma & Immunology; physician, Allergy and Asthma Associates of Northern California.

8 Weeks. 56 Days. You Did It!


You have officially completed the 8 Week Challenge! Congratulations! I hope you have learned the benefits that changes to your diet, exercise regime and emotional health can bring: increased energy, greater sense of well-being, the ability to sleep better, and increased mental clarity to name a few. Some of you mentioned that the greatest benefits came from changing your diet. There really is no substitute for healthy eating. Energy bars, and nutritional drinks are mostly hype (and often, full of sugar) and their advertisements are more about making the nutritional company money than they are about making you healthy. Consuming whole, non-processed foods, with a renewed focus on vegetables and legumes is a key component to increased longevity.

Another part of the challenge that received much discussion was the notion of taking a cable news or talk radio holiday. While some of you found this particular challenge very difficult, most of you seemed to really enjoy the break and noticed a reduction in your overall stress level with an increase in your feelings of well-being. Wonderful!

I hope that all of you who participated choose to continue to incorporate some of these changes into your life. Most importantly, I hope you continue to share your stories of success with me. For those of you who may need a refresher course from time to time, or for those who did not participate these last 8 weeks but want to give our 8 Week Lifestyle Challenge a try, start with our Let’s Get Grocery Shopping post or use our practice’s website to get our grocery shopping recommendations and view a full list of all of our challenges, from week one to week eight.

Great job everyone!