More Pollen. More Problems.


Pollen, from trees, grass, and weeds contain soluble allergens which can dissolve through the mucosa linings of the respiratory system and cause common allergy symptoms, like rhinitis, i.e. a runny, itchy, sneezy nose!

This is MISERABLE for those who suffer from pollen allergies. The best way to help shots and other allergy medicine is to avoid your exposure! While medication might be necessary, avoidance can lessen the severity and frequency of your symptoms.

Here are some tips on how to avoid pollen exposure: 

  1. Wash your hair before bed after a day spent outdoors
  2. Dont hang clothing and bedding out to dry
  3. Have someone cut your grass – (see any friendly neighbors?)
  4. Keep your car window closed while driving
  5. Close home windows and turn on the AC
  6. Stay indoors between 5am-10am when airborne count is highest or on especially dry, windy days.

(As seen in Harvard Health Report)



Understanding Chronic Cough


The following is an excerpt from our patient handout entitled, Understanding Chronic Cough. This handout is available to our patients in our practice.

Chronic Cough can be a frustrating problem for patients. A chronic cough is defined as a cough that lasts for more than 8 weeks. There are three major causes for a chronic cough. They include Cough Variant Asthma, Vocal Cord Dysfunction and Postnasal Drip. The drug Lisinopril can also cause a chronic cough. In most cases, there is more than one cause responsible for a chronic cough.

Cough Variant Asthma: Asthma classically presents with expiratory wheezing or shortness of breath. Asthma can also sometimes present solely as a cough. Diagnosis can be made by clinical exam and/or pulmonary function tests. Precipitating factors can be a viral infection or a subclinical bacterial infection. Additional triggers for asthma can include allergies, allergic rhinitis, sinusitis, reflux of stomach acid and irritants such as perfumes and pollution.

Vocal Cord Dysfunction: Vocal cord dysfunction (VCD) is an inflammation of the larynx or upper airway. Symptoms of VCD or Laryngopharyngeal Reflux can include a sense of tightening around your throat, an inability to feel like you can take a deep breath and inspiratory wheezing. Sometimes people feel as if they cannot breathe, start hyperventilating, and as a result, make the symptoms even worse. Symptoms are often misdiagnosed as a panic attack. The diagnosis can be made clinically and confirmed with a Flow Volume Loop or direct visualization with laryngoscopy. Treatment usually involves the use of a proton pump inhibitor (i.e. Pantoprazole, Dexilent), and an H2 antagonist (i.e. Zantac, Pepcid). If non-acid reflux is suspected, other drugs may be prescribed.

Obviously lifestyle measures should be undertaken to prevent reflux. These include the avoidance of acidic foods such as coffee and citrus fruits. Carbonated beverages are also to be avoided as well as chocolate, alcohol and a large intake of fatty foods which can cause relaxation of the lower esophageal sphincter muscles. Avoiding excessive liquids after 6 p.m. and not eating after 8 p.m. is recommended. In order for proton pump inhibitors to work correctly, they need to be taken one half hour before breakfast and one half hour before dinner (with the exception of Dexilent). Sometimes this medical regimen is ineffective and further testing is needed.

Postnasal Drip: Postnasal drip is typically caused by allergic rhinitis, non-allergic rhinitis or sinusitis. People with underlying allergies may have polyps, which can cause obstruction and secondary sinus infections. Treatment includes inhaled nasal steroids, oral antihistamines, nasal antihistamines, saline irrigation, leukotriene antagonists (Singulair) and occasionally, oral steroids. Diagnostic tests include CT scans of the sinuses and allergy testing.

In properly diagnosing chronic cough, we will also generally obtain a chest x-ray to make sure we are not dealing with any chronic lung infection or other possible pulmonary causes for cough. Depending on how difficult it is to make a diagnosis and effectively treat a cough, other testing may be prescribed. While chronic cough can be frustrating, the etiology can be found with a thorough investigation and effective treatment rendered. For more information, make an appointment with us or stop by our office to obtain a copy of one of the following patient handouts: Understanding Vocal Cord Dysfunction, Understanding Asthma, Understanding Allergic Rhinitis or Understanding Gastroesophageal Reflux.

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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.