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)



Resources for People with Allergies


Millions of Americans suffer from allergies, whether they experience seasonal discomfort or have to avoid certain foods, allergy sufferers can oftentimes feel frustrated about their condition. Thankfully, there are many great resources for those dealing with allergies, simply a click away.

The makers of Zyrtec (this is not an endorsement of a product, rather a mention of a great resource) provide an allergy forecasting tool wherein you can enter your zip code to determine your town’s short-term allergy forecast. This clever site will also warn you about the key allergens in the environment for the time period entered. offers many resources for allergy sufferers to include a Seasonal Allergy Map, a list of 10 Common Allergy Triggers and a comprehensive Allergies Health Center which includes allergy definitions, treatments and community boards which allow families dealing with food allergies to communicate and share their own tips and experiences with one another.

The Mayo Clinic offers a great article about lifestyle changes and home remedies to combat allergies and The Food Allergy Research and Education website offers a number of resources to parents, child care providers, schools and restaurants.

Of course, if you suspect that yourself or a family member may be suffering from an allergy, we welcome you to contact our office to schedule an appointment. Dr. Bernstein is an area expert in allergies and asthma and was the Capital Newspaper Readers Choice Awards Finalist for Best Allergist in 2013 and 2014. You can make an appointment by calling 410-224-5558.

Do You Need Allergy Shots?


Allergy shots, also called “immunotherapy,” can reduce reactions to allergens and result in less severe symptoms. Unlike medications, an effective period of treatment with allergy shots can result in symptoms that are less severe or disappear altogether, even after allergy shots are stopped. Potential reasons for starting allergy shots include:

  • Allergy symptoms are severe enough that the benefit from the shots outweighs the expense and time from getting the shots.
  • Allergy symptoms are not being adequately controlled with medications.
  • Side effects from medications pose a problem.
  • The patient wants treatment for the cause of their allergies rather than treatment for just the symptoms.
  • The patient has another condition that is being affected by allergic rhinitis such as asthma, or recurrent sinus or ear infections.
  • To reduce the risk of developing asthma.

Allergy shots are effective in treating both allergic rhinitis and allergic asthma. The shots reduce symptoms in patients who are allergic to pollens, animal dander, dust mites, mold, and cockroaches. Allergy shots are most effective when used in combination with medication and environmental controls. Patients taking allergy shots generally require less medication.

When you start immunotherapy, you may initially be asked to come to the office twice a week for shots. This is because initially the serum dosage is very dilute. With each shot, a little more allergen is given until a maintenance dose is reached. This helps the body develop a tolerance to the allergen and symptoms are reduced. Once the maintenance dose is reached, allergy shots are spread out to every other week and eventually once a month. After 6 months to one year, you and your doctor should have a good sense if allergy shots are going to be an effective treatment for you. If they do appear effective, your doctor will recommend a course of allergy shot treatments lasting 3-5 years, generally speaking.  

Most patients tolerate allergy shots without incidence, but reactions are possible. To reduce risk, we recommend that patients are observed in the doctor’s office for 20- 30 minutes after each shot. Patients who do not have an EpiPen must stay 30 minutes. It is during this 30 minute time frame that the most serious reactions tend to occur. The risk of having an allergic reaction can be reduced by taking antihistamines prior to receiving your allergy shot. If you receive allergy shots on a regular schedule without missing doses, you are less likely to have a reaction to an allergy shot. Different types of reactions include:

Local Reactions: Redness or swelling at the injection site (usually not a problem).

Systemic Reactions: May include sneezing, nasal congestion or hives. Swelling of the throat or chest tightness may also occur. If you experience these symptoms after receiving an allergy shot in our office, notify a member of our staff immediately.

Anaphylaxis: This is the most severe kind of reaction and it is extremely rare. It can cause low blood pressure and trouble breathing. If this were to occur, symptoms would usually begin within 30 minutes of the injection.

As an extra precaution, we generally recommend that our patients have an EpiPen on hand. If a systemic reaction occurs after you leave the office you should return to our office immediately or go to the emergency room. 

For further information or to schedule an appointment, please contact our practice at 410-224-5558.


Photo Source

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.