• All About Allergies
  • How We Test for Allergies
  • How We Treat
  • Food Allergies
  • Pediatric Allergy
  • Further Reading
  • Information for Current Immunotherapy Patients

Dr. Benke is an Otolaryngologist (ENT) who specializes in allergies and allergy treatment. He is a fellow of The American Academy of Otolaryngic Allergy (AAOA) and he would be happy to help you with your allergy concerns.

The AAOA is a group of specialty physicians dedicated to the quality care of patients with allergies of the ear, nose, and throat. They are board certified specialists in otolaryngology (ear, nose, and throat). Members of AAOA may attain the designation of Fellow (FAAOA) by meeting certain requirements, including passing a detailed examination covering the practice of Otolaryngic Allergy. Dr. Benke passed his fellowship exam in 2012, and has been practicing otolaryngic allergy for 25 years.

All About Allergies

The Most Common allergic symptoms are:

  • Stuffy Nose
  • Runny Nose
  • Itchy, Watery Eyes
  • Headache
  • Fatigue

Things that can trigger allergies include:

  • Inhalants
  • Foods
  • Pets
  • Other

Many other heath issues are associated with allergies including:

  • Asthma
  • Eczema
  • Food Protein Inhalant Allergen Cross Reaction(s) 

For more information about allergies please review these links:

How We Test for Allergies

At Benke ENT Clinic we use a type of In Vitro testing called an Immunocap test.

In Vitro Testing:

In Vitro testing for inhalant allergies deserves special mention because it is a proven technique that provides a significant advance in allergy testing. The term “In Vitro” refers to test procedures performed “outside the body,” as in a laboratory. As apposed to “In Vivo” procedures performed in or on the body directly, as when allergy skin tests are performed.

The principles of in Vitro testing

The allergic reaction is complex. It parallels the way the body defends itself against viruses and other dangerous “foreign” invaders. Just as an antibody recognizes a virus and attaches itself to it so it may be eliminated, a substance in human blood called immunoglobulin E (IgE) also recognizes and attaches itself to allergens- the substances such as dust and pollens, which cause inhalant allergies. Inhalants are substances which you take into your body by breathing. These include dust, pollens, molds, animal dander and tiny microscopic organisms called mites.

Just as there are specific antibodies produced for each specific virus, specific IgE is produced for each allergen. That is, there is one type of IgE specifically for ragweed pollen, another for rye grass pollen, etc. If you have enough of a specific form of IgE in your body to cause a reaction when you breathe one of these substances, you have an allergy.

During the first stage of an allergic reaction, IgE attaches to a special cell in the tissue called the mast cell. This combination forms an allergy “bomb” that is triggered only if it contacts the IgE specific allergen. When the “bomb” explodes, it releases many chemicals, including histamine, which cause the watery eyes, runny nose, congested nose, itchy throat, and the other typical symptoms of inhalant allergies. The more the specific IgE you have, the more allergic to the allergen you are, and the stronger your body’s reaction is when you breathe it.

The key to finding out what inhalants you are allergic to is to discover what specific types of IgE are present in your blood, and how much of each type is present. That sounds simple, except that we are dealing with microscopic particles which cannot be seen by the eye to identify even with the most powerful microscope. We have to locate and measure them by very sensitive chemical tests, and that is where the In Vitro tests come in.

Inside the Immunocap test

In Vitro tests sound very complicated, but actually, they are mechanically fairly simple. Here’s how they work.  As we mentioned, every allergic patient makes specific IgE to each allergen that they are allergic to. So if a drop of their blood serum or plasma (the liquid part of the blood that has been separated from the heavy blood cells) is combined with a drop of allergen, any specific IgE antibodies in the serum will attach to the allergen.  In the In Virto tests, the allergen to be tested is bound to plastic or paper, to which serum is added.

The IgE is measured by adding a weak radioactive marker in the test tube (Immunocap) or a chemical marker that will produce a color change (the enzyme linked immuno sorbent assay or ELISA test). These markers themselves may then be measured.

Using a tiny amount of blood serum, this test can be repeated to measure numerous allergens. Testing can be performed for inhalant allergens and for food allergens as well.


Although the results of the In Vitro tests are not available immediately, as are skin tests, they offer the convenience of requiring only 1 sample of blood to obtain the results for several different allergens. This is especially advantageous for children, as the discomfort is minimized.

Immunocap tests are very precise. As they indicate how allergic you are to each substance, they help guide your doctor to select a safe initial injection dose. If you are highly allergic to an allergen, your starting doses will be weaker than for those allergens to which you are less sensitive. This allows your treatment vials to be “tailor made” only for you. Older methods of testing could not measure the degree of sensitivity to each allergen before treatment was started. Because of this, all allergens would be started at the same strength, which was usually a very weak dose. Because of this, it would often require more injections and a longer period of time to reach a therapeutic dose than with In Vitro testing. In Vitro testing can also be as cost effective as the older methods of skin testing.

What to Expect

In Virto testing is extremely simple for the patient. After a thorough physical examination, your doctor will ask you to fill out a “patient history” form concerning the type of timing of your symptoms, to determine the most likely allergen you may be sensitive to, so these may be testing. You home and work environment (pets, trees, plants, etc) may provide important clues as to which allergens should be tested.  While any number of allergens can be tested, it is unnecessary to test for allergens to which you are not frequently exposed.

Next, a sample of blood will be drawn from your arm. The blood sample is given to a trained laboratory technician for testing. The laboratory sends your doctor a report indicating what allergens you are sensitive to, and how allergic you are to them. After explaining the results to you, your doctor will recommend a program to deal with your allergies. This may include changing your environment (such as eliminating offending substances around your home), medications, or taking allergy injections. With proper management, most symptoms of allergies can be very well controlled.

The labs we use are:

How We Treat

What is the best way to treat you allergies? We offer a number of options to explore, from managing symptoms to treating the root cause through immunotherapy. We can help you explore the benefits of each so you can choose which option is best for you.

1.) Lifestyle adjustments– Dietary adjustments and environmental control measures to reduce exposure to indoor and outdoor allergen are critical to reducing your symptoms. Based on your allergic profile, we can offer guidance to help you address those items that affect you most.

2.) Medication– Various medications can improve or relieve allergy systems. This includes over-the-counter or prescription pills and nasal sprays. Side effects are possible and can be discussed with your doctor. Medications may be needed life long, or as long as symptoms persist, but many patients report decreased medication use after immunotherapy begins.

3.) Immunotherapy– The only way to change underlying allergic disease is immunotherapy, or desensitization, which builds your immune system’s tolerance to allergens over time. This treatment can be administered in two forms.

Allergy injections (allergy shots)- For patients age five and over; a series of injections are typically given for a three to five year period.  Patients visit the office weekly for the first six to twelve months; during the build up or escalation. A physician is available in the office while treatment is given. Most insurance companies cover injections and the medication vial, though co-pays may apply. You should verify your insurance coverage prior to beginning treatment.

Sublingual immunotherapy (allergy drops)-  Allergy drops work much like allergy shots, slowly desensitizing you to what causes your allergic reaction, but they’re delivered under your tongue in a liquid from that you can safely take at home. As with allergy shots, most patients taking allergy drops find their treatments take three to five years to complete. While some patients feel relief in just a few weeks, it’s important to continue taking your drops until otherwise instructed to ensure long-term benefit. Drops are custom-formulated based on the results of your allergy tests. Our staff will instruct you on how to administer and store the drops. Most patients will only need a few visits each year to assess progress. Sublingual drops can safely and effectively treat a broad range of allergies including food and mold. Because of their safety profile, allergy drops can be an option for all patients including young children. For your convenience, allergy drops refills can be mailed to you. Most insurance companies will pay for the testing and office visit, but not for the drops. Most patients agree this temporary investment is well worth the improvement in their health, reduction in allergy related expenses (co-pays for other medications, missed work and school time, and other related expenses) and overall quality of life. Treatment is an expense that can be reimbursed through Health Saving Accounts (HSA) or Flex plans.

Food Allergies

Food Allergies in the News

  • Fear and Allergies in the Lunchroom:It’s 1 p.m. at Mercer Elementary School in Shaker Heights, Ohio, and Lena Paskewitz’s kindergarten class is filled with the happy hum of kids getting ready for their favorite part of the day: lunch. (More)
  • The Truth About Food Allergies: Yes, they’re afflicting more kids than ever–but our awareness and treatment options have also leaped exponentially in recent years. (More)

Information for Current Immunotherapy Patients

Reprinted from the American Academy of Otolaryngology-Head and Neck Surgery Web site with permission of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, copyright © 2013 and Reprinted with permission from Allergychoices Inc. © 2011 ALL RIGHTS RESERVED.