The Allergy Department at Virginia ENT is lead by Dr. Thomas Robertson and Dr. Daniel Van Himbergen and augmented by Emily Kane, NP.  We offer comprehensive evaluation and treatment options for inhaled allergens (pollens, dust mites, molds, and pet danders.)

Allergic rhinitis, which is an IgE-mediated hypersensitivity, triggers chronic inflammation throughout the respiratory system. It may lead to allergic conjunctivitis, hay fever symptoms, asthma, Eustachian tube dysfunction, ear infections, laryngitis, eczema, sleep apnea, and recurrent sinus infections. 

By incorporating allergy testing and treatment into our ENT practice we can treat patients much more effectively. If patients are experiencing nasal congestion, post nasal drainage, ear pressure, or frequent sinus infections, Virginia ENT is the clear choice to explore whether allergies may be an underlying cause.


Clinical diagnosis is made by taking a thorough patient history and performing a physical examination. The most common and most sensitive way to confirm IgE-mediated allergic disease is through skin-testing.

The skin is pricked and a droplet of allergen is applied. In a sensitized patient, chemical mediators are released in response to the allergen and a wheal and flare reaction with itching may occur. Sometimes intradermal testing is performed for additional sensitivity. The offending allergen(s) is identified within 30 to 60 minutes.

Not all patients are candidates for skin-testing and in-vitro bloodwork testing is available as an alternative. This test measures allergen-specific IgE in the blood serum and is suitable for patients who are unable to come off certain medications (such as beta blockers), have a history of anaphylaxis, certain skin conditions, or uncontrolled asthma.


After completion of allergy testing, patients follow up with our Nurse Practitioner, Emily Kane, to review results and formulate a treatment plan. Treatment includes avoidance measures for known allergens, appropriate medications, and possible immunotherapy.

Immunotherapy is administered through allergy shots, sublingual allergy drops or tablets, and is the only scientifically proven way to reduce the immune system’s tendency to react to allergens.

Allergy Shots (Subcutaneous Immunotherapy)

Allergy shots are administered in the clinic weekly during the initial buildup phase, which may last 6 to 12 months. During this buildup phase patients are given increasing amounts of allergens to build immune tolerance.

Once maintenance dosing, or maximum strength concentration, is achieved, the time in between shots is gradually increased until allergy shots are given just once monthly. Patients remain on the treatment for  duration of 3 – 5 years.

Allergen immunotherapy can lead to long-lasting relief of allergy symptoms after treatment is stopped, and frequently yields significant reduction in upper respiratory infections.

Please call 804.484.3700 x2039 for an updated daily allergy shot schedule and any relevant updates.

Sublingual (under the tongue) Immunotherapy

Sublingual immunotherapy (SLIT) is an alternate method of immunotherapy that is given under the tongue by the patient at home. Patients administer drops of allergenic extract under the tongue and hold for two minutes before swallowing.

SLIT has a very favorable safety profile and the drops may be escalated more rapidly than shots, with buildup phase completion in just 10 days. The convenience of self-administration at home make SLIT a very attractive option for many patients.

The U.S. Food & Drug Administration (FDA) still considers SLIT serum to be an “off-label” use of allergy shot serum at this time and most insurance companies do not cover its treatment cost. The recommended duration of treatment is also 3-5 years with SLIT.

Oral Tablet Immunotherapy

SLIT tablets are FDA-approved to treat both pollen and dust mite-induced allergies. The tablets each only treat one allergen and are safely administered under the tongue at home.

Research over the last twenty years has shown that both SCIT and SLIT are relatively safe and effective options for desensitizing the immune system to IgE-mediated hypersensitivies (inhaled allergens). Patients receiving immunotherapy should follow up with their healthcare provider every 6 to 12 months to determine efficacy, assess compliance, adjust dosing if needed, reinforce safety protocols, and determine when therapy may be discontinued. All patients on immunotherapy will be prescribed an epinephrine autoinjector in the rare instance of anaphylaxis.

Lung function testing may be done in our office for patients with asthma or suspicion of asthma to ensure adequate control before and during immunotherapy treatment.

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