For those suffering from some form of allergy or immune disorder, Cedar Valley Medical Specialists (CVMS)’ Allergy and Immunology Department can not only provide relief for daily living, but also can be a lifesaver in rare instances.
Allergy and immunology is a relatively small specialty in the world of medical care, with only about 4,000 specialists nationwide. In the Cedar Valley, CVMS’ Dr. David Redfern is just one of two.
“I’ve been in town about 20 years, and the (patient load) has been fairly steady for most of that time,” he says. “We’ve seen a general increase in the last couple of years, and this year we are experiencing another bump.
“It’s difficult to know the reason why, because we are not seeing just seasonal increases. We’re just seeing more cases.”
Dr. Redfern is seeing many people suffering from hives, a fair amount of dermatitis, and other issues. Chronic sinus problems “seem to be more and more prevalent over time.
“Allergies play a role in some of these and not others. But allergies are clearly worse over time. There are more food allergies, more airborne allergies,” he says.
A number of theories have been introduced as to the causes.
“Some center around exposure, some can even be from indoor exposures,” Dr. Redfern explains. “Some say our houses now are so tightly sealed that normal chemicals, for instance cooking fumes and aerosol sprays, could be adding to the number of cases seen. Some believe super-clean indoor environments have left our immune systems with nothing to do. If the immune system goes awry, allergies are a consequence. None of these theories has been proven 100 percent.”
Over the last 10 years, the number of peanut allergies has exploded, Dr. Redfern says, in addition to other food allergies. Some are serious enough to cause anaphylaxis. Others cause chronic swelling and development of scar tissue in the esophagus to the extent food won’t pass.
“Some even call it asthma of the esophagus. It can be related to food allergies or to acid reflux,” Dr. Redfern explains. “The cells you find in the esophagus also are found in the lungs with those with asthma. I saw maybe four cases in two years when going through allergy training. Now it’s not unusual to see six cases in a month. It’s a huge increase.”
Dr. Redfern’s office does not see as many sufferers of ragweed or other common allergies because there are many adequate over-the-counter medications.
He says there have not been huge “leaps and bounds” in the treatment of allergy or immune system problems in the last couple of years, but more of an “incremental” change. There are many antihistamines available over -the-counter. Other medications are almost 15 years old. There are many types of inhalers, “but the mechanisms are fairly similar.
“We have seen some injectable antibodies come out. We have treated some of our hive patients and asthma patients with these. One has been introduced that will block the allergy response. Some other new treatments have not come to market yet,” Dr. Redfern says.
One of the new peanut allergy prevention protocols may include very early introduction of peanut protein. Details on selection of appropriate candidates and the type and timing of introduction remain to be fully clarified. Another new way of treating pollen allergies is to place a tablet under the tongue that releases a lot of allergen. Some of the allergen is absorbed by the mouth lining. This can lead to desensitization to the allergen, like allergy shots cause.
“But it’s a very different protocol,” Dr. Redfern says. “You start with a large dose, not building it up like with the shots. We tried the first ones a couple months ago. There have been some attempts with sublingual drops but those have not been shown to be effective.”
The tried-and-true skin testing remains the fastest, most cost-effective and most accurate way to test, he says. A new generation of blood tests has been introduced, with the newest that approaches skin testing.
“Allergy specialists have to spend time with patients to figure out what they are exposed to and what is causing their symptoms,” Dr. Redfern says. “It’s more of a history-driven specialty. It’s not like we can do a CAT scan and say, ‘oh, you’ve got this.’
“It’s difficult for a primary doctor with 60 people on the schedule to try to discover the little things that might be a cause or to find the small exposure causing the problem. That’s where we come in.”
Dr. Redfern’s staff includes four full-time nurses and medical assistants.