Allergy care severely lacking in Cape Girardeau

Allergies are a big deal in this part of the world.

The air is known to be humid. The river region, a swamp just a few generations ago, provides an abundance of opportunities for all kinds of plants and molds to germinate and grow.

When the wind blows in the spring, pollen creates big problems for allergy sufferers. And for most people in the Cape Girardeau area, there are medical doctors such as Luke Small at Cape ENT (Ears Nose and Throat) to handle common allergy problems created by environmental triggers such as grasses, trees and mold.

But there are no allergists in Cape Girardeau addressing what's known as the Atopic Triad: eczema, asthma and allergies. For years, Cape Girardeau has been void of such a specialist.

Cape ENT, a Saint Francis medical partner, can help patients with common allergy problems who are referred by primary care doctors. Small, an otolaryngologist at Cape ENT, said the facility encourages preventative measures such as frequent cleaning of bed linens, fresh home air filters, masks if you're mowing the lawn and removing carpets, if possible. If problems persist after preventative measures are taken, Small said doctors will typically prescribe medicines.

"Then if we kind of hit a wall, once we try all that, the next step is allergy testing. Blood testing or skin testing," he said. Once the allergies are identified, patients can be put on shot regimens that, over time, change the body's reactions to certain allergens. Usually, it takes about three years for immunotherapy to train the body to no longer react to the allergen.

But as the name ENT would suggest, the facility and its medical staff are equipped to handle issues relating to ears, noses and throats. It doesn't specialize in allergies that affect the skin or lungs.

The Cape Girardeau region has lacked such allergy care since Dr. Janna Tuck left the region several years ago. Before Tuck, Dr. Robert Sacha provided allergy and asthma care in Cape Girardeau for decades.

Eczema, a skin irritation condition, is a cousin to asthma under the allergy umbrella. The relationship between the two is believed to be connected among certain people. The relationship is often referred to as the Allergic or Atopic March, as one condition changes to another condition over time.

Jennifer Bengtson, who works at Southeast Missouri State University, said Tuck provided care for her son who had severe eczema, a skin condition. Bengtson said doctors wanted to prescribe steroid therapy for her son, but she knew doing that long term would not be a good solution. Other types of non-steroid medications were extremely expensive at the time so she made an appointment with Tuck to get another opinion.

During the first visit, Tuck told Bengtson to limit her son's exposure to soaps and shampoos with dyes and fragrances. That advice seemed to do the trick, and the condition became much more manageable after that.

Bengtson said the expertise that Tuck brought to her son's care was obvious from the first visit; the doctor leaned on her experience as an allergist that her son's pediatrician simply didn't have.

She added that Tuck "helped us understand eczema on a fundamental level. She helped us understand why and how my son's skin worked the way it did. Having that knowledge was important to me. It helped me understand my son's experience better and helped me feel more confident about working toward controlling it. His quality of life improved a lot after seeing her."

She said she might not have had the same outcome had she been forced to travel to St. Louis for care.

There are dermatologists in the area, capable of treating rashes and skin infections, but again, none specialized in allergies, which can cause the symptoms.

Theresa Mattingly, M.D., a board-certified dermatologist, said she and her colleagues at Advanced Dermatology see a handful of patients a month who they recommend see an allergist. She said it's "kind of shocking" that an area the size of Cape Girardeau, with many specialists in many medical fields, doesn't have a single allergist in the community.

Mattingly, who has practiced in Cape Girardeau for about a year and a half, explained that Advanced Dermatology treats eczema, also known as atopic dermatitis. Advanced Dermatology can do what's called patch tests, which are used to determine whether the skin has a surface reaction to an allergen. But they don't do blood or stick tests that test for broader allergens, such as food or environmental allergies that may cause the outbreak.

"We can treat it, but we don't investigate the subset of cases where it's caused by certain allergies," Mattingly said. She said knowing an allergen that triggers the skin outbreak can have long-lasting benefits, and make the condition much easier to manage by simply avoiding the triggers.

She said her facility has seen an uptick in patients with eczema and in referrals to allergists with practices in St. Louis or Farmington, Missouri.

"Cape might not be huge, but we are a central hub for a lot of people in this area," Bengtson said. "In the position I'm in right now, I have the resources if I needed to go to St. Louis or Memphis, but that wasn't a situation I was in when I first started working at SEMO." She said she fears that driving hours for care for such situations may not be possible for lower-income individuals.

As for asthma, there are a number of pulmonologists (doctors who specialize in respiratory conditions, including sleep disorders) in the Cape Girardeau area, but not one that specializes in allergies.

The Asthma and Allergy Foundation of America lists St. Louis as No. 14 in the worst places to live for an asthmatic. The AAFA said St. Louis has the highest rate of asthma-related deaths of all 100 cities included in its report. It noted the area suffers from poor air quality and high levels of springtime pollen.

Dr. John Kraemer, an educator at Southeast Missouri State University, is involved in a state program that tests the environment inside homes to help families dealing with asthma become better equipped to proactively approach their condition. The program, called the Missouri Asthma Prevention and Control Program, is funded by the Centers for Disease Control and Prevention. Environmental testing is just one aspect of the program, but the one Kraemer is involved in.

"We have some excellent pulmonologists in both hospitals who can help with asthma, and the respiratory therapy folks are very good when it comes to that," Kraemer said. "But the ultimate goal is to keep them out of the hospital."

The likelihood of an asthmatic returning to the emergency department is 92%. That likelihood drops to 13% for those who go through the program, Kraemer said.

The home environmental tests can be much more beneficial, he said, if patients know what their allergic triggers are. He said part of the education is encouraging patients to undergo allergy testing.

He added that the program also involves communicating with doctors. Kraemer said the testing for allergens and the education on preventative measures increase communication between doctor and patient, which all has the effect of reducing hospital visits.

Kraemer said he goes into as many as 400 homes a year. He said people who go through the program are much less likely to return to the emergency room for asthma episodes.

Part of the program is to identify areas in the home where mold may be present, and educate people on how to install filters. He said a surprising number of people don't know about air conditioner filters and how often to change them.

A 2021 statewide study from the Asthma Ready Communities associated with the University of Missouri showed the estimated prevalence of asthma among children in Southeast Missouri is 9.8%, which is 12.6% higher than the statewide prevalence (8.7%). The prevalence of adults with asthma in Southeast Missouri was 6.2% higher than the rest of the state. The same study said that 55% of children with asthma in Missouri have conditions that are considered "uncontrolled." The report said, "this leads to frequent symptoms and urgent asthma attacks resulting in impairment (e.g., interference with sleep and normal activity), absenteeism from school, and a disproportionate share of emergency department visits and hospitalizations."

While Emergency Department rates for children with asthma are lower in Southeast Missouri than the state average, hospitalizations of such are 7% higher here than the rest of the state, according to the report. The report estimated hospital charges for asthma hospitalizations in children amounted to nearly $21 million. Medicaid and private insurance accounted for about 95% of that cost.

In 2021, about 20 million people had food allergies in the U.S., including about 4 million of whom are children, according to AAFA data. The CDC states that 8% of adults have asthma and 6.5% of children.

As for skin conditions, the AAFA cites 8 million children were diagnosed with eczema in 2021 in the United States.

Globally, up to 20% of children suffer from atopic dermatitis. It's estimated that 334 million people have asthma, including 14% of the world's children and 8.6% of young adults, according to the National Institutes of Health.