After 47 years, allergist Raymond G. Slavin, MD, professor of Internal Medicine and director of Allergy and Clinical Immunology at Saint Louis University is retiring in July from his practice.
Two clients, Slavin described as his “prized patients,” Sandra Alexander of St. Louis and Kenneth Naugles of Cahokia, Illinois, both had severe environmental allergies that were brought under control by immunotherapy – allergy shots.
“We think it’s very, very effective, but we usually hold off on that until we see what other measures will do,” Slavin said. “We think that environmental control – namely reducing the exposure that patients have to what’s bothering them is very, very important.”
Slavin said very effective medicines are now available for both the nose and chest.
“In the instances that they don’t work, then we go to the allergy shots,” Slavin explained. “Generally we confine them to patients whose allergies are more severe.”
Naugles is a more recent patient who has been receiving allergy shots for only a couple of years.
“I was sneezing a lot and it was messing with my asthma,” Naugles said. “Then I started getting the shot – and now, I’m better.”
It took about a year of immunotherapy before he realized he was doing well. Ragweed and pollen are two major allergic triggers for him. Now when he goes outside, Naugles says he feels, “Nothing really – not like it used to be.”
Naugles takes a few different medications for asthma and he also uses a prescription spray for nasal allergies.
“The shots really work,” Naugles said. “I don’t like needles, but like – it’s working.”
Alexander, on the other hand, has been going to Slavin for 30 years. Now, you don’t typically need to receive allergy shots for 30 years for relief. Her situation is atypical.
“She’s had every possible trigger for asthma,” Slavin said. “We tried the desensitization for five years and she is one of the ones where it didn’t work.”
Alexander had a number of issues to overcome when she was first hit with allergies at age 27 – like sinus polyps and subsequent surgeries; just about every kind of asthma trigger from inhalants you can fathom and a circadian condition called nocturnal asthma. It causes wheezing, coughing and sneezing – that disrupts breathing and sleeping at night which leaves you tired and worn out during the day.
“It started with headaches and drainage every night and then it escalated to wheezing in the mornings,” Alexander said. “It settled into a manifestation of coughing between the hours of 6:30 or 7:30 in the evening and I continued coughing until the wee hours of the morning – 3:30 or 4 o’clock. And I had that odyssey for three years – journeying from doctor to doctor.”
Alexander, who a career Army Reservist at the time went to a doctor at Ft. Leonard Wood, who treated and stabilized her condition and eventually routed her to Dr. Slavin.
“I followed doctor’s orders – I even prayed for my doctors because I was in great personal misery,” Alexander said.
And she kept a detailed diary of the symptoms she was experiencing.
“Dr. Slavin was very relentless in continuing a stabilized medication program for me because I was a member of a minority of asthma sufferers in America who have it in a chronic way” she said. “Every season is ‘out of bounds’ for me.”
She has been coughing a lot during this back and forth spring weather.
“But mentally, I know to rest – I know to be still, and even acquired a taste for hot coffee or tea, because caffeine in both of those beverages keeps the airways a little bit open after you’ve taken your medicine,” Alexander said. “And I’ve just learned to do certain things, diet-wise and environmentally to know that when something is going on on the inside, I can put a trigger to it or know that it’s time to go the doctor.”
If nasal rinses, sprays, over-the-counter or prescribed medication brings relief. That’s great.
Allergy shots aren’t for everybody.
Slavin said it’s an expense that takes time and commitment on the part of the patients.
“They have to come weekly a number of months,” Slavin described. “They have to stay in the office for 30 minutes.”
The half-hour wait times keeps patients close to medical help just in case there is a bad allergic reaction to the small, under-the-skin doses of the allergen that is injected to desensitize and build immunity.
“So if I can spare the patient the inconvenience of that cost, then I’ll do that,” Slavin said.
“It’s not a lifetime of therapy, we give shots for five years and most of that is given once a month,” Slavin explained. “And then we stop at five years and the great majority of patients do very well.”
“I hear so many people say you have to live with your allergies when you live in St. Louis and nothing could be further from the truth, Slavin said. “There is wonderful treatment available and people don’t have to just ‘exist’ – just because they live in St. Louis.”
As for Slavin, retirement doesn’t really mean retirement.
He plans to tackle asthma in children.
“Asthma is extremely common and generally more severe in the inner city,” Slavin said. “I am hoping to latch onto an inner city clinic in North St. Louis and do something for a huge problem in that area.”
