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At new clinic, allergy sufferers treated with pills, not shots

| Monday, July 17, 2017, 11:00 p.m.
Nate Smallwood | Tribune-Review
Dr. David Skoner, founder of EZ Allergy, poses for a portrait outside his offices in McMurray.
Nate Smallwood | Tribune-Review
Dr. David Skoner, founder of EZ Allergy, poses for a portrait in office in McMurray.

Most patients say “no” when Dr. David Skoner suggests they travel to his office once a week for allergy shots.

The pain and inconvenience of the shots, which must be administered for months or years to be effective, convince many patients to live with the runny noses, itchy eyes and occasional sinus infections of allergies, said Skoner, who has been an allergist for about 30 years.

At a newly opened business in McMurray, Skoner is steering more patients to allergy immunotherapy tablets, which do the same thing as the shots without all the office visits and needle pricks.

“We want them to have the benefits of immunotherapy conveniently and comfortably,” said Skoner, who opened EZ Allergy two weeks ago. Skoner also works as an allergist at West Virginia University School of Medicine and has worked at Pittsburgh health systems.

Skoner said he plans to start offering walk-in service soon. The business is open a couple of days a week, but he plans to be eventually be open six days a week

The Food and Drug Administration approved allergy tablets for grass and ragweed in 2014 and for dust mites this year. The tablets work through the same basic mechanism of the shots, exposing the body's immune system over time to small doses of the allergens to build up tolerance.

“They appear to be equally as effective and they actually appear to be safer,” said Dr. Deborah Gentile, director of research at the North Hills office of Pediatric Alliance. Gentile studied orally administered allergy immunotherapy at Allegheny Health Network before moving to Pediatric Alliance.

The tablets, which are taken daily, contain smaller amounts of allergens than the weekly shots, reducing an already-slight risk that they might provoke a severe allergic reaction in patients, she said.

The FDA has approved Oralair, from London-based drugmaker Stallergenes Greer, to treat grass allergies in 10- to 65-year-olds. The agency approved Grastek, from Danish drugmaker ALK, to treat grass allergies in 5- to 65-year-olds. It approved Ragwitek, also from ALK, for ragweed allergies in 18- to 65-year-olds. The agency approved a dust-mite tablet for people over 18 in March, but the pill is not yet available.

The pills, like the shots, are meant to be started months before allergy seasons start. Doctors prescribe epinephrine at the same time as the tablets for patients to use in case of severe allergic reactions.

Marilyn Grossman, a 59-year-old ear, nose and throat nurse practitioner who lives in Chatham, Virginia, said she tried allergy shots after antihistamines and nasal steroids provided little relief for her seasonal hay fever.

Grossman had started working on her family's goat farm again after years of living in a city, intensifying her allergies. The shots, which included serum for mold and other allergies in addition to her grass allergy, reddened her skin in a 10-centimeter area hours after she received the shots, she said. And the shots didn't relieve her symptoms.

Oralair worked better, eliminating most of her symptoms, she said.

Grossman said she hasn't experienced side effects of the pills, which can range from itching and swelling sensations under the tongue and throat to rare cases of anaphylaxis.

About 90 percent of people who take the shots for three to four years are cured of their allergies, Gentile said; early studies suggest the tablets might be able to cure the allergies with less time, she said.

Not all allergists have embraced the tablets yet, Skoner said, and some challenges stand in the way of broader use.

Patients must take their first tablet under a doctor's supervision in case they go into anaphylactic shock, he said. But patients usually need a prescription for the pills, requiring a trip to the pharmacy and a second appointment to get started. As a private business owner, Skoner uses samples from drugmakers to test patients' reactions – a practice most large hospital systems don't allow doctors to do.

The tablets cost about $300 per month before insurance, Skoner said. He said drug companies often offer discounts to lower the price.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676, wventeicher@tribweb.com or via Twitter @wesventeicher.

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