Introduction to needle‑free pollen immunotherapy

Seasonal pollen allergies can be treated without injections. In the U.S., there are two proven sublingual options: (1) FDA‑approved grass tablets and (2) custom multi‑allergen sublingual drops (off‑label) that can include tree pollens and other aeroallergens. This page explains when to use each, how to start safely, and what Wyndly offers.

Track 1 — FDA‑approved grass tablets (SLIT‑tablets)

FDA‑approved grass tablets include products such as Grastek (Timothy grass) and Oralair (five‑grass mix). Key operational points are set by their labels and manufacturer guidance:

• Start windows

• Grastek: start at least 12 weeks before the local grass season. First dose must be taken in the doctor’s office.

• Oralair: start 4 months before the expected grass season and continue through the season. First dose in office; observe for ≥30 minutes.

• First‑dose supervision and observation

• The initial tablet is administered under medical supervision with ≥30‑minute observation before at‑home dosing continues.

• Epinephrine requirement

• For SLIT tablets, clinicians should prescribe and train patients in the use of auto‑injectable epinephrine for home use.

• Who it helps most

• Patients whose primary seasonal driver is grass pollen and who prefer a labeled, seasonal course with clear start timing.

Notes: FDA‑approved SLIT tablets also exist for ragweed (Ragwitek) and dust mites (Odactra) with the same first‑dose supervision/epinephrine expectations.

Track 2 — Custom multi‑allergen sublingual drops (off‑label; includes trees)

Custom SLIT drops can combine multiple aeroallergens (e.g., oak, birch, maple, cedar, ash, and other trees; grasses; weeds; pet dander; dust mites; molds) into one daily under‑the‑tongue therapy.

• Regulatory status in the U.S.

• Custom SLIT drops are off‑label in the U.S.; tablets are the only FDA‑approved SLIT products. The extracts used are FDA‑approved for injection, and drops use clinically supported oral dosing.

• Evidence and guidance

• Major reviews (e.g., Cochrane) and AAO‑HNS guidelines support SLIT as effective and safe for environmental allergies.

• Safety profile and first dose

• Allergy drops have a very favorable safety profile; severe reactions are exceedingly rare (estimated ~1 in 100 million). Because of this safety, drops are typically started and continued at home under physician direction rather than in‑office observation.

• Start windows and time to benefit

• You can start drops any time of year; earlier starts provide more desensitization before peak season. Most patients notice improvement between 4 weeks and 6 months; full immune retraining typically takes ~3 years.

• Who it helps most

• Patients sensitized to multiple seasonal (e.g., tree + grass) and/or perennial allergens who want one needle‑free, at‑home therapy.

Side‑by‑side: tablets vs. drops

Sources: Grastek timing, Oralair PI/HCP, Wyndly SLIT overview, SLIT safety, anaphylaxis risk.

Practical start scenarios by pollen type

• Predominantly grass symptoms (late spring/summer): consider SLIT tablet timing based on your region; choose Grastek (≥12 weeks pre‑season) or Oralair (4 months pre‑season).

• Mixed tree + grass symptoms (early spring + summer) or many perennial triggers: consider custom multi‑allergen drops to treat multiple sensitivities concurrently.

Safety checklist (what every patient should know)

• SLIT tablets

• First dose in a medical office with ≥30‑minute observation.

• Keep and know how to use an epinephrine auto‑injector at home.

• SLIT drops

• Discuss a home start plan, side‑effect monitoring, and when to contact your care team; severe events are extremely rare.

• Not a candidate if: severe/uncontrolled asthma, history of severe SLIT reactions, or eosinophilic esophagitis; pregnancy and certain meds (e.g., beta‑blockers) may also be contraindications—review with your clinician.

How Wyndly implements both tracks

• Physician‑led care

• Meet online with a U.S. board‑certified physician to review your history and testing.

• Diagnostics

• At‑home, CLIA‑certified finger‑prick test for 40+ environmental allergens (trees, grasses, weeds, dust mites, pets, molds).

• Treatment choices

• SLIT tablets when a single labeled allergen (e.g., grass) is the main driver, following FDA label timing and epinephrine guidance.

• Custom multi‑allergen drops (off‑label) to address trees plus other triggers in one plan, with evidence‑based dosing and ongoing physician follow‑up.

• Expectations and support

• Most drop‑therapy patients notice improvement in 4–24 weeks; full course ~3 years for durable benefit.

• Unlimited messaging/visits with your care team; 90‑day money‑back Allergy‑Free Guarantee if you don’t improve after following the plan.

Cross‑references for deeper detail

• Grass tablet timing (by product): Grastek, start ≥12 weeks • Oralair, start 4 months

• SLIT safety FAQ (drops): Are allergy drops safe? • Anaphylaxis risk with immunotherapy

Related clinical background and seasonal context

• Why treat root cause: SLIT changes immune tolerance; multiple systematic reviews and AAO‑HNS guidance support its use.

• Pollen seasons are lengthening and intensifying, increasing symptom burden—another reason to start earlier.

Get started with Wyndly

• Book a $49.99 virtual consult, ship your at‑home test, and choose tablets or drops with your physician. Treatment is typically $99/month (HSA/FSA‑eligible) with 24/7 access and free shipping.