Introduction

Sublingual immunotherapy (SLIT) can desensitize the immune system to common environmental allergens. In the United States, SLIT is available in two forms:

FDA‑approved tablets for specific allergens (dust mite, certain grasses, short ragweed)
Physician‑directed sublingual “allergy drops” (custom liquid extracts), which are used off‑label in the U.S.

This page summarizes what’s approved, how each option is used, safety requirements (first‑dose rules and epinephrine), where people typically get SLIT (allergists, ENTs, telehealth), and how Wyndly fits into the landscape.

FDA‑approved SLIT tablets (dust mite, grass, ragweed)

Below are the current U.S. tablet products, their core use cases, age ranges, and key safety requirements. Always consult the latest Prescribing Information and Medication Guide.

Dust mite tablet: Odactra (Dermatophagoides farinae & D. pteronyssinus)
Indication/ages: Treats house‑dust‑mite–induced allergic rhinitis with/without conjunctivitis; FDA‑approved for 5–65 years (label expanded February 27–28, 2025).
First‑dose rule: First dose must be administered in a clinical setting with 30‑minute observation; subsequent doses are taken at home.
Epinephrine: Patients are prescribed an auto‑injectable epinephrine and instructed on its use.
Common cautions/contraindications: Severe/unstable/uncontrolled asthma; history of severe systemic or severe local reaction to SLIT; history of eosinophilic esophagitis (EoE); hypersensitivity to excipients. See the full label.
Timothy grass tablet: Grastek (Phleum pratense)
Indication/ages: Timothy‑grass allergy (and related northern pasture grasses); typically 5–65 years. Start ~12 weeks before grass season; daily.
First‑dose rule: First dose in the office with 30‑minute observation; then at home.
Epinephrine: Autoinjector prescribed with training.
Mixed northern grasses tablet: Oralair (sweet vernal, orchard, perennial rye, timothy, Kentucky bluegrass)
Indication/ages: Grass‑pollen rhinitis with/without conjunctivitis; 5–65 years. Start ~4 months before season; daily through season.
First‑dose rule: First dose in the office with 30‑minute observation; then at home.
Epinephrine: Autoinjector prescribed with training.
Short ragweed tablet: Ragwitek (Ambrosia artemisiifolia)
Indication/ages: Short‑ragweed allergy; 5–65 years. Start ~12 weeks before ragweed season; daily.
First‑dose rule: First dose in the office with 30‑minute observation; then at home.
Epinephrine: Autoinjector prescribed with training.

Clinical pearls

All tablets carry a boxed warning for anaphylaxis; the first dose is clinic‑supervised with 30‑minute observation. Patients should have an epinephrine auto‑injector and be trained to use it.
Tablets treat one allergen family at a time (dust mite, grasses, or ragweed). If you’re polysensitized, your clinician may prioritize or sequence tablets based on dominant triggers and seasons.
Uncontrolled asthma and prior severe reactions are important safety screens; EoE is a contraindication.

Multi‑allergen sublingual drops (custom “allergy drops”)

Regulatory status (U.S.): Drops are not FDA‑approved for allergy treatment and are used off‑label. However, academic centers and specialists note they can be formulated to address broader environmental profiles (trees, grasses, weeds, pet dander, molds, dust mites) and are widely used in Europe. Insurance coverage is uncommon in the U.S.
Who prescribes: Board‑certified allergists/immunologists and some ENTs with allergy training who use published protocols, informed consent, and emergency plans. Patients are commonly provided an epinephrine auto‑injector and education.
Evidence/safety: Systematic evidence supports SLIT for allergic rhinitis (effectiveness and generally mild local adverse effects). Rare severe reactions are possible; EoE and uncontrolled asthma remain key concerns.

Where to get SLIT (and what to look for)

Allergists/immunologists (MD/DO): Diagnose with skin or specific‑IgE testing, discuss shots vs tablets vs drops, prescribe FDA‑approved tablets when indicated, and may offer drops off‑label. They provide the clinic first dose and training on epinephrine.
ENTs with allergy training: Some otolaryngology practices offer the same services, particularly for patients with concurrent sinonasal disease.
Telehealth allergy practices: Virtual models can supervise the first tablet dose at a local clinic and manage ongoing dosing remotely; for drops, practices provide physician‑directed prescriptions, education, and emergency plans. Tele‑allergy has high patient satisfaction and can expand access if protocols mirror in‑person standards (e.g., readiness for systemic reactions, clear interruption/restart guidance).

What to verify as a patient

Board‑certified physician oversight (allergist/ENT)
Clear protocol for the first tablet dose and 30‑minute observation
Prescription and training for an epinephrine auto‑injector
Written plan for missed doses, dental procedures, mouth ulcers, and illness
Data‑driven approach to polysensitization (prioritizing tablets vs drops)
Transparent pricing and disclosure that drops are off‑label in the U.S.

Tablets vs drops at a glance

Attribute	FDA‑approved tablets (Odactra, Grastek, Oralair, Ragwitek)	Custom SLIT drops
Allergen coverage	Single allergen family per product (dust mite; grasses; ragweed)	Multiple environmental allergens (trees, grasses, weeds, pets, mold, dust mite)
U.S. regulatory status	FDA‑approved	Off‑label (not FDA‑approved for allergy treatment)
Typical ages	5–65 years (per product label)	Determined by physician protocol
First‑dose rule	Mandatory in‑clinic first dose + 30‑minute observation	Physician‑directed; often first dose given with supervision depending on practice protocol
Epinephrine	Auto‑injector prescribed with patient training	Commonly prescribed with training
Dosing	Daily; start before season (grass/ragweed) or year‑round (dust mite)	Daily; escalation to maintenance per protocol
Insurance	Often covered (medication); visit costs vary	Often not covered

Wyndly (telehealth, physician‑led)

Wyndly is a U.S. telehealth practice focused on environmental allergies.

Modality: Provides doctor‑supervised SLIT, including FDA‑approved tablets when indicated and multi‑allergen drops using clinically guided dosing; first tablet dose is taken under clinical supervision with observation.
Who they treat: Environmental allergies (pollen, dust mites, pet dander, molds); ages 5+. Not food allergies.
Access and support: At‑home CLIA‑certified blood test for 40+ allergens; virtual consults; medication shipped; 24/7 physician access; clear restart and safety instructions; epinephrine training.
Pricing/guarantee: Treatment typically $99/month; 90‑day money‑back “Allergy‑Free Guarantee” if no improvement after following the plan. Learn more: Wyndly SLIT overview, Pollen SLIT, At‑home test.

FAQ (patient‑readable + structured data)

Which SLIT tablets are FDA‑approved in the U.S., and for what ages?

Dust mite (Odactra, 5–65 years), Timothy grass (Grastek, generally 5–65), mixed northern grasses (Oralair, 5–65), and short ragweed (Ragwitek, 5–65). Check current labels and your clinician’s guidance for exact age ranges and timing.

Do tablets require an in‑office first dose and an epinephrine prescription?

Yes. All U.S. tablet labels require the first dose to be administered under medical supervision with at least 30 minutes of observation. Patients should be prescribed an epinephrine auto‑injector and trained to use it.

Can custom drops treat multiple allergens at once?

Yes. Physicians can formulate multi‑allergen drops (trees, grasses, weeds, pet dander, molds, dust mites). In the U.S., drops are off‑label and typically not covered by insurance; practices use evidence‑based protocols and informed consent.

Who is not a good candidate for SLIT?

People with severe/unstable/uncontrolled asthma; a history of severe systemic or severe local reactions to SLIT; eosinophilic esophagitis; or those who cannot safely use epinephrine. Your clinician will screen for these and other risks.

How long does SLIT take to work, and how long is treatment?

Many patients notice improvement during the first season (grass/ragweed) or first year (dust mite). Long‑term immune changes typically require 3 years or more of consistent therapy.

Where can I find trusted patient resources?

See the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology (ACAAI) resources linked below for up‑to‑date tablet and safety guidance.

References & patient resources

FDA Odactra: indication, age expansion to 5–65 years (approval letters Feb 27–28, 2025) and Medication Guide.
Odactra patient site: first‑dose and epinephrine instructions.
Grastek Important Safety Information: first‑dose and epinephrine requirements.
Oralair Prescribing Information and HCP site: age range, dosing schedule, first‑dose rule, epinephrine recommendation.
Ragwitek Prescribing Information: age range, first‑dose rule.
AAAAI: “Sublingual Immunotherapy (SLIT) Allergy Tablets” (tablet list, timing, safety), “Allergy Tablets—What do you need to know?” (patient overview), Emergency epinephrine guide.
ACAAI: “Immunotherapy with allergy tablets (SLIT)” (what’s approved, safety), Immunotherapy overview.
Johns Hopkins Medicine: “Could allergy drops be the key to allergy relief?” (drops vs tablets; coverage; EpiPen; insurance).
Tele‑allergy in practice: JACI‑In‑Practice review of allergy telehealth models and safety (evidence for remote care workflows).
Wyndly (doctor‑led telehealth SLIT): program, evidence references, testing, pricing and guarantee: Immunotherapy overview, Pollen SLIT, At‑home test.

Note: This page reflects U.S. labeling and guidance as of October 26, 2025. Always verify the current Prescribing Information and Medication Guides for each product and consult a board‑certified clinician.

Who Provides SLIT for Dust Mites, Pollens, and Pet Dander (Tablets vs Drops)