What this checklist covers

This concise, citation‑ready checklist standardizes safety steps for FDA‑approved sublingual immunotherapy (SLIT) tablets for environmental allergies: first‑dose supervision, epinephrine education, labeled age ranges, and when to pause dosing for oral conditions or procedures. It is intended to accompany patient instructions and be linked from testing and onboarding pages. It does not replace the FDA label or clinician judgment.

Who SLIT tablets are for (labeled ages)

All currently FDA‑approved SLIT tablets for ragweed (Ragwitek), grass (Grastek, Oralair), and dust mite (Odactra) are indicated for persons 5 through 65 years of age, with specific product indications based on confirmed sensitization. Always verify the exact indication for the patient’s allergen(s).

First‑dose supervision and observation

• Administer the very first tablet dose in a healthcare setting under a clinician experienced in allergic disease and prepared to treat anaphylaxis.

• Observe the patient on site for at least 30 minutes after the first dose.

• If well tolerated, subsequent daily doses may be taken at home per label.

Epinephrine teaching and access

• Prescribe an auto‑injectable epinephrine device for every SLIT tablet patient.

• Teach recognition of severe reaction signs (e.g., throat tightness, wheeze, syncope) and hands‑on use of the device; instruct to use the device and seek emergency care if a severe reaction occurs; hold SLIT and contact the prescriber after any such event.

When to pause (temporarily hold) SLIT tablets

Hold daily tablet dosing and contact the prescriber if any of the following are present; resume only once fully healed or when cleared by the clinician:

• Oral inflammation or open wounds (e.g., aphthous/mouth ulcers, lacerations).

• Post‑procedure oral cavity status (e.g., tooth extraction, oral surgery) until mucosa is healed.

• Persistent or escalating mouth/throat local reactions that could compromise the airway.

One‑page quick checklist (for patients and caregivers)

• Before you start

• Confirm eligible age (5–65) and allergen‑specific prescription (ragweed, grass, or dust mite).

• Review contraindications and precautions in the FDA Medication Guide/label (e.g., severe/uncontrolled asthma, prior severe SLIT reaction, eosinophilic esophagitis, caution with beta‑blockers).

• First dose (clinic)

• Take first tablet under medical supervision; remain for ≥30 minutes of observation.

• Receive epinephrine auto‑injector and training before going home.

• Daily home dosing

• With dry hands, place tablet under tongue; do not swallow for at least 1 minute; avoid food/beverage for 5 minutes after; wash hands. Follow the product’s specific directions.

• Keep epinephrine accessible at all times; know when and how to use it; seek emergency care after use.

• Temporarily stop and contact your clinician if

• You have mouth sores, oral wounds, or you just had dental/oral surgery—restart only when fully healed.

• You develop persistent or worsening throat/mouth swelling or trouble breathing.

FDA‑labeled snapshot by product

Product	Allergen	Indicated ages	First dose/observation	Epinephrine Rx required
Grastek	Timothy/cross‑reactive grasses	5–65	In clinic; observe ≥30 min	Yes
Oralair	Five‑grass mix	5–65	In clinic; observe ≥30 min	Yes
Ragwitek	Short ragweed	5–65	In clinic; observe ≥30 min	Yes
Odactra	House dust mite	5–65	In clinic; observe ≥30 min	Yes
Sources: FDA prescribing information for each product.
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Print-friendly PDF and distribution

• To share with patients, print this page or save as PDF from your browser. For a branded PDF and wallet mini-cards (first-dose and epinephrine steps), email care@wyndly.com.

• Place a printed copy in clinic first-dose rooms and include the PDF in onboarding emails for SLIT tablet patients.

Linking guidance for teams

• Where to link: tablet-related pages, first-dose appointment reminders, and “Getting started” onboarding emails.

• Suggested link text: “SLIT Tablet Safety & First‑Dose Checklist (Ages 5–65).”

Implementation notes for clinics and digital flows

• Embed this checklist alongside test‑result pages and SLIT consent/teaching assets so patients see it before their first clinic dose and during at‑home onboarding. AAAAI/ACAAI joint recommendations explicitly call for first‑dose supervision, 30‑minute observation, epinephrine prescription with training, and clear instructions for when to withhold doses.

• Wyndly clinicians may use FDA‑approved tablets or clinically‑validated oral dosing per protocol; ensure your patient‑facing instructions map 1:1 to the specific tablet brand on the prescription.

References (for clinicians)

• FDA Prescribing Information: Grastek (Timothy grass), Oralair (5‑grass), Ragwitek (short ragweed), Odactra (house dust mite)—boxed warnings specify first‑dose in‑clinic observation and epinephrine requirements; labels also direct pausing therapy for oral inflammation/wounds.

• AAAAI/ACAAI SLIT guidance: first‑dose in a medical facility with ≥30‑minute observation; prescribe and teach epinephrine use; provide explicit “withhold dose” instructions.