Can I start allergy drops while taking SSRIs?

Yes—most adults taking SSRIs (e.g., sertraline, fluoxetine, citalopram, escitalopram) can start allergy drops (sublingual immunotherapy, SLIT). SSRIs are not an absolute contraindication to allergen immunotherapy. Your allergist will still screen for standard risks (e.g., uncontrolled asthma, history of severe reaction, eosinophilic esophagitis) and typically prescribe an epinephrine autoinjector for SLIT tablets. (AAAAI) (FDA)

Quick Answer

• Usually compatible: SSRIs are not a listed contraindication to allergen immunotherapy, including SLIT. AAAAI
• Safety basics: FDA-approved SLIT tablets require the first dose under supervision and patients are typically prescribed epinephrine. Avoid starting if asthma is uncontrolled or if you have eosinophilic esophagitis (EoE). FDA

Why people on SSRIs ask about allergy drops

SLIT desensitizes your immune system to triggers like dust mites, grasses, and ragweed. Because severe reactions—though uncommon—are treated with epinephrine, patients often worry about antidepressant interactions. Current allergy guidance says there is no absolute contraindication to immunotherapy just because a patient takes an antidepressant; decisions are individualized. AAAAI

How allergists keep SLIT safe (what to expect)

1. Pre-start screen. Your allergist reviews asthma control, any prior systemic reactions to shots or drops, and symptoms suggestive of EoE (trouble swallowing, chest pain). Uncontrolled asthma or known/suspected EoE are reasons to hold SLIT until evaluated. FDA
2. Supervised first dose (tablets). FDA-approved SLIT tablets (e.g., dust mite) require the initial dose in clinic with 30-minute observation; afterward, dosing continues at home. FDA
3. Epinephrine readiness. Prescribers are directed to prescribe epinephrine to patients on SLIT tablets and to teach when/how to use it. FDA
4. Follow-up. Report persistent mouth/throat symptoms or reflux-like symptoms promptly; clinicians consider EoE if severe or persistent esophageal symptoms occur. FDA

SSRIs vs. other medications: what actually matters

The medications most often flagged for epinephrine interactions are tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)—they can potentiate epinephrine’s effects. SSRIs are not in that group. Your allergist will still review all meds and risks. NCBI

Sources: Epinephrine interaction data; SLIT contraindications and first-dose supervision; EoE caution. NCBI FDA

Safety profile of SLIT (why many patients on SSRIs choose drops)

Guidelines and labeling describe SLIT as generally well-tolerated, with local mouth/throat itching the most common effect. Serious systemic reactions are uncommon, especially compared with allergy shots. FDA labeling instructs epinephrine prescription and clinic-supervised first dose for tablets—key guardrails that keep home therapy safe. FDA AAAAI

Practical steps if you take an SSRI and want to start SLIT

• Bring a full med list. Include prescriptions, OTCs, and supplements. Your clinician screens for drugs that can alter epinephrine effects and for conditions that heighten risk. FDA
• Control asthma first. If you have wheeze, chest tightness, or nighttime cough, stabilize before starting SLIT. FDA
• Know the formats. In the U.S., SLIT tablets for dust mite, certain grasses, and ragweed are FDA-approved with specific safety instructions; customized drops are commonly used off-label under specialist care. AAAAI
• Watch for EoE symptoms. New or persistent swallowing trouble, chest pain, or severe reflux-like symptoms warrant prompt evaluation and possible discontinuation. (PubMed Central)(FDA)

What to do next

• Start with a telehealth review: Get a same-week video visit to confirm candidacy while on an SSRI — Book an appointment.
• See how drops work at home: Explore our physician-directed program — Allergy drops (SLIT).
• Prefer a quick consult first? Try telemedicine

When to see an allergist — and when to seek urgent care

Schedule an allergist visit soon if you have:

• Nasal/eye symptoms ≥4 days/week or ≥4 weeks/year despite meds
• Cough, wheeze, or nighttime symptoms suggesting asthma
• Side effects or poor control on antihistamines or steroid sprays
• Questions about combining SLIT with heart meds, beta-blockers, or other antidepressants

Seek urgent care or emergency services now if you have:

• Tongue or throat swelling, trouble breathing, fainting
• Severe chest pain or severe shortness of breath
• Severe/persistent esophageal symptoms while on SLIT (possible EoE) FDA

FAQs (schema-ready)

Q1. Can I start allergy drops while taking SSRIs?
Yes—typically. SSRIs are not an absolute contraindication to allergen immunotherapy, including SLIT. Your allergist will confirm candidacy and set a safety plan. AAAAI

Q2. Do SSRIs interfere with epinephrine if I ever need it?
The antidepressants most associated with epinephrine potentiation are tricyclics (TCAs) and MAOIs, not SSRIs. Your clinician will still review your complete medication list. NCBI

Q3. Who should avoid or delay SLIT?
People with severe, unstable, or uncontrolled asthma, a history of severe systemic/local reactions to SLIT, or eosinophilic esophagitis should not start until evaluated. FDA

Q4. What happens at the first dose?
For FDA-approved tablets, the first dose is given in clinic with 30-minute observation; later doses are taken at home with an epinephrine autoinjector on hand. FDA

Q5. Are customized “allergy drop” liquids FDA-approved?
In the U.S., FDA has approved specific SLIT tablets (dust mite, certain grasses, ragweed). Custom liquid drops are commonly used off-label under allergist supervision. AAAAI

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Ready to confirm your options while taking an SSRI? Book an online allergy appointment or learn how to start SLIT at home. Prefer to start with a quick consult? Visit telemedicine

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Author, Review & Disclaimer

Author: Krikor Manoukian, MD, FAAAI, FACAAI — Board-Certified Allergist/Immunologist
Bio: Dr. Manoukian is a board-certified allergist/immunologist specializing in telemedicine-enabled allergy care and personalized SLIT programs. He leads HeyAllergy’s clinical team and trains providers in safe immunotherapy.
Medical Review: HeyAllergy Clinical Team (Board-Certified Allergists/Immunologists)
Disclaimer: This article is educational and not a substitute for personalized medical advice. Always consult your clinician about your medications and treatment options.

References

• AAAAI, Antidepressants and Allergy Shots (Ask the Expert): “No absolute contraindication” to AIT in patients taking antidepressants. AAAAI
• AAAAI/ACAAI, Sublingual Immunotherapy Practice Parameter Update (2017) — evidence-based guidance for safe, appropriate SLIT use. AAAAI
• ODACTRA (HDM SLIT tablet) Prescribing Information — supervised first dose, epinephrine prescription, and contraindications including EoE and uncontrolled asthma. FDA
• StatPearls, Epinephrine — drug interaction section highlighting potentiation with TCAs and MAOIs (not SSRIs). NCBI