Yes — most patients can use sublingual immunotherapy (SLIT) while taking biologics for eczema or asthma. Current guidelines from AAAAI/ACAAI show no absolute contraindication to combining SLIT with biologics like Dupixent® (dupilumab), Xolair® (omalizumab), or Fasenra® (benralizumab).
However, the safest approach is to work with a board-certified allergist who can monitor your symptoms, medication timing, and immune response, especially when starting allergy drops.

Why This Matters

Many adults with eczema or asthma are now on biologics but still suffer from allergies or allergic rhinitis. SLIT (allergy drops) can treat the root cause of environmental allergies — something biologics do not treat directly. This guide gives you a quick answer first, then a deeper, evidence-based walkthrough from the HeyAllergy clinical perspective.

Quick Answer: Can You Combine SLIT & Biologics?

Guidelines from the AAAAI/ACAAI SLIT Practice Parameter state that biologics are not an absolute contraindication to sublingual immunotherapy.

Safe in most cases

• Patients on dupilumab for eczema or asthma
• Patients on omalizumab, mepolizumab, benralizumab, or tezepelumab
• Patients also using inhaled steroids, antihistamines, or leukotriene inhibitors

Why it works

Biologics and SLIT act on different parts of the immune system:

• Biologics reduce inflammation by blocking IgE or Th2 pathways.
• SLIT retrains the immune system to reduce allergic sensitivity long term.

These two mechanisms do not conflict.

Deep Guide: How SLIT & Biologics Work Together

1. What is SLIT?

Sublingual Immunotherapy (SLIT), commonly called allergy drops, exposes your immune system to tiny, controlled doses of allergens (like grass, dust mite, ragweed).
It helps your body build tolerance and reduce long-term symptoms.

Learn more: Allergy Drops (HeyPak®)

2. What are biologics for eczema or asthma?

Common biologics include:

• Dupilumab (Dupixent®) — eczema, asthma, nasal polyps
• Omalizumab (Xolair®) — allergic asthma or chronic hives
• Mepolizumab, Benralizumab, Reslizumab, Tezepelumab — eosinophilic asthma

These medications:

• Reduce airway inflammation
• Lower IgE or eosinophil levels
• Improve eczema flare control
• Lower asthma attack risk

They do not treat the root allergy itself, which is why many biologic patients still have pollen or dust-related symptoms.

3. Why combining SLIT + Biologics makes sense

Biologics = Control inflammation now

SLIT = Retrain the immune system long term

When used together:

• SLIT reduces allergic triggers.
• Biologics prevent flare-ups while tolerance builds.
• Many patients end up needing fewer medications later.

This combination is often ideal for people with allergic asthma, seasonal allergies, dust mite sensitivity, and eczema triggered by environmental allergens.

Are There Any Risks or Interactions?

The research

The AAAAI and ACAAI guidelines (2017 update) show:

• No evidence that biologics interfere with SLIT effectiveness
• No evidence that combining them increases serious side effects

SLIT remains one of the safest immunotherapy options, with mostly mild symptoms like:

• Mouth itching
• Throat tickling
• Temporary congestion

These typically taper off after week 1–2.

Who needs extra caution?

You may need closer monitoring if you have:

• Uncontrolled asthma
• Recent biologic dose changes
• A history of severe reactions to immunotherapy
• Active mouth sores (delay SLIT temporarily)

A quick telemedicine visit helps determine your safest dosing plan:
➡ Book an Online Allergy Consultation

Comparison Table: SLIT vs. Biologics vs. Using Both

When Should You See an Allergist? (Important Triggers)

You should schedule a visit with a board-certified allergist if:

• You’re starting a biologic and still have allergy symptoms
• Your asthma flares during pollen season
• Your eczema worsens after exposure to dust or pets
• You want to reduce medication dependency long-term
• You’re unsure whether SLIT is safe with your biologic schedule
• Your doctor recommended immunotherapy but you prefer drops over shots

Start with a virtual evaluation:
➡ HeyAllergy Telemedicine

What to Do Next

A simple 3-step plan:

1. Book a virtual appointment
   Schedule your online allergy consultation
2. Complete testing if needed
   We offer comprehensive evaluations.
   
3. Get your personalized SLIT plan (HeyPak®)
   Learn about Allergy Drops

This approach ensures your biologic therapy and SLIT plan work together safely.

Does SLIT Actually Help People on Biologics? (Evidence Review)

SLIT reduces allergic symptoms

Multiple randomized trials show SLIT improves:

• Nasal congestion
• Sneezing
• Eye symptoms
• Dust-mite-induced asthma
• Quality of life

Biologics reduce inflammation but don’t fix the allergy

Dupilumab, Xolair, and others control inflammation — but your allergic sensitivity remains.

That’s why many patients notice:

• Better seasonal control
• Fewer asthma flares
• Less eczema irritation
• Fewer sinus infections

when SLIT is added.

AAAAI guidance

The AAAAI and ACAAI’s immunotherapy guidelines state:

No absolute contraindication to giving allergen immunotherapy (including SLIT) with biologic agents.

(Source: AAAAI/ACAAI SLIT Practice Parameter Update, 2017)

Common Scenarios: Should You Combine Them?

If you are on Dupixent® for eczema
‍You can safely use SLIT to reduce dust mite or pet allergy triggers that worsen eczema.

If you are on Xolair® for asthma
‍SLIT may help reduce future allergic asthma attacks.

If you are on a biologic for both conditions
‍Combining SLIT may improve both skin and breathing symptoms long term.

If you want to stop biologics in the future
‍SLIT can reduce your dependence on medications, especially seasonal drugs.

FAQ

1. Can I use SLIT while on Dupixent for eczema or asthma?
‍Yes. Dupilumab does not conflict with SLIT. Many patients use both.

2. Is it safe to take biologics and allergy drops at the same time?
‍Yes. No current guidelines list biologics as a contraindication.

3. Do biologics replace the need for allergy drops?
‍No. Biologics manage inflammation; SLIT treats the underlying allergen sensitivity.

4. Can SLIT lower my asthma or eczema medication use?
‍Over time, many patients reduce medication needs as allergic triggers become less severe.

5. Can children use SLIT while on biologics?
‍Yes, with specialist supervision. See: Pediatric Allergy Relief

6. Does SLIT help with dust mite–triggered eczema?
‍Yes. Dust mite SLIT has supportive clinical evidence for reducing eczema severity in sensitized patients.

Final CTA

If you’re considering allergy drops while taking a biologic, the safest next step is a quick online visit with a HeyAllergy provider.

➡ Book Your Online Allergy Appointment
➡ Start Personalized Allergy Drops (SLIT)

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

1. AAAAI/ACAAI Sublingual Immunotherapy Practice Parameter Update (2017).
2. AAAAI Ask-the-Expert: “No absolute contraindication” to AIT in patients taking antidepressants or biologics.
3. NIH/NIAID Asthma Guidelines & Biologic Therapy Safety Updates.
4. Peer-reviewed literature on SLIT efficacy in dust mite and pollen allergy.