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Allergy and cold

Allergy shots and under-the-tongue immunotherapy

Immunotherapy
Other names: allergy injections, SLIT, Grastek, Odactra, Ragwitek, Oralair

FAA guidance

Acceptable with conditions.

Wait

48 hours

after the first dose, then 4 hours after each later dose

Different waits apply in other cases.

Examiner

The examiner can issue when the document's criteria are met

FAA label

ACCEPTABLE

Source: FAA, Allergy – Antihistamines & Immunotherapy Medication. FAA date 30 September 2026. Checked by Crosscheck 14 October 2026

The FAA's allergy sheet lists allergy shots as acceptable for conditions controlled by desensitization, and under-the-tongue immunotherapy (SLIT) as acceptable for allergic rhinitis but prohibited for airmen 65 or older who have an asthma diagnosis that does not meet CACI criteria.

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Compare FAA documents: Allergy shots and under-the-tongue immunotherapyWhat each of the three FAA documents says, in plain wordsOpen

Wait

  • 24 hours after the first dose of a later season (the FAA's MedGuide)
  • 4 hours after the final dose (the FAA's MedGuide)

The initial observation time is a 48-hour no-fly after the first dose and a 4-hour no-fly after each subsequent dose. The sheet also says the pilot must confirm with their treating physician that no other medication is being taken which would impair the effectiveness of epinephrine (should it be needed) or increase the risk of heart rhythm disturbances, and that airmen who are exhibiting symptoms, regardless of the treatment used, must not fly.

The FAA's Item 35 allergies table says, for hay fever controlled solely by desensitization without antihistamines or other medications, to submit all pertinent medical information and a current status report, including duration of symptoms, name and dosage of drugs and side effects; if it responds to treatment and without side effects, the examiner issues; otherwise it requires an FAA decision. Both documents are quoted.

The FAA's MedGuide names subcutaneous immunotherapy, the allergy shot, as allowed, for allergies, with a wait of 48 hours after the first dose for the first season ever taken or 24 hours for subsequent seasons, 4 hours after each dose and the same after the final dose, used as prescribed. The MedGuide defines allowed as acceptable for use while performing flight or safety-related duties, provided the condition is stable/aeromedically acceptable and no adverse side effects are present.

  • the first season of allergy shots: 48 hours after the first dose: no flying
  • 4 hours after each dose: no flying
  • a later season of allergy shots (the FAA's MedGuide): 24 hours after the first dose: no flying
  • 4 hours after stopping: no flying
Show the FAA's words: Allergy shots and under-the-tongue immunotherapyThe official FAA wording: four passages, each with its document and dateOpen
FAA, Allergy – Antihistamines & Immunotherapy Medication · FAA date 30 September 2026
Immunotherapy: Airman must confirm with their treating physician that no other medication is being taken which would impair the effectiveness of epinephrine (should it be needed) or increase the risk of heart rhythm disturbances.
Allergy injections: Acceptable for conditions controlled by desensitization.
Sublingual immunotherapy (SLIT): Acceptable for allergic rhinitis; however, prohibited for airmen 65 or older who have an asthma diagnosis that does not meet CACI criteria (See Lungs and Chest).
Initial observation time: 48-hour no-fly after the first dose AND 4-hour no-fly after each subsequent dose.
Generic: subcutaneous immunotherapy (SCIT); allergy shot (injection)
Brand Name: Immunotherapy injections
Drug Class: Allergen-Specific Immunotherapy
Underlying Condition: Allergies
Use: ALLOW
INITIAL Wait Time (after first dose): 48 hours (for first season ever taken); or 24 hours (for subsequent seasons)
SUBSEQUENT Dose Wait Time (after each dose): 4 hours
DISCONTINUATION Wait Time (after final dose): Same as subsequent dose wait time
Frequency Use Limit: As prescribed
FAA, Allergy – Antihistamines & Immunotherapy Medication · FAA date 30 September 2026
Airmen who are exhibiting symptoms, regardless of the treatment used, must not fly.
FAA, Allergies · FAA date 25 February 2026
Hay fever controlled solely by desensitization without antihistamines or other medications
All
Submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs and side effects
If responds to treatment and without side effects - Issue
Otherwise - Requires FAA Decision
FAA, MedGuide (FAA Office of Aerospace Medicine medication reference) · FAA date 1 October 2026
ALLOWED: The medication is acceptable for use while performing flight or safety-related duties, provided the condition is stable/aeromedically acceptable and no adverse side effects are present.
Sources and dates: Allergy shots and under-the-tongue immunotherapyThree FAA documents, with the FAA's date and when Crosscheck checked themOpen

See also

Medication guidance alone does not determine whether a pilot is medically qualified to fly. The underlying condition, dosage, side effects, medication combinations, and certification history may affect FAA eligibility.

For informational purposes only. Not legal or medical advice.