Online allergy treatment: from antihistamines to sublingual immunotherapy
Most seasonal and perennial allergy management is OTC plus a single prescription if needed. Telehealth fills the gap when you want guided treatment without scheduling an in-person visit for a refill. Sublingual immunotherapy (SLIT) is the more interesting frontier — telehealth-delivered allergy desensitization, no needles.
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OTC foundation
Second-generation antihistamines (cetirizine, loratadine, fexofenadine) — daily, non-sedating, cheap. Intranasal corticosteroids (fluticasone, mometasone) — most effective for nasal allergies, takes 1-2 weeks for full effect. Eye drops for ocular symptoms (ketotifen, olopatadine). All OTC.
Prescription escalation
Intranasal antihistamines (azelastine), combination intranasal sprays (Dymista = azelastine + fluticasone), montelukast (oral, FDA black-box warning for psychiatric side effects, use cautiously), oral corticosteroid burst for severe seasonal flares. All telehealth-prescribable.
Sublingual immunotherapy
FDA-approved SLIT tablets (Grastek for timothy grass, Ragwitek for ragweed, Odactra for dust mite) deliver allergy desensitization at home over 3-5 years. First dose must be in-clinic. Subsequent doses are home self-administration. Telehealth programs handle prescriptions, monitoring, and refills.
When to see an allergist
Refractory symptoms despite OTC + prescription escalation, suspected food allergies needing testing, asthma overlap, or interest in subcutaneous immunotherapy (allergy shots — must be in-clinic). Telehealth handles the routine; the allergist handles the complex.