SLIT tablets.

Assess current control and exacerbations. Acarizax, Itulatek and Oralair include product-specific lung-function criteria; read the selected monograph.

Include ophthalmic beta-blockers. The Canadian SLIT labels list beta-blocker treatment because it can interfere with treatment of a systemic reaction.

Do not start SLIT during pregnancy. Continuing an established, tolerated course is a separate specialist risk–benefit decision, not an automatic stop rule.

Active ulcers, significant oral inflammation, thrush or recent extraction/surgery require assessment and usually a delay until healing. Recurrent ulcers need evaluation; a healed past episode is not a permanent exclusion.

EoE history requires specialist review and is an explicit contraindication in newer tablet labels. Persistent dysphagia, chest pain or food sticking during SLIT needs treatment interruption and assessment.

Flag previous anaphylaxis or a severe local reaction to SLIT for product-specific review. The Canadian ALK tablet labels contraindicate prior severe systemic reactions to immunotherapy with the relevant allergen: grass (Grastek), ragweed (Ragwitek), birch or related trees (Itulatek), or house dust mite (Acarizax). Oralair lists extreme sensitivity to its allergen demonstrated by previous anaphylaxis after exposure. A severe reaction to an unrelated trigger is not a blanket contraindication to every SLIT product; review the history and selected monograph.