Oak Mix Allergy Shots (SCIT)
Oak-mix allergy shots (SCIT) are the most-prescribed Fagales formulation east of the Rockies — targeting the dominant spring tree allergen across the Southeast and Mid-Atlantic by total pollen volume, with daily counts exceeding 1,000 grains per cubic meter for weeks. No oak-specific SCIT RCT exists, but the Itulazax TT-04 trial (634 adults) documented meaningful oak-season symptom reduction in birch-sensitized patients, establishing birch-oak PR-10 cross-protection as clinically confirmed.
About Curex’s SCIT program
Curex’s at-home allergy shots (SCIT) are coming soon and focus on the most common environmental allergens:
- • Pollens — tree, grass, weed & ragweed
- • Pet dander — cat & dog
- • Dust mites
- • Molds — Alternaria & mold mix
Oak Mixis covered here for general education and may not be part of Curex’s current treatment set. Join the waitlist and our care team will help confirm your options.
Oak Mix Allergy Immunotherapy: How It Works
Allergy immunotherapy is the only long-term treatment that re-trains the immune system to stop overreacting to oak mix — rather than just masking symptoms with antihistamines or steroids. By gradually exposing the body to controlled doses of oak mix allergen, immunotherapy shifts the underlying allergic response and produces relief that often outlasts treatment by 7–10 years.
There are two evidence-based forms of oak mix immunotherapy used today, both built on the same desensitization principle but delivered very differently.
of sustained relief after a complete immunotherapy course — the only allergy treatment with proven long-term effect after stopping.
Allergy Shots (SCIT)
Weekly injections of oak mix extract in a clinic, escalating over 3–6 months until a maintenance dose is reached. Continued monthly for 3–5 years. Longest clinical track record for oak mix allergy.
- Strongest evidence base for severe and polysensitized patients
- Covered by most insurance plans
- Requires 50–100+ in-person clinic visits across the full course
- Or at home with no clinic visits— Curex’s Virtual Shot Room model delivers the same SCIT program with live video supervision by trained Curex clinical staff for the first injection from each new vial or concentration and restarts after gaps or reactions.
Allergy Drops / Tablets (SLIT)
Daily drops or dissolvable tablets containing oak mix extract, held under the tongue at home. Same desensitization principle, delivered without injections. WHO-recognized as an effective form of allergy immunotherapy since 2001.
- Taken at home — no weekly clinic trips, no needles
- Lower systemic reaction rate than allergy shots
- Curex offers prescription oak mix immunotherapy drops with allergist oversight
The rest of this page goes deep on allergen-specific immunotherapy with shots — protocol, efficacy data, side effects, and cost. If you’d rather skip the clinic and treat oak mix allergy with at-home drops, see how Curex sublingual immunotherapy compares below.
What is Oak Mix?
The biology, taxonomy, and clinical fingerprint of Oak Mix — the foundation of how SCIT targets it.
Oak catkins shed enormous quantities of pollen across the Southeast each spring — daily counts regularly exceed 1,000 grains per cubic meter for weeks in Atlanta, Charlotte, and Washington DC, making oak the dominant spring tree allergen by aggregate pollen mass in much of the US.
- Scientific name
- Quercus spp. (Q. alba + Q. rubra + regional species)
- Family
- FagaceaeBeech family
- Type
- Deciduous tree pollen blend
- Native to
- Eastern North America; also California, Southwest; widespread across the continental US
- Allergen proteins
- Que a 1 (major) — PR-10/Bet v 1 homolog, ~17 kDa, 72–95% sequence identity with Bet v 1 (WHO/IUIS)Quercus profilin — pan-allergen (catalogued at WHO/IUIS)Quercus Ca-binding proteins — polcalcins (catalogued at WHO/IUIS)NOTE: Que a 1 is the only formally named US Quercus IUIS allergen; other North American oak species lack named allergens
- Particle size
- 25–35 μm
- Avoidance difficulty
- Nearly impossible
How Oak Mix Allergy Presents
Symptoms by body system — useful for distinguishing Oak Mix sensitivity from overlapping allergies and infections.
Respiratory
- Moderate-to-severe sneezing and profuse rhinorrhea during the March–May oak season across the Southeast
- Nasal congestion on high-pollen days — counts exceeding 1,000 grains/m³ for weeks in Atlanta, Charlotte, and Washington DC
- Itchy, swollen nasal passages that worsen on warm, dry, windy days when catkins peak
- Allergic asthma exacerbations — wheezing and chest tightness in oak-sensitized asthmatic patients
- Post-nasal drip and chronic cough from prolonged high-pollen exposure during the 6–8 week oak season
Ocular
- Intense bilateral eye itching and watering — common on high oak-pollen days in the SE
- Conjunctival redness and swelling (allergic conjunctivitis) during peak weeks
- Morning crusting and periorbital puffiness after overnight pollen accumulation
- Reduced outdoor tolerance during the core March–April oak-pollen peak
Dermal
- Oral allergy syndrome (OAS) to raw apple, hazelnut kernel, peach, cherry, or carrot via Que a 1 / Bet v 1 PR-10 cross-reactivity — less prominent than with birch monosensitization, but possible in oak-sensitized patients with high PR-10 IgE
- Contact urticaria from direct pollen contact in highly sensitized individuals
- Atopic dermatitis flares coinciding with high oak-pollen weeks in spring
Systemic
- Severe fatigue from prolonged high-pollen exposure — the SE oak season is 6–10 weeks of sustained exposure
- Sleep disruption from nighttime nasal obstruction during peak March–April weeks
- Impaired outdoor work and recreation during prime spring weather
- Cumulative quality-of-life impact from one of the longest sustained pollen exposures of any US tree allergen
In the Southeast, oak puts more pollen into the air than any other spring tree by total mass — daily counts over 1,000 grains per cubic meter for weeks. We don't have an oak-specific RCT, but the Itulazax TT-04 trial showed birch SCIT measurably reduces oak-season symptoms, which gives us strong immunologic rationale for treating oak-sensitized patients with a birch-anchored Fagales mix.
When & Where Oak Mix Peaks
Allergen intensity by month and by state. Useful for timing SCIT start dates and travel planning.
12-Month Intensity
Peak: late March through April across the Southeast and Mid-Atlantic; February–April in the Gulf states· ~6–10 weeks of sustained high pollen exposure; the highest aggregate pollen output of any US spring tree allergen
US Exposure Map
14 high-intensity statesExposure intensity by state (text version)
- ME:
- Low
- VT:
- Low
- NH:
- Low
- WA:
- Moderate
- MT:
- Low
- ND:
- Low
- MN:
- Low
- WI:
- Low
- MI:
- Low
- NY:
- Moderate
- MA:
- Moderate
- OR:
- Moderate
- ID:
- Low
- WY:
- Low
- SD:
- Low
- IA:
- Low
- IL:
- Moderate
- IN:
- Moderate
- OH:
- Moderate
- PA:
- High
- NJ:
- High
- CT:
- Moderate
- RI:
- Moderate
- CA:
- Moderate
- NV:
- Low
- UT:
- Low
- CO:
- Low
- NE:
- Low
- MO:
- Moderate
- KY:
- High
- WV:
- Moderate
- VA:
- High
- MD:
- High
- DE:
- High
- AZ:
- Low
- NM:
- Low
- KS:
- Low
- AR:
- Moderate
- TN:
- High
- NC:
- High
- SC:
- High
- OK:
- Moderate
- LA:
- Moderate
- MS:
- High
- AL:
- High
- GA:
- High
- TX:
- Moderate
- FL:
- High
- AK:
- Low
- HI:
- Low
What Oak Mix Cross-Reacts With
Patients sensitized to one allergen often react to others sharing similar proteins. This map shows the documented molecular overlaps.
Oak's Que a 1 shares 72–95% sequence identity with birch Bet v 1, and ImmunoCAP inhibition assays show white oak pollen extract inhibits 77.4–81.5% of Bet v 1 IgE binding (Jeong 2016). This makes oak one of the strongest cross-reactive pairs in the Fagales PR-10 family — and explains why birch SCIT reduces oak-season symptoms in the Itulazax TT-04 trial.
Within-genus PR-10 cross-reactivity; Que a 1 is the only named US Quercus allergen
Within-genus; no named Q. virginiana allergen; cross-reactivity inferred from Que a 1 homology
Que a 1/Bet v 1 — 77.4–81.5% Bet v 1 IgE inhibition by white oak extract (Jeong 2016)
Birch SCIT cross-protects against oak season per Itulazax TT-04 secondary endpoint
Mal d 1 PR-10 OAS — less common with oak monosensitization than birch; heat-labile
Cor a 1.04 PR-10 OAS; less prominent in oak-monosensitization than birch
Oak PR-10 Oral Allergy Syndrome (less prominent than birch)
Oak monosensitization can produce PR-10 OAS to raw apple, hazelnut kernel, peach, cherry, carrot, and celery — but OAS is considerably less common and less severe in oak-monosensitized patients than in birch-sensitized patients. If your OAS is prominent, consider whether birch co-sensitization (Bet v 1) may be the primary driver. See the white birch page for the complete PR-10 OAS food table. A board-certified allergist can separate oak-vs-birch sensitization via component-resolved testing.
Is SCIT Right for Your Oak Mix Allergy?
Answer five questions to assess whether oak-mix SCIT is likely right for your spring tree allergy.
How severe are your spring oak-season symptoms (March–May)?
The Oak Mix SCIT Protocol
Oak-mix SCIT uses non-standardized Q. alba and Q. rubra extracts (often blended into Eastern X-tree mixes) in a conventional build-up and maintenance ladder. High-pollen-volume Southeast patients benefit from initiating build-up out of season — summer is ideal — to avoid co-exposure during titration.
Injections begin at 1:100,000 w/v (Curex's conservative starting concentration; more dilute than the textbook 1:10,000) and increase incrementally based on local reactions. Southeast patients with high ambient oak pollen exposure during the March–May season should ideally complete build-up before this window. A summer start (June–August) is preferred. Mandatory 30-minute post-injection observation period at every visit.
Ongoing maintenance injections sustain oak-specific and Fagales PR-10 cross-reactive tolerance. Most patients see symptom improvement by the second oak season. The Itulazax TT-04 trial confirms that Bet v 1/Que a 1 cross-reactive immunotherapy produces meaningful oak-season symptom reduction even without a dedicated oak extract.
Lasting benefit of 7–12+ years is associated with completing the full 3–5 year course. Because oak seasons are long and high-intensity in the Southeast, patients who discontinue early frequently relapse quickly.
Extract Concentration Ladder
You progress through each vial during build-up. Concentration increases ~10x per step.
What the Research Shows for Oak Mix SCIT
No SCIT RCT has been conducted specifically for Q. alba or Q. rubra. All efficacy estimates derive from the birch-homologous family evidence base, particularly the Itulazax TT-04 oak-season secondary endpoint — the strongest available clinical evidence for oak SCIT.
- Oak-season symptom reduction (birch-homologous cross-protection)62%Itulazax TT-04 secondary endpoint — oak season; ALK/EMA 2019, N=634 birch-sensitized adults
- Bet v 1 IgE inhibition by white oak pollen extract79%Jeong et al., J Korean Med Sci 2016 (ImmunoCAP inhibition — 77.4–81.5% range)
- Sensitization rate in US allergy clinic populations30%Pooled US allergy clinic data — 20–40% range routinely reported
No oak-specific SCIT RCT exists for US populations. The Itulazax TT-04 oak-season secondary endpoint and the Jeong 2016 inhibition assay provide the strongest mechanistic and clinical rationale for oak SCIT within a birch-anchored Fagales approach. Clinicians should be transparent with patients that the SCIT evidence for oak derives from birch-homologous family extrapolation rather than a dedicated oak RCT.
Ready to skip the surprise bills?
At-home allergy shots (SCIT) are designed by board-certified allergists. See the listed SCIT plan rate in our pricing record and request a quote for eligibility, initiation and total care costs.
- MD-ledBoard-certified allergists
- QuoteTotal care estimate
- 50K+Patients treated
- HSA/FSAEligible
Oak Mix SCIT Side Effects
Oak-mix SCIT side effects follow the standard inhalant SCIT profile. Southeast patients initiating build-up during the March–May oak season face higher reactivity risk from active co-exposure — a summer build-up start is strongly preferred.
Local reactions
4 documented| Reaction | Rate | Severity |
|---|---|---|
Injection-site swelling Expected during build-up; resolves within 24 hours in most cases | Rate 30–50% | Mild |
Injection-site itching Ice and pre-treatment antihistamine on injection days recommended | Rate 20–40% | Mild |
Large local reaction (>25 mm) Higher during active pollen season; does not predict systemic risk | Rate 5–10% | Moderate |
Persistent redness Resolves within 24 hours in most cases | Rate 10–20% | Mild |
Systemic reactions
4 documented| Reaction | Rate | Severity |
|---|---|---|
Rhinitis/conjunctivitis flare Sneezing or eye watering within minutes to 1 hour; antihistamine responsive | Rate 0.5–1% | Mild |
Urticaria Generalized hives; managed with antihistamines ± epinephrine | Rate 0.1–0.5% | Moderate |
Bronchospasm Higher risk in asthmatic patients; baseline spirometry before SCIT recommended | Rate 0.1–0.3% | Moderate |
Anaphylaxis Rare at properly titrated doses; a prescribed epinephrine auto-injector is confirmed on hand and the first injection from each new vial or concentration is supervised live in the Virtual Shot Room by trained Curex clinical staff, with a 30-minute self-observation after each dose. | Rate <0.01% | Severe |
A 30-minute post-injection observation accompanies every oak SCIT dose, whether given in a clinic or self-administered at home with Curex — where the first injection from each new vial or concentration is supervised live in the Virtual Shot Room by trained Curex clinical staff and a prescribed epinephrine auto-injector is confirmed on hand. Southeast patients should initiate build-up in summer (June–August) to avoid the elevated reactivity risk that occurs when build-up doses coincide with peak ambient oak pollen counts in March–April.
SCIT vs Alternatives for Oak Mix
Oak-sensitized patients have four main pathways: Fagales-anchored SCIT (treating oak via birch-homologous cross-protection) — now self-administered as a weekly at-home shot with Curex — sublingual drops, avoidance strategies (limited given oak's extreme pollen output), and daily seasonal medications.
| Criterion | SCITBest | SLIT | Avoidance | Medications |
|---|---|---|---|---|
| Effectiveness | High — family-level Phase 3 evidence via Itulazax TT-04 oak-season secondary endpoint | Moderate — no FDA-approved oak SLIT tablet in US; off-label drops available | Low — oak pollen counts >1,000 grains/m³ for weeks; essentially unavoidable in SE | Moderate — antihistamines + nasal steroids for mild-to-moderate symptoms |
| 5-yr cost | $3,500–$15,000 over 5 years | Varies by provider; sublingual drops are a general allergy modality, not Curex's product | Low — HEPA, pollen masks, air purifiers | $500–$2,000 over 5 years |
| Duration | 3–5 year course | 3–5 year course | Indefinite — no tolerance change | Indefinite — seasonal use |
| Convenience | At-home weekly self-injection with Curex; summer start preferred for SE patients; the first injection from each new vial or concentration supervised live in the Virtual Shot Room | Daily at-home — no clinic required | High inconvenience in spring outdoor season | High convenience |
| Safety | Excellent — your oak serum is USP <797> sterile-compounded, the first injection from each new vial or concentration is supervised live in the Virtual Shot Room by trained Curex clinical staff, a prescribed epinephrine auto-injector is confirmed on hand, and a 30-minute self-observation follows | Favorable — no systemic anaphylaxis in EU SLIT trials | Safe | Generally safe |
| Lasting effect | 7–12+ years after completion | Emerging — less durability data vs SCIT | None — symptoms return each March | None — must take every season |
SCITBest
SLIT
Avoidance
Medications
SCIT has the strongest evidence for lasting tolerance to the highest-volume spring tree pollen in the US — with the potential to reduce oak-season symptoms not just this year but for 7–12 years after completing the 3–5 year course. With Curex, eligible patients self-administer that shot at home with pricing confirmed in a current program quote instead of committing to weekly clinic injections, with the first injection from each new vial or concentration supervised live in the Virtual Shot Room and a prescribed epinephrine auto-injector confirmed on hand.
What Oak Mix SCIT Actually Costs
Oak-mix SCIT is covered by most major US insurers under standard allergy immunotherapy benefits when ordered by a board-certified allergist with supporting positive skin test or specific IgE. Oak is typically included in a multi-tree Eastern mix — pre-authorization should specify the full tree mix composition and leading allergens. Curex at-home IgE testing identifies specific oak mix sensitization before allergist consultations, eliminating the need for an initial skin-test visit.
Cost range varies by deductible, co-insurance, and clinic.
Verify these codes with your insurer to confirm coverage.
See the listed Environmental Allergy Shots Plan rate, commercial terms dated 2026-10-12; consultations are included without copay. Confirm availability, eligibility, other included services, testing, any in-person care, insurance responsibility and billing cadence in your written quote before enrolling.
Join the waitlistStop guessing about your oak mix allergy. Get a plan.
Take Curex’s 3-minute allergy quiz. A board-certified allergist will review your symptoms and recommend the right immunotherapy path for you — shots or drops.
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Oak Mix SCIT — Frequently Asked
Quick answers to the questions patients ask most before starting treatment.
Oak trees are wind-pollinated and rely entirely on aerial pollen dispersal for fertilization — meaning they must produce enormous quantities of pollen to ensure reproduction. Unlike insect-pollinated trees that produce sticky, targeted pollen, wind-pollinated oaks release light, dry pollen in volumes that can reach 1,000 to 5,000 grains per cubic meter of air for weeks across the Southeast during peak season. A single mature oak can release billions of pollen grains per season. This massive volume — not any particular difference in protein allergenicity — is why oak drives more allergy symptoms per day than almost any other spring tree in the US, even though individual oak proteins may be less potent sensitizers than birch Bet v 1 on a per-grain basis.
Likely yes, via the same PR-10 cross-protection mechanism. Que a 1 and Bet v 1 share 72–95% sequence identity, so oak SCIT desensitizes the same PR-10 epitopes targeted by birch SCIT — and vice versa. The Itulazax TT-04 trial confirmed this explicitly: birch-sensitized patients on Bet v 1 immunotherapy showed meaningful symptom reduction during the oak season as a secondary endpoint, confirming bidirectional cross-protection. In practice, a single birch-anchored Fagales mix provides simultaneous coverage against oak, hazel, alder, and beech without requiring a separate extract for each species.
Most patients notice improvement during the oak season after 6–12 months of SCIT build-up. Because oak season is 6–10 weeks long with very high pollen counts, improvement is often noticeable even with partial build-up progress — patients may experience milder symptoms in their first spring on SCIT even before reaching maintenance dose. Full symptom reduction — comparable to the Itulazax TT-04 family-level endpoints — typically develops by the second or third oak season on maintenance. Completing the full 3–5 year course is associated with lasting benefit that may persist for 7–12 years after stopping.
Yes, oak-mix SCIT is covered by most major US insurers under standard allergy immunotherapy benefits. Oak is one of the most commonly tested and treated tree allergens in the Southeast, so most insurers are familiar with oak SCIT claims. Coverage requires a positive skin prick test or specific IgE for oak or Que a 1, a prescription from a board-certified allergist, and documentation of symptom severity. CPT codes 95115, 95117, and 95165 are standard for SCIT billing. Pre-authorization is recommended, and you should clarify whether the extract preparation cost is included in your coverage.
An oak-mix typically blends Q. alba (white oak) and Q. rubra (red oak) — two of the most abundant and clinically important oaks in the eastern US. Because within-genus Quercus cross-reactivity via Que a 1 (the only formally named US oak allergen, found in Q. alba) is very high, the mix broadens regional species coverage rather than adding distinct new epitopes. In regions with specific dominant species — for example, live oak (Q. virginiana) in the Gulf coast or blue oak in California — local allergists may customize the oak component of a tree mix to better match the patient's regional exposure. In practice, the clinical difference between oak-mix and single-species oak SCIT is typically minimal.
Possibly, but to a lesser degree than birch SCIT. OAS driven by the PR-10 Bet v 1 / Que a 1 shared epitope (apple Mal d 1, peach Pru p 1, hazelnut kernel Cor a 1.04) occurs in oak-sensitized patients, but is considerably less common and prominent than in birch-monosensitized patients. If your primary sensitizer is oak (Que a 1) and you have PR-10 OAS to raw apple or peach, oak-anchored SCIT that reduces Que a 1 IgE may also reduce OAS severity over time. However, if your OAS is driven primarily by birch Bet v 1 with oak as a secondary co-sensitization, a birch-anchored SCIT approach is likely to have greater impact on both the OAS and the tree-pollen rhinitis. Component-resolved testing is needed to determine which PR-10 allergen is the primary driver.
Yes — species composition and timing differ by region. In the Southeast, Q. alba, Q. rubra, Q. stellata (post oak), and Q. velutina (black oak) are the dominant deciduous species with a March–April peak. Live oak (Q. virginiana) dominates the Gulf coast with a February–April evergreen season. In the Northeast, Q. alba and Q. rubra are the primary species with an April–May peak. In California, valley oak (Q. lobata) and blue oak (Q. douglasii) are dominant. An allergist familiar with your region can select the most appropriate oak species for your extract composition — but because within-Quercus Que a 1 cross-reactivity is high, the clinical difference between regional formulations is usually small compared with getting the correct Fagales anchoring (birch vs oak primary).
This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. Content reviewed by board-certified allergists at Curex.
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