Launch HN: Wyndly (YC W21) – Allergy relief through at-home oral drops
Wyndly is focused on making long-term allergy relief convenient through at-home allergy immunotherapy drops and telemedicine. These personalized oral drops train your immune systems to stop reacting to allergy triggers like pollen, pets, or dust.
Manan is an ear-nose-and-throat surgeon and allergy doctor, and in his physical practice, he’s treated thousands of patients with at-home allergy drops, a form of allergy immunotherapy. During allergy immunotherapy, you gradually introduce your immune system to your allergy triggers. Over time, your immune system learns to tolerate these allergy triggers and stops reacting to them. For patients, this means greatly reduced allergy symptoms and long-term relief [1] without any other medicine for years after patients finish their immunotherapy.
While allergy drops are 80% of allergy immunotherapy in some European countries, in the United States, allergy drops are just 5.9% of allergy immunotherapy prescriptions [2] and are really only available in university hospitals like Johns Hopkins, University of Pittsburgh, and West Virginia University [3] [4] [5].
Part of the reason for their limited availability is physician training, and another part is the health insurance system’s incentives. Most allergy doctors were trained on allergy shots, and prescribe what they are most experienced with. Additionally, health insurance programs incentivize prescribing allergy shots.
In his medical training, Manan trained on both allergy drops and shots. When Manan gave his patients the choice between at-home allergy drops and allergy shots, his patients always chose drops, which are safer, convenient, and don’t require needles [6].
When Covid-19 hit Denver in March 2020, Manan switched all of his allergy drop patients to online care to continue treatment. After shelter-in-place was lifted, his patients continued online care due to the convenience, which told us one thing—patients preferred and were comfortable with telemedicine for allergy care. And that's why we started Wyndly.
We’re trying to make allergy immunotherapy convenient and affordable, so that any one of the 60 million people in America suffering from allergies has the opportunity to get lifelong relief—just like braces straighten your teeth and Lasik fixes your vision.
We’ve done our best to make our patient experience as easy as possible. First, we learn more about you and your allergy history. Then, our medical team creates a personalized treatment plan with treatment sent straight to your door. Most patients notice benefits at 6 months, and some patients have reported allergy symptom relief as early as 6 weeks [7]. Patients lock-in lifelong allergy relief after a few years [1]. Throughout this time, we stay in touch with the patient to work with them towards allergy relief.
Please let us know if you have more questions or feedback. We love talking about the science behind allergy immunotherapy, our treatment model, and what we’re doing. We're happy to answer any questions!
[1] Long-lasting effects of sublingual immunotherapy according to its duration: a 15-year prospective study https://pubmed.ncbi.nlm.nih.gov/20934206/
[2] Comparison of allergen immunotherapy practice patterns in the United States and Europe https://pubmed.ncbi.nlm.nih.gov/20084837/
[3] Sublingual Immunotherapy (SLIT) for Allergy Treatment: Johns Hopkins | Q&A https://www.youtube.com/watch?v=dpWomI4iPLY
[4] Benefits of Sublingual Immunotherapy | UPMC However, Wyndly only treats environmental allergies like pollen, pet dander, and dust. We do not treat food allergies. There are a number of promising therapies currently undergoing clinical trials for food allergy oral immunotherapy, and we are optimistically awaiting the results. Here's some trials from the Sean N. Parker Center for Allergy & Asthma Research at Stanford University: https://med.stanford.edu/allergyandasthma/clinical-trials.ht... The first food allergy OIT product, Palforzia, released last year. It's claim to fame (and competitive moat) is the combination of them sponsoring a series of large trial using the same, standardized protocol which now has become part of the drug labeling, so physicians don't have to decide themselves, as well as a exclusive supply agreement for peanut flour that is characterized so each pre-measured capsule has a known amount of protein rather than just a known amount of flour. From what I remember, SCIT (sub-cutaneous allergy shots) have generally not performed very favorably in research for food allergies; they cause too many severe adverse reactions and they are not anyone's favorite anyway. - I want to try this but I'm not sure how much it will cost in total. I see a lot of hints, but no clear pricing on the total treatment cost. I know from experience with a local allergy clinic, this treatment is ridiculously expensive. - I also see no claims around how long the treatment will last (on average) - I'm not sure I understand how an at home allergy test works or suffices for diagnosis. I'm also fairly skeptical on how allergies are diagnosed in general--when I have had the skin tests performed, they were highly "subjective" to the point of lunacy--drawing circles, measuring with a ruler, etc. - Can you treat food allergies? - There are quite a few UI issues--lack of borders, padding, and clutter. You're going for trust here, you should make sure your website looks the part. - I also keep getting a cookie request thing from a separate domain, wtf? On total cost: We charge $99/mo. It's hard to give a total cost without knowing more about each person's specific allergy triggers and how well immunotherapy takes for them. Generally, we expect patients to be with us for up 5 years. On how long treatment lasts: I spoke to this in the total cost section, but it's hard to make a blanket statement. On our at-home allergy test: We use a CLIA-certified allergy test which is used by allergy doctors across the United States. Specifically, we test for allergen-specific immunoglobulin E (IgE). IgE antibodies are normally found in small amounts in the blood, but higher amounts can be a sign that the body overreacts to allergens. This can lead to an allergic reaction. We don't treat to the test, however. Every patient shares their personal allergy history with their doctor, and the doctor uses both the allergy test and reported allergy history to create the personalized allergy treatment plan. On food allergies: Wyndly only treats environmental allergies like pollen, pet dander, and dust. We do not treat food allergies. There are a number of promising therapies currently undergoing clinical trials for food allergy oral immunotherapy, and we are optimistically awaiting the results. UI issues: You're absolutely right, we need to establish trust, and a shoddy website does not help us. We're always trying to improve the UI and UX. Cookie request: I'm not sure what this is. Can you share a screenshot? It is possible it is from our HIPAA-compliant scheduler which is embedded through an iframe. Patients see improvement in symptoms after 6 months, with some patients reporting improvement as soon as 6 weeks. If patients stays on drops for 5 years, they can expect significant decrease in allergy symptoms for decades, even once they have stopped taking a daily allergy drop. If the patient stops taking their allergy drops, they will still see a reduction of their allergy symptoms, but it won't last for decades -- it may only last a few months. Ordered an Allergy Test kit. Will update everyone in 5 years if it was worth it or not! :) I asked my allergist about this when I started shots. He said that it might help with the Eczema, but nothing is guaranteed. There is at least anecdotal evidence indicating that allergy shots might be helpful for Eczema.
https://acaai.org/news/your-severe-eczema-may-best-be-treate... If you don't have insurance, Dupixent is like $2000 per month. Not sure whether their copay assist program will defray some of the cost. However, Dupixent has been life-changing for me. I went from having itchy flaky skin all over my body to being essentially normal. Especially milk and milk products. If you decide to try this, don't do it halfway. Read the ingredients of everything you eat. Don't eat at restaurants. Stick with it for three months. I went from having difficulty walking, and being unable to use my hands due to severe dishydrotic eczema, to being completely 100% healed. This was after I was diagnosed with shingles, given a ton of very harmful steroids and steroid creams, told by multiple doctors and dermatologists that it was an incurable autoimmune condition that I'd be living with forever. I was also told explicitly by one dermatologist that it was impossible that my problems were caused by a food allergy, that any results I was seeing were coincidence. It turned out, I'm allergic to milk protein. If you're battling this as well, it might be worth your time to look into elimination diets. Apparently he literally only eats meat an some vegs, and was able to make substantial changes to some kind of debilitating condition. https://en.wikipedia.org/wiki/Jordan_peterson#Health_problem... It's annoying. It disappears when I go to a different tab. Before that, it blocked any scrolling on your page in Brave. The "schedule your free online visit" section is empty. I'm assuming because I didn't click "ok". While I've suffered from allergies my entire life, I don't think I care enough to spend several thousand to probably cure it. However, it's certainly interesting. Thanks for the information. You're right that it needs to be addressed. If you have an HSA or FSA, you can put it towards treatment with us. Many of our patients have employer-funded HSAs that they put towards their treatment with us. Stanford has a shellfish clinical trial going on right now. See https://med.stanford.edu/allergyandasthma/clinical-trials.ht... How do you deal with the risk of severe reactions? Is that risk diminished with drops instead of shots? I'm undergoing shot therapy now and had a life threatening anaphylactic reaction to a shot just a couple months ago. I'm concerned if I had been by myself at home I may have died? I was at the doctors office but they still called 911 for "backup" because I got so sick so fast. What struck me about the experience was the speed of the whole thing. I was fine one moment, the next moment I didn't feel great, then I started dry heaving, then I got upset with the staff as I was insistent I be allowed "just lay on the floor" which they wouldn't allow. This whole deterioration took maybe 5 minutes? I felt very very tired like I wanted to sleep. When they gave me an EPI injection it didn't just magically fix everything right away. I was still very sick for another 15-20 minutes. I never had any breathing distress I was aware of and had I been alone I don't think I would not have injected myself with EPI, I think I would have just gone to sleep and not woken up. I presume you all have thoughtfully addressed this risk but I didn't see that in my quick skim of your materials/website so I'm interested in how you handle it? Is this treatment different than OIT? Is it more suitable for less-threatening allergies like seasonal allergies? or is there a cut-off in IgE levels this treatment would be indicated for? The risk of severe reaction is much less with allergy drops compared to allergy shots [1]. Allergy drops expose the patient to less allergen and in a less invasive way at any given time compared to allergy shots. Allergy drops are much less concentrated (because they're used daily), and they deliver the allergens to the body through a mucosal membrane. Allergy shots are more concentrated (as they're used weekly or even monthly), and the body reacts to an injection much more aggressively than something taken orally. Still, we offer every patient an EPI pen to give them peace of mind. Patient comfort is of utmost importance. I don’t believe so. At least it’s recommended by our allergy doctor before the shots and I’ve read it on other allergy doctors’ websites also. In fact this link suggests that it improves the effectiveness[0] [0] https://acaai.org/resources/connect/ask-allergist/antihistam... Antihistamines and nasal sprays handle the symptoms, but they don't try to correct your immune response, which is the root cause of the symptoms. Allergy immunotherapy trains your immune system to not attack the harmless allergens and not trigger the allergy symptoms. My fear with something like this is that in a lot of other cases - if it worked, it would be science. So it's difficult for me to be an early adopter here. We cite research studies whenever we can to demonstrate that this treatment is medically sound and is used every day to treat thousands in the US and millions in Europe. What specific questions do you have that are holding you back? Rather, i'm just saying that as a layman in the medical field i am definitely of snake oil - since there is so so much on the market. I am a pretty bad pollen allergy sufferer, fwiw. Appreciate your work here, i hope to use this once i can feel confident in it :) Using terms like “learn how to beat your allergies in 60 seconds” and “leave your allergies behind” are efficacy claims that the FDA takes very seriously. Right now it gives the impression that the company guarantees I’ll beat my allergies and I can do it in 60 seconds, both of which I doubt are true. Plenty of companies have been cited for less bombastic claims than those. I'm currently working on a product for companies in your space. I'm in the research phase - do you mind if I reach out to you for a quick chat? * the first dose MUST be administered by a doctor (so that they can take measures if an acute adverse reaction happens) - for the same reason you must not leave the doctor for some half an hour after the first dose * you must stick to the regime if it's going to be efficient (i.e. no forgetting your dose) * for dust mite allergy, it takes 3 years, lasts for 3 years, and then you need to reepat it * in general, its efficiency is measured by the amount of medication you need daily - it should diminish with time * it's not effective in all cases * you can measure its efficiency also by a specialized blood test * in Europe, the drops cost ca €70 for two months Our goal is to give our patients lifelong allergy relief with as little hassle as possible. "sublingual immunotherapy was able to reduce the mean number of asthma attacks per year from 8.2 ± 3.05 before treatment to 0.44 ± 0.79 after 3 years, ie, the recommended duration of sublingual immunotherapy; complete clinical remission was recorded in 95% of patients with asthma and in 82% of patients with rhinitis" However, my doctor told me that what happens after 3-5 years after you stopped taking it is uncertain and often the therapy is repeated. The studies I saw about it are fairly recent so I guess researchers themselves might not be 100% sure about the long-term effectivity. I have had surgery for nasal polyps related to this twice if that might help my case. If you have an HSA or FSA, you can put it towards treatment with us. Many of our patients have employer-funded HSAs that they put towards their treatment. But I just can’t justify the 100 bucks out of pocket each month when insurance will pay 100% for the shots. I know this insurance situation is ridiculous and out of your control. That said, I think it will be huge for you if you can work that out. Good luck and I’ll keep an eye on this for sure. $99/mnth for possibly 5 yrs is a helluva commitment. Most people are going to have difficulty with both the cost and time IMHO. I looked at the alternative (shots), but that’s multiple visits per week to the clinic, with 1 hour observation time after each shot. Drops are so much more convenient. Add in the $10 doctor visit co-pay 2x / week when getting the shot, that’s $80/month already. So $960 + 850 is $1910, so I’d save $710 using these drops instead of the shots. Like I do for all of my in office patients that also take at home allergy drops we always educate our patients thoroughly about the risks of treatment and the correct way to use it. We also use the same emergency plan for our patients as we have used in office. Thankfully in the thousands of patients I, and most of my colleague physicians, have treated this has not been an issue. > .. risk of anaphylactic shock with allergy drops is incredibly low. The literature cites that risk as 1/billion or 1/100 million which is thankfully very low. Indeed, in 30 years of using allergy drops there has never been a documented reaction that caused a death. Can you point me to the specific literature? The reason I am asking as the Asthma & Allergy Foundation of USA states 1 in 50 for anaphylaxis (not the allergy drops). That discrepancy is an incredibly large number. (https://www.aafa.org/anaphylaxis-in-america/) https://pubmed.ncbi.nlm.nih.gov/21154351/ Another paper discussing the safety of sublingual immunotherapy can be found here: Sublingual allergen immunotherapy: mode of action and its relationship with the safety profile
https://pubmed.ncbi.nlm.nih.gov/22150126/ That number is from the line "SLIT-induced anaphylaxis equate to around one case per 1000 million SLIT administrations or per 526,000 treatment years'. Another nice review paper can be found here: https://pubmed.ncbi.nlm.nih.gov/28964530/ Hope this helps! Manan Are you recommending people to collect the blood sample right after exposure to the allergen? How is that used in your dosage recommendations? To start, our goal isn’t home allergy testing- our goal is convenient and accessible immunotherapy for all. We will work with patients as long as their testing is valid and from a reliable source. For some patients this means using their existing allergy tests. For other patients who want testing through insurance we will prescribe them a prescription for an immunocap allergy test through a local lab like quest diagnostics. But many patients want the convenience of a home test so we’ve partnered with a highly reliable and clia certified allergy lab to supply home allergy tests. I didn’t just trust the company’s word for it, in fact, many of my friends and family members volunteered to be tested both ways when we tested this out for use in our office and we found the results of the home test to be reliable and accurate. Unlike allergy shots where the skin testing results affect the initial dose, for sublingual allergy drop immunotherapy the initial dose is incredibly small for everyone for safety, and then escalated up. This is why the combination of symptom history, geographic area and testing can be combined by an experienced doctor to tailor a therapy for you. As an allergy sufferer, I am super happy that you're pursuing this, going to bookmark it - good luck!! Ofc, this wouldn't work with super extreme cases where you're allergic to a very specific uncommon thing. but this is a 80/20 solution. Avoiding weekly doctor's office visits (and all those shots) is appealing. Would I need to do the take home test, or would it be possible to have my doctor forward my existing results? I think my worry is that I'd start something like this and experience the same low grade symptoms (e.g., a treatment like this might improve my symptoms, but only take them from low-grade to low-grade.) As someone who does take an allergy med during seasonal allergy seasons but is able to function without them, is there much benefit into looking into SLIT? Or is this something that's designed to treat folks who are experiencing a certain level of quality of life impairment? Our treatment is for people who don't want to worry about taking an allergy medication during allergy season at all. We have done both shots and medications from our vet that help alleviate the symptoms, but they don't have any long term solutions. We've moved while having our pets, so we have had two different vets for this issue and they basically say the same thing and have similar treatments. They also say that it's a huge problem to the point where during a bad allergy season over half of their patient visits in a day are related to allergies. If there’s a way to spend $25/month on this for my dogs I’d be all in!143 comments
[ 0.29 ms ] story [ 199 ms ] thread