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Launch HN: Wyndly (YC W21) – Allergy relief through at-home oral drops
207 points by ahstilde on Feb 22, 2021 | hide | past | favorite | 139 comments
Hi HN! I’m Aakash, and I’m a long time HN reader. My cousin Manan and I are excited to share our startup Wyndly (https://www.wyndly.com) with HN today.

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 https://www.youtube.com/watch?v=TpP41WQ6pBc

[5] Sublingual Immunotherapy: An Alternative to Allergy Shots https://www.youtube.com/watch?v=THszgnYNM1I

[6] Efficacy and Safety of Subcutaneous and Sublingual Immunotherapy for Allergic Rhinoconjunctivitis and Asthma https://pubmed.ncbi.nlm.nih.gov/28964530/

[7] Clinical improvement after escalation for sublingual immunotherapy (SLIT) https://pubmed.ncbi.nlm.nih.gov/21938688/




Hey, good luck with the lauch! I just want to note that I'd be wary to try any medical treatment if the website had a testimonial from a fake person like Jason (https://www.pexels.com/photo/adult-beard-boy-casual-220453/).


Hey Guys,

Thank you for the feedback and this all totally makes sense.

Sorry we took a few minutes to get back to this! Unfortunately for HIPAA reason's we cannot use identifying data of patients. This is why we didn't use last names, or patient photos (faces are identifying- and we thought it'd be creepy to do the medical journal thing of putting a black box over the eyes).

We are certainly working on finding patient champions who might feel comfortable being totally public, but there are some legal issues around that.

That said- these are real stories. Also, feel free to google me, Manan Shah MD ENT in Colorado and you can see people's google reviews. Like all review sites, I'm sure you'll find that I didn't click with some people, but in general I'm pleased that most of my patients really had a great experience!

Does this make sense? But I definitely agree, having pretty stock images is something we'll talk to our design team about to avoid the 'marketing scam' feel!

Manan


You could make a little footnote (and have clicking on the photo send you to that anchor) explaining this. Then it would come off as kind/cool rather than (potentially) suspicious. And you could point out (if it's true) in the footnote that the testimonials are the unedited actual words of people who've used the product.


That's a good idea! We're hoping to get permission from some of our patients to directly share their stories, too.


You can also use a randomly-generated image from https://www.thispersondoesnotexist.com/

Reload the page for a new nonexistent person.

And don't forget to show your appreciation at https://www.patreon.com/lucidrains


Looking through the testimonials, they all look like stock photos. Probably a lot easier and nicer looking than actual photos of the people, but it doesn't do anything for my "this is a marketing scam" feeling...


Whoa. Surprised to see they haven’t responded to this. Had signed up for a consultation and this will be one of my first questions.


Congrats on your launch! This sounds really promising!

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?


I'm sorry you had to go through that experience. I've fainted in a doctor's office and woken up in an ambulance. It was a very unpleasant experience.

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.

[1] https://www.youtube.com/watch?v=TpP41WQ6pBc


Unpleasant indeed, I'm delighted to hear your whole approach reduces that risk! Seems like you have far better approach, congrats!!


Do you take an antihistamine before your shots? If not you may want to do that, that severely reduces the risk of a reaction.


Wouldn't that reduce the benefits of the shot as well?


Disclaimer: I’m not a doctor, but speaking from personal experience.

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...


Based on this video [1] linked in the OP, it seems like one of the big benefits is that anaphylaxis is not a side-effect of the drops.

[1] https://www.youtube.com/watch?v=TpP41WQ6pBc


My understanding would be that Ananphylaxis can never ve a zero risk for severe allergies. After all, most anaphylaxis is triggered by accidentally eating an allergen or a tiny cross-contamination with an allergen. Everything depends on sensitivity of your allergy. I am excited about this startup, because we've been researching OIT (oral immunotherapy) treatment for my daughter who has multiple life-threatening allergies. My understanding is that oral therapy is only just beginning to be approved in the US and that most protocols call for first few months of dosing to be done in a doctor office, followed by maintenance doses that can be done or even prepared at home.

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?


Indeed, thank you!


General feedback:

- 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?


Thank you for the feedback!

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.


So I think being up front that you think it will take 5 years to complete the therapy is a good idea. That this isn't a quick fix is key. But for people with bad allergies or long term users of OTC treatments this might be clarity they need for long term treatment. Also you might want to compare it to other long term life therapies, like braces..which are almost as expensive. I like the idea..I think the $99 price tag a month for 5 years might be a sticker shock though.


Here's an image of the cookie pop-up. https://imgur.com/tu2flYc

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".


It looks like Brave browser blocks our HIPAA-compliant scheduling software, Cogsworth. I'll look into this.

Thanks for flagging it!


How effective is this against eczema? Without proper insurance, this is a better deal than medications like Dupixent, right?


I recently started allergy shots, and am also on Dupixent.

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.


I'm glad to hear about your Dupixent journey! We're looking forward to getting some. Thanks for the insight on allergy drops.


As someone who's battled this my whole life, and gone down a crazy number of rabbit holes on it, my personal recommendation to you is to try elimination diet.

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.


Wow, thank you, I've finally found a name for the rash I used to get on my hands. It showed up when I ate wheat several days in a row, when I played with Play-doh, and when I used latex dishwashing gloves. Took years to figure it out. I still have scarring because of it.


A high profile example of what you state is Jordan Peterson.

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...


We do not suggest allergy drop immunotherapy for eczema.


Is IgE present in the bloodstream if I have not been exposed to the allergen recently? E.g. will I show as positive for a pet dander allergy if I have not been around pets for many years?


Yes, the test can detect allergies even if you haven't been exposed for some time.

However, we can use any allergy test you have -- a QuestLabs ImmunoCap or a traditional mulit-needle scratch test.


I'm trying to interpret this statement. Are patients paying for therapy for 5 years before seeing effects, or is a course of treatment valid for 5 years?


Sorry about that! I'll try to be more clear:

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.


When do the drops reach their max potency ?


Our protocol is proprietary, but in general the drops reach maintenance dosage between 3 to 9 months.


Well I definitely have some mild environmental allergies (some cats & rabbits) but nothing life threatening. This somewhat reminds me of 23&me, except with some obvious potential quality of life improvements.

Ordered an Allergy Test kit.

Will update everyone in 5 years if it was worth it or not! :)


I would recommend toning back some of the emotional language in your treatment comparison table -- things like "confusing terminology", "Busy staff with no time to help", and "Unhelpful Google searches". Your value prop of convenience of no shots is super obvious to me but the biased comparison table is a turn-off. It would give me a lot more confidence if the language in the table were more scientific and clinical. Specifically, I want to be able to look at the table and know for what type of person In-office shots would be better than At-home drops instead of being distracted by the language.


Yea, the emotional tone has me thinking this is more "essential oils cure all" than it is actual science.

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.


If you have allergies and have doubts, you can speak directly to a physician with a free visit: https://www.wyndly.com/allergy-visit

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?


No specific question. My comment was more a voice on my thought process, not a critique; apologies if it came off as a critique.

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 :)


As someone who works in healthcare I’d tone down the language before the FDA sends them a warning letter.

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.


Good marketing is emotional. Thr target audience probably has very little overlap with the HN audience.


Yeah, I was gonna say that I actually quite like a lot of the copy; it speaks to a consumer's specific problems and feelings, which is, like, marketing 101.


Thanks for your feedback! When we redo our site, we'll keep it in mind.


A couple of friends and I (back in London) tried to work on this exact same problem, we built an allergy-log app which in theory was going to sync with the doctor's office so that they could recommend a therapy (or even skip the visits with docs and specialists). Our monetizing strategy was to ship you the "therapy" and take a cut - we worked on it for 6 months and then..life threw us some lemons. Definitely a good idea and a missed opportunity!

As an allergy sufferer, I am super happy that you're pursuing this, going to bookmark it - good luck!!


I’ve thought about similar apps, and gave up on the end because allergies were to complex to surface through logging. What type of allergies and tracking were you working on?


The most common ones in food and the most common ones in the air. Our idea was to track how people react, compile a log and have it processed so that we can tell them - yup you have this one allergy because of this pattern of what you ate, did, the air you breath etc. based on the evidence submitted. It was a very long "LOG" but if people were serious about compiling it and didn't l eave things blank, the folks on our med team were certain we could have given them a "cure" that worked for their allergy.

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.


Thanks for that. In my case I suffered guessing and tracking for years before I gave in and had extensive tests done. As for cures, that’s another story.


I have a dust mite allergy and have tried doing this in the past, but had to stop because I moved away from my allergist. I would be interested in this type of service, but $99/month is a bit expensive for me. I have health insurance, is there any way I could get them to pay for it for me?

I have had surgery for nasal polyps related to this twice if that might help my case.


Unfortunately, we don't accept insurance right now because of the complexities involved with insurance and telemedicine (the laws are literally being written right now).

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.


I’d do this in a second if you accepted insurance. It’s a huge hassle to go and get shots especially given I have to wait like I’m waiting on the doctor (sometimes it’s 30 mins then I have to wait around to make sure I’m ok.

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.


I’ve been doing SLIT in the US for ~2 years. The drops themselves are off label, and no insurance will cover it. I’m allergic to basically everything and the drops are $250 for a 90 day supply. So that’s $1k/year already. After copays for office visits I’m definitely in $99/mo territory.


Have you considered trying those ultrasonic dust mite repellents? They work for me and really made a huge difference.


> $99/month is a bit expensive

$99/mnth for possibly 5 yrs is a helluva commitment. Most people are going to have difficulty with both the cost and time IMHO.


Before starting SLIT I was unable to spend more than an hour outside in the spring before I turned into a disgusting mess (this is with daily OTC pills). Now I can go play with my kids all day in the sun. $99/mo is well, well worth it.

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.


Pre-Covid the cost of just getting my “specific doses” of the compounds I needed was $850 with insurance. Regulations changed apparently and they couldn’t reuse the same combo of like pollen, cat/dog etc so each client needs a “custom” formulated dosage.

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.


Congratulations Aakash and Manan on your launch! Talk about addressing an actual, physical pain point. Best of luck unstuffing the nation. A few questions: 1) How many months treatment time is necessary to see recognizable results? 2) How soon after starting Wyndly treatment can users stop using antihistamines such as anti-histamine pills and inhalers? 3) Generally how long must treatment be maintained before it can be stopped, and how long will the results last? A European poster in this thread mentioned his dust mite allergy requires 3 years of drops before they can be stopped for 3 years, after which the treatment must be repeated.


Thank you!

Patients see improvement in symptoms after 6 months, with some patients reporting improvement as soon as 6 weeks. For most patients, this means they can stop taking their antihistamines.

You mentioned inhalers. While there has been connection between allergy immunotherapy and asthma, allergy immunotherapy is not a replacement for your asthma inhaler.

If a patient stays on drops for 5 years, they can expect decades of allergy relief after they stop the drops. If the patient stops taking their allergy drops earlier, they will still see a reduction of their allergy symptoms, but it won't last for decades -- it may only last a few months, depending on how long they took the drops.

I just saw the European poster. I don't have the details of his treatment, so I can't address why they had to repeat their treatment. For our patients, the goal is lifelong allergy relief as easily as possible. We don't want you to have to repeat your treatment. If you never talk to us after your treatment, that means we did something right.


Do you have a patient transition plan in place in the unfortunate case of Wyndly dissolving or a contingency for continual treatment for the duration of the 5 years?

It seems that it would be rather difficult for a patient to transition to another providers care on their own given how few doctors are working with SLIT.


We partner with physicians and pharmacies to provide SLIT. If anything was to happen to Wyndly, we'd transition patients directly to these physicians and pharmacies and make sure the patient experience was as seamless as possible.

It's incredibly important to us that our patient experience is as easy and seamless as possible. We'd bring this same philosophy to any transition.


Thank you for the info, which I'll gladly share with friends and family that are sufferers. What determines when the user has achieved relief and can stop the drops treatment? What data or tests allows Wyndly to know if a user has achieved relief in 2, 3 or 5 years?


Patients experience relief when they no longer have allergy symptoms.

Here are some research papers you can share:

Long-lasting effects of sublingual immunotherapy according to its duration: a 15-year prospective study https://pubmed.ncbi.nlm.nih.gov/20934206/

Efficacy and Safety of Subcutaneous and Sublingual Immunotherapy for Allergic Rhinoconjunctivitis and Asthma https://pubmed.ncbi.nlm.nih.gov/28964530/

Clinical improvement after escalation for sublingual immunotherapy (SLIT) https://pubmed.ncbi.nlm.nih.gov/21938688/


OK a few points from someone who uses oral drops for (strong, class 6) dust mite allergy.

* 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


Thanks for sharing your experience! It sounds different from many of our patients' experience -- we don't want our patients to have to repeat treatment!

Our goal is to give our patients lifelong allergy relief with as little hassle as possible.


My personal experience is obviously limited - I'm using Staloral drops, they're very popular in Europe. Also, they seem to be very effective[0]:

"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.

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363974/


Genuine question: there are already many others doing this, including online. For example:

https://myallergydrops.com/

https://www.allergyeasy.com/

How do you folks differentiate?


When we started Wyndly, we didn't find anyone doing the patient-focused care that we would want if we were patients. Our patients love our treatment and our patient experience, and that's what's most important.

We're happy to see that other people are trying to make oral allergy drops more popular! Allergy drop immunotherapy is easier and more convenient than the standard allergy shots.

I can't speak to these specific companies -- I am not familiar with them and their business models.


Haha fair - "we don't differentiate" is a totally fine answer! It's a tool that should be more widespread. The reason I was asking is historically these companies haven't done well (AllerDrops is another example), and so I'm curious as to if you've looked at them at all, that's all. :)

FWIW, SLIT didn't work for me, but shots did. Everyone's different! :)


Considering that first link just has big buck bunny for all their videos and stock photo testimonials im guessing they aren't actually operating


Yeah, you are right. OP has stock photo testimonials but at least got rid of any stock videos :)


This is awesome. I have been following SLIT and SCIT for a while and it's great to see a startup helping to make SLIT more accessible. It's quite hard to find a local provider unless you live in a big city.

One question for you: What do you base your maintenance allergen dosage on? (e.g., research studies, your clinical experience, what Europe does, something else). Specifically, could you let me know for dust mite droppings, what your dosage is?

I ask because I've been thinking about SLIT for a while, but I follow the allergy subreddit and there's a guy on there that seems to comment on every single SLIT thread saying that in the US, the allergen level used for SLIT is way too low, and much lower compared to what is used in research studies [1]. He cites a bunch of research papers that seem to support what he's saying, so would love to hear your perspective.

[1] Here's an example comment by larkasaur; https://www.reddit.com/r/Allergies/comments/in0v4j/is_anybod...


I have mixed feelings about at home allergy testing. I know that various clinical labs may have their own reference ranges for IgE/*. Combined that with a low amount of blood collected and sampling exposure time, the data would seem very messy unless you have a high quantity of samples.

Are you recommending people to collect the blood sample right after exposure to the allergen? How is that used in your dosage recommendations?


This is a great question!

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.


This is amazing. I was not happy when my doctor told me I had to do 3 shots, twice a week, for my allergies, with 30min wait time at the doctors, while I could have just had sublingual pills from the comfort of my home if I were in Europe. Those shots lasted for 5+ years... Really hope the best of success to your start-up !


Allergy shots have their place, but for most patients they're much too inconvenient! Thank you for your kind words.


As someone who did 5 years of immunotherapy, which changed my life, I can vouch for this being a brilliant idea.

My allergist told me after completing the full course of treatment that <10% of patients do so because of the diligence required to do weekly shots week in week out.


Thanks! We really are trying to make allergy immunotherapy more convenient and accessible.


Glad to see more people working in this space. Hopefully you will be able to treat food allergies in a similar way, e.g. working up the milk ladder with a set course of pills.

My son was born with multiple food allergies, and whilst he has outgrown some, the current approach here is 'wait and hope they grow out of it' or 'try introducing the allergens very gradually so that the immune system learns to not react to the allergen').

One suggestion - state what allergies you can currently treat above the fold. I shouldn't need to scroll down to learn it is only for pollen, pet, and dust allergies. Best of luck!


Hi, This is so very timely! I just got a allergy skin test yesterday for animals and in the doctor's words it was "negative" - however my irritated eyes would disagree - and the fate of the guinea pig in my living room is hanging in the balance.

Given the number of google results for this it would be great if you discussed how a skin response could be different than a sinus/eye response...

Also, in the section for the at home blood test - i'd be interested in understanding how blood test differ from a skin test and if it's less subjective. While I have a hive response to bee I don't have any to dog... does the blood test give me specific #'s on this spectrum? Do you use these as inputs to provide an appropriate dose of that allergen, or are all starting doeses very low.

How does this work for something like a severe bee alergy?

Given the complexity of allergies and the numerous ways they have symptoms, it would be great if you discussed how immunotherpy can help individual symptoms. Perhaps your UX could have a journey that the customer goes down. What are you alergic to? Where do you see symptoms? How bad are they? -> here's our recommedation and research that backs up why this will work for you.


I read that other oral allergy drops are best suited for individual allergies and that shots are best if you have multiple allergies. Is that true for these drops?


My allergies are seasonal and pet related, and they provide me some nuisance every year but aren't generally debilitating. That said, itchy eyes and a nasal drip are annoying and there's probably some amount I'd pay to just not have to deal with them.

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?


Allergy drop immunotherapy (SLIT) can help allergy sufferers with both sever and mild symptoms have significant reduction in their symptoms -- or, in your language, it helps people with low-grade allergies too. However, if an over-the-counter allergy med is all you need, then maybe that's the right treatment for you.

Our treatment is for people who don't want to worry about taking an allergy medication during allergy season at all.


I'm so dependent on Singulair and Zyrtec daily but it's so hard to get actual allergy treatment. I'm so excited to hear about this treatment because even with great insurance in the USA the doctor experience has been abysmal. How can I get started?


The fastest way to get started is to share your allergy history for one of our physicians to review: https://form.jotform.com/210268541588057


Have you looked into doing drops for pets? Both of my dogs get bad seasonal allergies. Their paws get so itchy they will lick the fur off unless we get them help. The allergies start up in July and persist until the first frost of the season (late October or November).

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.


Interesting! Maybe that's an expansion opportunity after we've treated all the humans.


It would be fantastic. Regular allergy pills for dogs is insanely expensive ($100+/month).

If there’s a way to spend $25/month on this for my dogs I’d be all in!


We’ve been trying to find a suitable partner in this space. Email me salim at AsthmaMD.org


Will do!


As someone with food hypersensitivities (not quite typical/traditional allergies), is there a usecase for me to take these drops and hope they will also improve my unusual issues?

Examples of symptoms: stomach upset/aches, acid reflux, chills/sweats, nausea (though typically only when the symptoms are very bad)

Examples of triggers that I know of: most tree nuts, fresh pineapple, fresh kiwi, kale, most fish

It's an odd situation because I've had allergy panels done, and the results of those don't match but the doctors have insisted it's an issue of hypersensitivity, which sounds like an umbrella term under which normal allergies fall under.


Hi! Wyndly only treats environmental allergies like pollen, pet dander, and dust. We do not treat food allergies or sensitivities.

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...


As a life long sufferer of cold/flue (once every 3 months bout lasting for over a week), I tried various natural things on myself. I probably have found solution that works for me. Allergy/cold free from 2015-6 ( go only when I deliberately tried to get it to find out if it works) and worked during 2020 too. Even worked for my family too. I even wrote to CDC director about it (but no response). How does one go about does one go about finding efficacy on others? I'm into software so have no clue. tia.


This is incredible, congratulations on your launch!

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?


Sure! Send a quick email to aakash@wyndly.com


One gap in the website that may be deliberate: I don't see any "how long will I be using the drops?" information. You posted it here, but not on the site (or if it's there, it's not obvious).

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.


Every patient is different, so we've not made a blanket statement on our website saying "you're with us for 3 years!"

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.


Aakash, what is the intended age for this product? I am asking because I have two younger children with food allergies.


OIT (oral immunotherapy) and SLIT (sublingual) is still in a clinical research stage for food allergies; however, a small subset of doctors do currently offer it in their own practice outside of the research setting (see oit101.org). Some of these practitioners do tell patients at some point that they have achieved "sustained unresponsiveness." Most allergists do not yet offer it as there is no standardized protocol for it, it's not considered "standard of care."

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.


Hi! Children as young as 4 can start on allergy drops.

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...


Right before the pandemic started I went to an allergist and was considering getting shots, but obviously the last year has put many things on hold.

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?


We can use your existing results. Email team@wyndly.com and we'll collect your allergy test results in a HIPAA-compliant manner.


I can't see anyone referring to the FDA directly here. Can you be explicit about the FDA approval process for what you are doing?

Where does it sit, in approved treatments?

(not a US resident, so this is at best, indirectly relevant to me but the Australian equivalent process would reflect on what the FDA said)


The FDA has approved the individual allergens (allergy triggers) that are used for allergy immunotherapy, both allergy shots and allergy drops.


How will you deal with an anaphylactic shock when someone takes too much of your therapy product?


The good news is the 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.

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.


I need a bit more clarification to

> .. 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/)


Absolutely, one great paper that summarizes many of the studies is the Cochrane review. They are an independent scientific body focussed on evidence based medicine. You can read the Cochrane review article on sublingual immunotherapy here:

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


Congrats on an awesome launch homie :) My brother is severely disabled and I've always hoped he could have a companion dog but he's severely allergic. This very well could changes things. Cheers to a hella bright future.


Hi bud! Can't wait to see you in person after everything returns to normal.

If I can help with your brother, let me know.


Also, is it a one-size-fits solution for dog allergens or does it vary by breed?


Much appreciated! I'll talk to my mom about it and see if she'd be down to try it for him. He's been exceptionally reactive to vaccines and allergens so there may be some hesitation. If you have any info about this therapy being used by people with autism, mental disabilities, etc. hook me up.


Going to take this off of HN and text you


Congrats on the launch! I live with two cats and sadly I am allergic to cats. It's not super bad but certainly noticeable. Will your treatment work for people like me?


Yes, Wyndly at-home allergy drop immunotherapy does help with cat and dog allergies! Many of our patients come to us because of a small baseline allergy that impacts their quality of life.


This sounds incredible.


Thank you! It's unbelievable that so many people struggle with managing their allergy symptoms instead of trying to take care of the root cause. We're hoping we can change that.


What is the root cause?


Allergic reactions begin in your immune system. When a harmless substance such as dust, mold, or pollen is encountered by a person who is allergic to that substance, the immune system may over react by producing antibodies that "attack" the allergen. The can cause wheezing, itching, runny nose, watery or itchy eyes, and other symptoms.

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.


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You can't accuse another user like that. We ban such accounts. Please read the site guidelines and don't do it again.

https://news.ycombinator.com/newsguidelines.html


How are oral doses tailored for regional pollen allergies? For example, the US Northwest flora is different from the Tennessee Valley flora.


Each patient’s allergy drops are prescribed individually by their physician based on their symptom history, allergy test results, and region. So yes, the northwest patients typically are treated for different pollens than those in Tennessee valley, however, it is usually even more specific than that: one patient in the same region will likely have different sensitivities and thus a different prescription than another in the same region. This is why the treatment has to be individualized per patient.


Ah... thanks for the answer. I also did not know that the physician has to prescribe the plan. Makes sense now.


Great YC idea, 99/month is expensive, you'll be priced out. Look at channel selling/private labeling through primary care.


I suffer from awful allergies and went through shot-based immunotherapy! I'm excited to give you guys a try!


So how does a vaccine train your body to attack an antigen but allergy shots/drops do the opposite?


It actually works in a very similar fashion. Both vaccines and allergy drops change the immune system and create antibodies. In the case of vaccines, your body creates antibodies that bind to the virus to prevent them from causing symptoms of the virus (sickness/illness).

For allergy shots/drops your body also makes antibodies to bind to the allergens and prevent them from causing symptoms of the allergens like sneezing or nasal congestion. So both work in a similar mechanism. The challenge with allergy drops and allergy shots is the clinical data shows that it takes a much longer time for your body to create an immune system change that decreases your allergy symptoms than it does for your body to create antibodies to block a virus. Does this make sense?


Interesting. I still don’t see why one causes inflammation and one lessens it.


I really want this. Any plans to address shellfish allergies?


Right now, Wyndly only treats environmental allergies like pollen, pet dander, and dust. We do not treat food allergies because oral immunotherapy for food allergies is still being researched.

Stanford has a shellfish clinical trial going on right now. See https://med.stanford.edu/allergyandasthma/clinical-trials.ht...


Don’t use them. They use arbitration clause. You will lose your rights.


What is the efficacy difference between shots and drops?


Are you able to service customers in Canada?


We only serve the United States right now. If you search around Canada for a "sublingual immunotherapy allergist" you might find a physician doing this in Canada.


What about Americans traveling overseas? Is shipping the issue? is there a way to pre-ship a larger supply in anticipation of a longer trip?


Will you be coming to Canada any time soon?


"The Providers are independent of Wyndly Health and are merely using the Site as a way to communicate with you. Any information or advice received from a Provider comes from them alone, and not from Wyndly Health."

So...

Who makes the drops?

Who decides what goes in them?

Where are they made?

Under what conditions?

Are they approved by the FDA?

You post some publications about the benefits, but how am I supposed to be able to evaluate what you're offering and verify that it's not some pseudoscience like homeopathy?


ayyy my boi going hard, go akash


Hi there, Bucky!


YC startups are becoming scum bags day by day. Can you address this? If your treatment is faulty, why do I need to give up my rights?

Binding Arbitration. These Terms of Use provide that all disputes between you and Wyndly Health that in any way relate to these Terms of Use or your use of the Site will be resolved by BINDING ARBITRATION. ACCORDINGLY, YOU AGREE TO GIVE UP YOUR RIGHT TO GO TO COURT (INCLUDING IN A CLASS ACTION PROCEEDING) to assert or defend your rights under these Terms of Use. Your rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury and your claims cannot be brought as a class action. Please review the Section below entitled Dispute Resolution; Arbitration Agreement for the details regarding your agreement to arbitrate any disputes with Wyndly Health.


Pretty harsh and uncalled for feedback that’s not constructive at all.

Calling them scumbags because of their T&Cs instead of asking for why they have such language in there is counterproductive in any civil conversation.

Maybe there’s precedence they’re following or it was an overzealous lawyer writing it and they haven’t taken a second look because you know, getting a business off the ground is hard work.




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