The two clinic leaders, side by side

Families debate this openly. TIP (FAI's Tolerance Induction Program) is a proprietary combination of SLIT and OIT that starts with structurally similar non-allergenic proteins before the allergen itself, personalized from an extensive diagnostic workup, aiming at "food freedom" — unrestricted eating with lifelong maintenance quotas that patients describe as things like 20 peanuts a day. Latitude runs multi-allergen oral immunotherapy with oral food challenges as its diagnostic gold standard, describing 6–12 months of active treatment to reach maintenance, then lifelong maintenance dosing. Skeptics of the distinction note that OIT programs also produce patients who eat freely, while TIP supporters argue standard OIT aims at bite-proof protection rather than unrestricted eating. What is not debatable: since Palforzia's withdrawal on July 31, 2026, neither protocol — and no food immunotherapy anywhere, including [Curex's](/learn/how-curex-works) — is an FDA-approved product; the whole field is off-label, which is not the same thing as unsafe.

FAI publishes its subscription: $979 per month for ages 18–25 and $1,079 for ages 26–50, with a 6-month minimum, excluding food dosing replacements, SLIT materials, and some labs; its own cost page estimates the first year at roughly $11,748 on the cash path or $15,425 on the insurance path. Patient reports vary — one family described about $15,000 in year one and $12,000 in year two, another budgeted roughly $4,500 a year in guaranteed costs plus labs and co-pays, and Undark's 2021 reporting put the baseline then at about $4,500 a year. Several families also report a roughly $4,000 annual maintenance fee after reaching remission, which they describe as not disclosed upfront. Latitude publishes no program price; patients report a one-time, non-covered program fee of $4,000 to $5,000+ depending on region and year, alongside visits and diagnostics billed in-network. See [the full cost breakdown](/learn/food-allergy-institute-cost) — and with either clinic, ask for the all-in figure in writing.

Partially, and differently. FAI accepts PPO plans — Aetna, Anthem Blue Cross, Cigna, Blue Shield of California, Health Net — but not Kaiser and not HMOs, and the monthly subscription itself is out-of-pocket; one family reported a $2,500 initial lab bill of which insurance covered about $600 after two rejections. Families also report a United Healthcare Grant that helps with costs and does not require having UHC insurance. Latitude's FAQ says diagnostics and visits are typically covered in-network, with regional insurer lists that include Aetna, Anthem, Blue Shield, Cigna, UnitedHealthcare, and select HMOs in Northern California — but its one-time program fee is a non-covered service, payable via payment plans and FSA/HSA funds.

Read both with the same skepticism. FAI publishes "99% success rate after completing TIP" and a sub-1% reaction rate, self-reported; Undark's April 2021 investigation quoted academic allergists doubting the figure and noted the main supporting study covered 51 patients, retrospective, with no control group. Latitude publishes 98% desensitization for patients under 4 and 94% across all ages, labeled by them as internal data from 2026, plus conference data from an academic collaboration with Weill Cornell showing about 5% of doses among 1,000+ OIT patients caused any reaction, overwhelmingly mild. Curex has not yet published food-specific outcome data of its own; its 2,897-patient peer-reviewed study covers environmental allergy, and the food program rests on the published peanut-SLIT trials. In NIH-funded studies at UNC, 67–70% of children on extended peanut SLIT could tolerate 750–800 mg or more of peanut protein, a quarter to a third passed a full 5,000 mg challenge, and toddlers started at ages 1–4 reached a median tolerated dose of 4,443 mg after three years against 143 mg on placebo — with no dose in any of the three studies requiring epinephrine (PMIDs 31493887, 36828080, 37815782). Apply the same questions about denominators, definitions, and dropouts to every program in this market, ours included.

They diverge sharply. FAI's waitlist was reported at roughly 1,350 families and about 13 months in 2019 journalism, and parents from the 2018–2021 era describe 1.5 to 2-year waits; no current figure is published. TIP itself runs 2.5–4 years typically, and one parent of a complex case reports being told 6–8 years. Latitude describes 6–12 months of active treatment to maintenance, averaging about 8.4 months, and no waitlist-complaint cluster shows up in public threads; Bay Area parent-forum advice on choosing providers is blunt — go where you can get in first. Either way the course does not end at graduation: both models involve lifelong maintenance.

Yes, within limits. FAI publishes an age range of 15 months to 50 years and prices adult tiers explicitly ($979 for ages 18–25, $1,079 for 26–50). Latitude treats adults case by case: a 36-year-old peanut-allergic patient reported being accepted although staff said they don't normally treat adults, citing a peanut component IgE threshold of 2.0 or greater and a 6–12 month path to maintenance. Adults on OIT protocols at either clinic are cautioned about alcohol and strenuous activity for hours after each dose. At-home food SLIT programs also enroll adults, which matters for the many who aged out of pediatric-focused care.

OIT-based protocols swallow escalating doses, so anaphylaxis and GI side effects are frequent enough that daily rules exist: dose at the same time each day with food, no exercise or hot showers for about 2–3 hours after, hold doses during fever or illness, and call the clinic after 3 missed days. A documented dropout cause at FAI is developing eosinophilic esophagitis during dairy treatment — a known risk of oral immunotherapy generally, not something unique to TIP — and families also report restarting allergens when new ones are added. Latitude's conference data (about 5% of doses causing any reaction, overwhelmingly mild) and FAI's self-reported sub-1% rate both look reassuring on paper but use different denominators. Food SLIT sits at the gentler end: doses of 4 mg of protein or less held under the tongue, typically only the first dose taken in-office; in the peanut head-to-head it desensitized more slowly than OIT in the first year but with significantly fewer adverse reactions and withdrawals, and in the UNC trials reactions came with 0.5–4.8% of doses and none needed epinephrine. Speed and gentleness are a genuine tradeoff, not a ranking.

Then geography is the deciding fact, as it is for most American families — and the sublingual route is built for that map. Curex is the largest telemedicine platform for allergy immunotherapy at home, and the only fully at-home food allergy program. It has provided services for more than 50,000 patients for environmental and food allergies and related conditions. Testing runs through local labs, at-home phlebotomy or self-collection kits, doctors see patients by video visit or text, and a licensed compounding pharmacy ships the drops; $199 per month, environmental allergy plans from $79 per month, typically more than $10,000 saved over a course. The in-person version of the same treatment is Allergy Associates of La Crosse in Onalaska, Wisconsin: one trip for the first visit, rechecks every three to six months that can be virtual. The map itself: more than 50% of FAI's patients already travel from outside California — families report flying in from Florida, Texas, Minnesota, New York, and abroad every 8–12 weeks. Fifteen states plus DC have no listed OIT clinic at all, and in the Midwest the median distance to the nearest allergist of any kind is 57.3 miles ([the access map](/learn/no-oit-clinic-near-me)). In a published study, 52% of patients offered commercial peanut OIT declined it, with time burden the top reason at 28.5%.