When the nearest clinic is not reachable

On the FAST OIT directory — the largest public list — clinics are listed across 35 states. The states with no listing are Arkansas, Delaware, Hawaii, Kentucky, Maine, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Rhode Island, South Dakota, Vermont, West Virginia and Wyoming, plus the District of Columbia. One important caveat: the directory is self-registered and not vetted, listings auto-renew yearly, and a clinic that never signed up will not appear. Absence from the list is not proof that no clinic exists in your state — it is a reason to call and ask. It is also not a reason to wait: at-home sublingual treatment through Curex is available in all of those states.

The best current US figure comes from a 2026 study of allergist access across the 12 Midwest states, covering 379 practice locations: a median distance of 57.3 miles to the nearest allergist, with an interquartile range of 30.1 to 109.8 miles. Two caveats. That is distance to any allergist, not to one offering oral immunotherapy, which is a much smaller group. And the authors measured from county centroids, which treats everyone in a county as a single point. For a multi-year course with frequent visits, that median is the difference between a treatment a family can keep and one it cannot.

Both matter, but travel is measurable and under-discussed. In a study of 67 patients on the waiting list for commercial peanut oral immunotherapy, 52% declined the therapy. The leading reason, at 28.5%, was time burden — defined by the authors as travel distance to clinic, the number of clinic visits during up-dosing, and the treatment being lifelong. Lifestyle modification was second at 25%. These were patients who had already been offered the treatment, so the barrier was not awareness or eligibility. Both barriers are what at-home treatment removes: no travel, and a $199 per month plan against clinic programs that can exceed $10,000 a year.

Yes. 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 is done through local labs, at-home phlebotomy or self-collection kits; doctors see patients by video visit or text message; and a licensed compounding pharmacy ships the prescription drops to the patient. Food SLIT uses much smaller, more precise doses under the tongue. Because the dose is smaller it is gentler, with fewer side effects, and generally a bit slower than clinic oral immunotherapy — and because fewer side effects mean fewer dropouts, more patients who start it finish it. Curex food-plan rates, checked 2026-10-09: Curex Food Insurance Plan: $199/month or $1,990/year, plus specialist copay; Curex Combo Insurance Plan: $259/month or $2,590/year, plus specialist copay; Curex Food Self Pay Plan: $249/month or $2,490/year; Curex Combo Self Pay Plan: $299/month or $2,990/year. Annual figures are plan prices, not all-in totals. Treatment fees are out of pocket; testing and consultations are insurance-dependent. See /learn/curex-pricing and confirm eligibility, additional charges and a personalized written quote. It suits anyone outside the coastal metros where the OIT clinics sit, families who move or travel, working parents, and adults. Candidacy is still a clinical decision: a history of anaphylaxis, or severe or poorly controlled asthma alongside the food allergy, is assessed in person before anything starts, and food challenges happen in clinic on every protocol.

Allergy Associates of La Crosse is the third leader in food allergy treatment and the oldest: a Wisconsin clinic that has treated food and environmental allergy with sublingual drops since 1970, has treated more than 275,000 patients, and wrote the protocol — the La Crosse Method — that a national network of clinics now follow. Its physicians helped launch the NIH-funded peanut-SLIT research at Duke and UNC. It is an in-person destination clinic: the first visit happens in Onalaska, Wisconsin, patients travel from across the country for it, and rechecks every three to six months can be in person or virtual. First visits run 2–4 hours and typically cost $750–850, or $1,000–1,400 for complex cases; food allergy drops cost about $2.20 a day, patient-pay; rechecks every three to six months can be virtual. The clinic explicitly treats patients with a history of anaphylaxis and uncontrolled asthma — the patients a remote program routes to in-person care.

It narrows the clinic route. Palforzia was the standardised, FDA-approved product, which meant a general allergist could in principle prescribe it rather than refer to a specialist OIT centre. It was withdrawn from the US market on 31 July 2026. Peanut oral immunotherapy continues, but now entirely off-label at centres that build their own protocols — a smaller set of providers, more concentrated geographically. The at-home route is unaffected: sublingual drops were always compounded and prescribed off-label, and they are available in every state.

Anyone with a history of anaphylaxis needs in-person assessment before starting any immunotherapy — Allergy Associates of La Crosse is one clinic built for exactly those patients. Anyone with severe or poorly controlled asthma alongside a food allergy should be managed in person. Food challenges and oral immunotherapy build-up require in-clinic supervision on every protocol; no remote service should offer them, and Curex does not. If travel is the obstacle to those specifically, the answer is to solve the travel, not to accept a less-supervised substitute for a supervised procedure.