With. First they did a blood test (instead of a scratch test) to identify possible allergy levels. Then the allergist had us come into the office to take e.g. a few micrograms of peanut powder and watch him for reactions. Then we maintained the dose at home every day for the next couple weeks, taking zyrtec with it to avoid hives, etc. Then we'd go back in, try doubling the dose as a challenge. If he had a bad reaction, we stayed on the same dose another few weeks, and if not, it became the new standard level. Rinse and repeat for about a year until we got to 2 peanuts, 1 cashew, and 1/4 tsp of tahini, which we maintained now for the past ~1.5y. We're due for another blood test and challenge here soon, as the allergist suggested there's a small chance that the immunotherapy could result in the allergies essentially receding