Clinicians show inconsistent compliance with peanut allergy guidelines, screenings
Clinicians did not consistently adhere to peanut allergy–related guidelines or conduct proper allergy screenings, according to three different abstracts presented at the American Academy of Allergy, Asthma and Immunology Annual Scientific Meeting.
Infants aged 4 to 6 months old
In the first abstract, Ruchi S. Gupta, MD, MPH, professor of pediatrics at Northwestern Medicine and Lurie Children's Hospital in Chicago, and colleagues reviewed responses from 369 pediatricians who answered an emailed survey regarding the 2017 Addendum Guidelines for the Prevention of Peanut Allergy. These guidelines recommend assessment for peanut allergy in infants aged 4 to 6 months old before early introduction of foods containing peanut.
Gupta and colleagues found that 11% of clinicians did not use the guidelines at all, 62% used parts and only 28% used all the guidelines.
“The results were realistic. It is very hard to follow the full guidelines for pediatricians as they have a ton of things to review at these well-child visits in a limited amount of time,” Gupta told Healio Primary Care Today.
Pediatricians said the most common barriers to completely following the guidelines was parental concerns about allergic reactions (41%), followed by understanding the guidelines (35%), lack of clinic time (30%), novelty of the guidelines (29%), and performing in-office peanut ingestion (28%).
“We need to work with pediatricians to develop the resources that work for them including decision support tools to help them determine high or low risk and next steps easily and quickly and parents support materials,” Gupta said.
Infants aged younger than 12 months
In the second abstract, David E. Tapke, MD, MPH, an allergy and immunology fellow at The Ohio State University Wexner Medical Center and Nationwide Children's Hospital and colleagues conducted a retrospective chart review of infants with suspected eczema or egg allergy who had at least one well-child visit.
Tapke and colleagues found that early peanut introduction occurred in 3.3% of the 240 well-child visits conducted at 4 months, 3.3% of 238 well-child visits conducted at 6 months and 3% of 172 well-child visits conducted at 9-month visits. Eczema skin care was discussed in 61.7% of the 4-month visits, 64.7% of the 6-month visits and 51.7% of the 9-month visits.
“Going into the study, I expected to find that there were missed opportunities in the primary care setting to discuss early peanut introduction. I was still somewhat surprised that these discussions were taking place so infrequently,” Tapke told Healio Primary Care Today.
He sensed a knowledge gap and time constraints attributed to the findings.
“Having done my residency in pediatrics, I appreciate the challenges faced by pediatricians as they navigate comprehensive well-child visits with busy schedules,” he said.
“While time constraints certainly play some role, part of the issue is still a lack of awareness of the guidelines. I think most pediatricians have a general sense that early introduction of peanut was shown to be beneficial from the LEAP study, but the ability to translate that knowledge to clinical practice is a process that will take time,” Tapke said.
Clinicians who are unaware of the guidelines should consult the National Institute of Allergy and Infectious Diseases website, he added.
Infants aged less than 11 months
In the third abstract, Sofija Volertas, MD, an asthma and allergy fellow at the University of Michigan and colleagues conducted a retrospective chart review of 81 infants aged younger than 11 months who were tested for peanut allergy at an outpatient allergy clinic.
Of those 81, 67 were referred by pediatricians, and 33 met National Institute of Allergy and Infectious Diseases screening guidelines. Of those 33, 12 had a negative skin prick test, eight had a skin prick test wheel of 3 mm to 7 mm and five had a wheel higher than 7 mm.
“Reasons for referrals not meeting guidelines include mild-moderate eczema and family history of food allergy. Infants who meet criterion for screening prior to introduction are also being missed. [The] guideline to offer challenges to patients with a skin prick test of 3 to 7 mm is often not followed,” Volertas and colleagues wrote. – by Janel Miller
Gupta RS, et al. “Implementation, practices, and barriers to the 2017 Peanut Allergy Prevention Guidelines among pediatricians.”
Tapke DE, et al. “Implementation of early peanut introduction guidelines among pediatricians.”
Volertas S, et al. “Infant peanut allergy testing in the post-LEAP world.”
All presented at: American Academy of Allergy, Asthma and Immunology Annual Scientific Meeting; Feb. 22-25, 2019; San Francisco.
Disclosures: Healio Primary Care Today was unable to determine the authors’ relevant financial disclosures prior to publication.