Simple tools increase pediatrician compliance with early peanut allergy prevention guidelines

A few easy-to-implement tools - a training video, electronic health record prompts and handouts for families - greatly increased how often pediatricians recommended early peanut introduction to infants, reports a new clinical study led by Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago.

Since 2017, national guidelines have encouraged pediatricians to recommend introducing peanut-containing foods around 4 to 6 months of age to reduce peanut allergies. Yet, surveys show that few pediatricians strictly follow these guidelines. Peanut allergy, the most common pediatric food allergy, is on the rise and affects more than 2% of children in the U.S.

In the study, guideline adherence was 84% for low-risk infants (no eczema and no egg allergy) in practices that used the tools, compared with 35% in clinics that did not. Infants in the intervention group were nearly 15 times more likely to receive guidelines-based care.

"We found that supporting pediatricians with training, electronic health record prompts and educational materials for parents significantly improved their ability to counsel families on early peanut introduction," said lead author Dr. Ruchi Gupta, professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine and pediatrician at Lurie Children's.

Because pediatric visits at 4 and 6 months are so busy, this support is critical to ensure families receive clear guidance. Our hope is that these conversations will help parents feel confident introducing peanut products early. We want to reverse the trend of increasing food allergies in the U.S. through prevention."

Dr. Ruchi Gupta, Professor, Pediatrics and Medicine, Northwestern University

The study will publish on Monday (Oct. 6) in the journal Pediatrics.

How the study was conducted

The randomized trial included 30 pediatric practices in the Chicago and Peoria, Illinois, regions, spanning federally qualified health centers, private clinics and academic practices. Intervention practices received a clinician training video, electronic health record prompts, visual aids for parents and a scorecard to identify severe eczema; control practices did not.

The primary outcome was clinician adherence to guidelines, documented in the electronic health record (EHR) data at the 4- or 6-month well-child visit. In total, 18,480 infants were seen by 290 clinicians. In total, 18,480 infants were seen by 290 clinicians.

Lucy Bilaver, lead statistician for the study and associate professor of pediatrics at Feinberg noted the importance of leveraging EHR data for this pragmatic trial. "We were able to measure the primary outcome by making use of the clinical notes and structured data that pediatric clinicians generate during these well-child visits," she said.

The findings

Among low-risk infants, guideline adherence was 84% in the intervention group versus 35% in controls. For high-risk infants, adherence was 27% in the intervention group versus 10% in controls. In addition, 36% of high-risk infants in the intervention group were referred to an allergist or given an allergy test, compared with 10% in the control group.

"While more work is needed, the success of this intervention supports wider dissemination to prevent peanut allergy in children," Gupta said.

Outcomes in the trial will be tracked until children are 2.5 years old to see if the intervention reduces actual peanut allergy prevalence.

What parents need to know

Since 2017, national guidelines have recommended introducing peanut-containing foods around 4 to 6 months of age - a major shift prompted by a landmark clinical trial that showed early introduction cuts peanut allergy risk by more than 80%. Before that, parents were often told to delay peanut feeding out of concern it might trigger allergies.

When your baby is developmentally ready to start solids, peanut products can be introduced, according to the study authors. (Instructions for how to do this are linked here.) Early introduction of egg and other common allergenic foods is also encouraged, based on family preference.

The study, titled "Pediatric Clinician Adherence to Peanut Allergy Prevention Guidelines: A Randomized Trial," was funded by the National Institute of Allergy and Infectious Diseases (NIAID U01AI138907).