Implementation of the Addendum Guidelines for Peanut Allergy Prevention by US allergists, a survey conducted by the NIAID, in collaboration with the AAAAI

Abstract

Background: In 2017, the Addendum Guidelines for the Prevention of Peanut Allergy were published with recommendations on early introduction of peanut-containing foods based on infants' clinical history. Objective: We sought to conduct a nationwide US survey to assess Guidelines implementation among allergists and immunologists who manage infants for food allergy. Methods: Survey invitations were delivered to 3281 nonretired, US members of the American Academy of Asthma, Allergy & Immunology, board certified in allergy and immunology. The survey assessed awareness and implementation of the Guidelines and barriers to implementation. Descriptive statistics were generated. Results: Twenty-nine percent (946 of 3281) of surveyed allergists/immunologists responded, and 87.1% (825 of 946) of responders met eligibility criteria. Among eligible responders, 97.1% were aware of the Guidelines. Of these, 64.5% reported full implementation of the Guidelines as published, 34.4% reported partial implementation, and 1.1% reported using none of the Guidelines. Barriers to Guidelines use included parental (47.6%) and self (21.8%) concerns about allergic reactions, lack of referrals (33.6%), parents uninterested in early feeding (28.2%), and lack of clinic time (20.9%). The 2 most common deviations from the Guidelines were considering additional factors not specified in the Guidelines such as family history (50.2%) and conducting skin prick testing in non-high-risk children (43.9%). Of respondents using the Guidelines, 45.7% indicated they needed more education or training. Conclusions: Essentially all allergists/immunologists who responded to the survey reported full or partial Guidelines implementation. Parental concerns and lack of referrals are major identifiable barriers. Improved Guidelines messaging to parents and referring physicians is warranted.

The future of food allergy: Challenging existing paradigms of clinical practice

“…51,68 Implementation of the guidelines for food allergy prevention has been challenging. [70][71][72] Although peanut introduction in the first year of life in Australia increased from 28.4% to 88.6%, the rates of peanut allergy did not significantly reduce (3.1% in 2007-2011 vs. 2.6% 2018-2019, p = 0.26). The paper did not report on the duration or frequency of peanut intake, or the way in which peanut was introduced (e.g., boiled, roasted, in a matrix), only timing of peanut introduction.…”

“…Implementation of the guidelines for food allergy prevention has been challenging 70–72 . Although peanut introduction in the first year of life in Australia increased from 28.4% to 88.6%, the rates of peanut allergy did not significantly reduce (3.1% in 2007–2011 vs. 2.6% 2018–2019, p = 0.26).…”

How primary care providers can help prevent food allergies

“…Although early introduction of peanut has increased since 2015, there continues to be variation in implementation of these guidelines [16 ▪ ,17,18 ▪ ]. Reasons for this include provider lack of knowledge or comfort, parental concerns, lack of clear guidance on risk stratification, and inconsistent recommendations across various guideline documents [19,20 ▪▪ ,21,22 ▪ ,23 ▪ ]. Furthermore, the use of allergy testing in both high-risk and low-risk infants has increased as these guidelines were introduced, which can inadvertently delay peanut introduction [24].…”

Can Peanut Allergy Prevention Be Translated to the Pediatric Population?

“…Other clinical trials have been conducted, but when it comes to widespread implementation of a novel guideline, other studies have not had the capacity to study prevalence, but have rather utilized surveys to assess guideline awareness and implementation. For example, in 2018, Johnson et al administered a cross-sectional survey to 825 allergists in the US to assess their awareness and implementation of the 2017 National Institute of Allergy and Infectious Diseases (NIAID) Addendum Guidelines for the Prevention of Peanut Allergy. The survey found that nearly all allergists (97.1%) were aware of the guidelines and 64.5% reported full and 34.4% reported partial implementation.…”