Pre-emptive screening for peanut allergy before peanut ingestion in infants is not standard of care

The Journal of Allergy and Clinical Immunology: In Practice

Shaker

Oppenheimer

et al. 2020

Self Cite

102

Shared decision making (SDM) is a management paradigm that empowers patients as partners in their own care in a bidirectional exchange of information and values, and optimize the decision-making process. During the current coronavirus disease 2019 pandemic, there is a greater need to encourage participation in the SDM process. The pandemic has created both challenges and opportunities for delivering care, as system adaptations influence the physician-patient relationship. Although social distancing and health service reallocation can interfere with preference for an in-person visit, these measures also provide an avenue to study and implement virtual SDM processes. Communicating risk at a time of heightened uncertainty may pose a barrier to SDM engagement but provides the opportunity to foster a patient-centered approach within a more personalized context. Social media influence during coronavirus disease 2019 has resulted in an “infodemic” but highlights the importance of patient engagement. The pandemic has changed how we deliver care but allows us to re-evaluate common practices and enhance effectiveness of our management strategies. Navigating the uncertainty of subsequent pandemic waves creates confusion about how to safely reinitiate clinical service. This will require ongoing SDM with our patients and among colleagues through current—and future—challenges. Coronavirus disease 2019 has created many difficulties but has forced us to reexamine how to provide more patient-centered and high-quality care.

Section: Communicating Uncertaintymentioning

confidence: 99%

The Challenges and Opportunities for Shared Decision Making Highlighted by COVID-19

The Journal of Allergy and Clinical Immunology: In Practice

Shaker

Oppenheimer

et al. 2020

Self Cite

102

“…12 However, allergy screening tests are poorly specific, do not alter the natural history of food allergy, are not cost-effective, and can result in overdiagnosis of peanut allergy. 13,14 An Australian study estimated that preemptive screening of infants considered at high risk for peanut allergy would result in screening 16% of the infant population and still miss 23% of peanut allergy cases. 15 The current pandemic may further the narrative already being established in favor of a less medicalized, at-home food introduction, instead of potentially unnecessary preemptive screening.…”

Section: Safementioning

confidence: 99%

What the COVID-19 Pandemic Can Teach Us About Resource Stewardship and Quality in Health Care

The Journal of Allergy and Clinical Immunology: In Practice

Singer

Shaker

et al. 2021

Self Cite

The coronavirus disease 2019 pandemic has forever changed how we view health care service delivery. Although there are undoubtedly some unintended consequences that will result from current health care service reallocation, it provides a unique opportunity to consider how to deliver quality care currently, and after the pandemic. In the context of lessons learned, moving forward some of what was previously routine could remain reserved for more exceptional circumstances. To determine what is "routine," what is "essential," and what is "exceptional," it is necessary to view medical decisions within the paradigm of highquality care. The Institute for Healthcare Improvement definition of the dimensions of quality is based on whether the care is safe, effective, patient-centered, timely, efficient, and equitable. This type of stewardship has been applied to many interventions already deemed unnecessary by organizations such as the Choosing Wisely initiative, but the coronavirus disease 2019 pandemic provides a lens from which to consider other aspects of care. The following will provide examples from Allergy/Immunology that outline how we can reconsider what quality means in the postecoronavirus disease health care system.

“…Recent research supports stronger recommendations than previously, for the active introduction of allergenic foods early in life. Further, there is now compelling evidence that warrants changing other, related recommendations, including the definition of an infant at high risk for developing allergic conditions [ 3 , 8 ], the role of pre-emptive screening [ 8 – 12 ], the role of hydrolyzed formula [ 13 , 14 ]] for allergy prevention, and the preventive role of breastfeeding in balance with the early introduction of solid foods [ 15 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

Dietary exposures and allergy prevention in high-risk infants

Allergy Asthma Clin Immunol

Watson

Leek

et al. 2022

Self Cite

Infants at high risk for developing a food allergy have either an atopic condition (such as eczema) themselves or an immediate family member with such a condition. Breastfeeding should be promoted and supported regardless of issues pertaining to food allergy prevention, but for infants whose mothers cannot or choose not to breastfeed, using a specific formula (i.e., hydrolyzed formula) is not recommended to prevent food allergies. When cow’s milk protein formula has been introduced in an infant’s diet, make sure that regular ingestion (as little as 10 mL daily) is maintained to prevent loss of tolerance. For high-risk infants, there is compelling evidence that introducing allergenic foods early—at around 6 months, but not before 4 months of age—can prevent common food allergies, and allergies to peanut and egg in particular. Once an allergenic food has been introduced, regular ingestion (e.g., a few times a week) is important to maintain tolerance. Common allergenic foods can be introduced without pausing for days between new foods, and the risk for a severe reaction at first exposure in infancy is extremely low. Pre-emptive in-office screening before introducing allergenic foods is not recommended. No recommendations can be made at this time about the role of maternal dietary modification during pregnancy or lactation, or about supplementing with vitamin D, omega 3, or pre- or probiotics as means to prevent food allergy.