Infectious Disease

Gaps remain in knowledge of early peanut introduction recommendations

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Many parents, pediatric residents and attendings remained unaware of recommendations for early introduction of peanuts to children at high risk for allergy, according to a study published in Annals of Allergy, Asthma & Immunology.

Improved education could have a significant impact in preventing peanut allergy in high-risk populations, Sumeet Sandhu, MD, an allergist and immunologist with the division of allergy and immunology at the Center for Allergy and Asthma Research of SUNY Brooklyn Health Sciences University, and colleagues wrote.

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Based on the 2015 Learning Early About Peanut Allergy (LEAP) study, the National Institute of Allergy and Infectious Diseases 2017 Addendum Guidelines recommended introducing peanut to infants with severe eczema and/or egg allergy at age 4 to 6 months and to infants with mild to moderate eczema at age 6 months.

The researchers then developed a pair of projects to assess knowledge and implementation of these guidelines among parents and pediatric residents and attendings.

A voluntary, 12-question survey was distributed to all pediatric residents and general pediatric attendings in the pediatric training program at State University of New York at Downstate Medical Center.

Also, the researchers distributed a voluntary 18-question survey to the parents of patients in a hospital general pediatric clinic serving a Black population.

The researchers reported 69 pediatric residents and eight general pediatricians completing the survey. Results included:

  • 42% were not aware of the LEAP study;
  • 61% did not know about the 2017 Addendum Guidelines;
  • 41% always asked about peanut introduction;
  • 19% rarely or never discussed the guidelines;
  • 62% started discussing peanut introduction with parents during or after the 6-month well-child visit;
  • 7% never discussed the guidelines;
  • 88% had never ordered peanut-specific serum IgE to confirm peanut allergy; other
  • 43% were not comfortable interpreting results.

So, 182 parents completed the survey. Approximately half of them were born outside the US, with most achieving a high school diploma or equivalent. Most had fewer than three children in the household, and one-third of the patients were aged younger than 1 year. Results included:

  • 15% were comfortable with starting peanuts or peanut-including food between age 4 and 6 months;
  • 40% would start peanuts after age 1 year;
  • 52% were aware that early introduction decreased development of food allergies, with 71% of these parents hearing this information from their pediatrician;
  • 29% reported that their child had eczema;
  • 9% reported that their child had a food allergy; other
  • 49% reported a family history of atopic conditions, including asthma, seasonal allergic rhinitis, food allergy or eczema.

Based on these results, the researchers concluded that pediatric residents and attendings as well as parents have knowledge gaps pertaining to guidelines for early peanut introduction.

The researchers further noted a greater prevalence of atopic dermatitis among this Black population compared with the general population, making the early introduction of peanut even more imperative in preventing peanut allergy.

Next, the researchers will educate their physicians via posters, handouts and presentations about the guidelines to, in turn, better educate families and therefore prevent peanut allergy in this high-risk population.

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Danelle M. Fisher, MD)

Danelle M. Fisher, MD

I am a bit surprised by these findings because of the length of time it has been since the LEAP study and subsequent change of guidelines. I would expect that our pediatric residents are being taught the most up-to-date guidelines and hope that the attendings out there will start to educate themselves about the best recommendations for their patients.

My experience is with a population that is multicultural. There are some parents from all cultures that are surprised by the change in guidelines, but not one group more than others. The information that I impart is for patients of all backgrounds, and I hope to spread the word to the community in that way.

Prevention is one of the parts of pediatric medicine that is the most satisfying and exciting. Pediatricians do not just provide care to the sick. They also hope to promote good health to children that will lead them to be healthy adults. Preventing food allergies is something we can influence in a positive direction for our patients and their families.

I would like to see this study repeated in a multi-centered approach for all training programs in the US or at least in different regions of the country. The education needs to come from training and dissemination of information from the source.

Danelle M. Fisher, MD

Specialist in Pediatrics, Providence St. Johns Health Center, Los Angeles

Disclosures: Fisher reports no relevant financial disclosures.

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