Many parents still fail to introduce peanuts to infants before age 11 months

Implementation of guidelines to prevent peanut allergy appeared suboptimal in the U.S., with only 44.7% of parents and caregivers reporting having introduced peanuts to their children by 11 months, according to survey data.

Further, results of the survey — presented at this year’s American College of Asthma, Allergy & Immunology Annual Scientific Meeting — showed only 13% of parents and caregivers were aware of the National Institute of Allergy and Infectious Disease’s Primary Prevention of Peanut Allergy (PPA) guidelines. That guidance, released in 2017, recommended earlier introduction of peanuts to prevent allergy, especially among infants with eczema.

The guidance was based on data from the 2015 LEAP study, which showed that early and regular consumption of peanuts reduced risk for peanut allergy development among those at high risk by more than 80%.

“We have important data and guidelines for the prevention of peanut allergy,” Ruchi S. Gupta, MD, MPH, director of the Institute for Public Health and Medicine – Center for Food Allergy and Asthma Research and professor of pediatrics, medicine and preventive medicine at Northwestern Medicine Feinberg School of Medicine, told Healio. “We strongly recommend following these guidelines knowing that intervening early can potentially reduce peanut incidence in the United States. We conducted this research because we wanted to identify the best way to get this information to pediatric clinicians and caregivers, and support them through any barriers to implementation.”

Gupta and a multidisciplinary team of pediatricians, pediatric allergists and survey methodologists developed a survey to evaluate U.S. parent/caregiver attitudes, knowledge and behaviors regarding introduction of common food allergens.

A total of 3,062 parents/caregivers of children aged 7 to 42 months completed the survey between Jan. 21 and Feb. 15 of this year.

Overall, 11% reported that their infants had eczema, 26% of whom had been prescribed a cream or ointment, indicating that they had more severe disease.

More than half (58%) of respondents said their child’s primary care provider had discussed peanut introduction. This figure increased to 69% when researchers focused the analysis on infants with eczema.

Of those whose PCP had discussed peanut introduction, only 40% overall and 46% with eczematous children were recommended to introduce peanuts before age 11 months. In total, 44.7% of parents or caregivers introduced peanuts to their infants before 11 months.

Gupta said that, based on her previous research on guideline awareness and barriers for implementation, these findings aren’t surprising.

Ruchi S. Gupta

“Because these guidelines are still relatively new and there are both time restraints and numerous implementation barriers for clinicians, parents are not always counseled or aware of the new early introduction guidelines,” she said. “We are working hard to find ways to better support clinicians through this process and hope these numbers will continue to increase. For example, we are currently working on a NIH-funded U01 aimed to support pediatrician adherence to these guidelines through a clinical decision support tool integrated in their electronic medical records.

“By making the identification of high-risk infants and next steps for recommendations clear and standardized for clinicians, we hope to see an improvement in early peanut introduction among high-risk infants,” she said.

Further, only 13% of all respondents and 18% of those with eczematous children reported knowledge of the PPA guidelines.

“As a pediatrician myself, I know how challenging it can be to cover all necessary conversation topics in the short time we have allotted with patients,” Gupta said, adding that her team’s survey research has showed that about 64% of pediatricians were partially adhering to the guidelines, with 28.7% fully adhering to them.

“Some of the most common concerns for guideline implementation were conducting an in-office, supervised feeding of peanut, lack of clinic time, parents’ concern about allergic reactions and PCPs not understanding or correctly applying the guidelines,” she said. “Despite these barriers, the majority were interested in further education/training on the guidelines so they can successfully implement them in their practices.”

Gupta added that practice aids and resources may help to explain the guidelines to parents, in addition to walking them through the process of safely introducing peanuts.

“We have been working on creating digestible, accessible and informative materials for parents to help guide them through this process and alleviate any confusion and stress,” she said.

Reference:

• Four years after release of guidelines, parents still not informed about early peanut introduction. https://annualmeeting.acaai.org/2021/peanut-introduction.cfm. Published Nov. 5, 2021. Accessed Nov. 5, 2021.