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‘Missed opportunities’ in managing peanut allergy in primary care

Irene Mikhail

Sharp differences were found in how pediatricians and allergists managed peanut allergy in their patients, suggesting changes need to be made to how pediatricians provide such care, according to an abstract presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology in Orlando.

“In talking to many parents, I realized many people with food allergy did not know their children could outgrow their food allergy... Many aspects of food allergy management were being overlooked,” Irene Mikhail, MD, an allergy and asthma fellow at Nationwide Children’s Hospital, told Healio Family Medicine. “I sought to better understand the current way peanut allergy is being managed outside of the allergist office in order to learn if there is room for improvement.”

Mikhail and colleagues conducted retrospective chart reviews of 926 children (mean age, 9.9 years) who had at least one well-child check while at a primary care clinic and had a peanut allergy diagnosis during that visit or on their problem/allergy list.

Researchers found that 477 of the children had been seen by a pediatric allergist. These children were more likely to be black, have public insurance and other atopic conditions (P <.01 for each) These children were more likely to also have:

• food allergy action plans (OR = 126; P < .0001);
• peanut allergy testing (OR = 45; P < .0001);
• conversations on avoiding peanuts during an annual visit (OR 21; P < .0001);
• weight appropriate epinephrine prescription (OR = 7.5; P < .0001); and
• pediatricians more likely to record asthma management as opposed to peanut allergy during the well child check (OR = 1.7; P < .0001).

Researchers also found that pediatricians recommended peanut butter as a healthy snack at 52% of well-child checks, even when peanut allergies were also discussed, which Mikhail said was “very surprising” and likely stemmed from automated anticipatory guidance handouts.

“Pediatricians have done an excellent job incorporating asthma management into well-child checks. However, there are many missed opportunities in managing peanut allergy in the primary care setting, such as repeat allergy testing and monitoring for the resolution of their allergy,” Mikhail also said. – by Janel Miller

Reference: Atalla JE, et al. “Differences in peanut allergy management between allergists and primary care provider” Presented at: American Academy of Allergy, Asthma and Immunology annual meeting; March 2-5, 2018; Orlando.

Disclosure: Mikhail does not report any relevant financial disclosures. Healio Family Medicine was unable to determine the other authors’ relevant financial disclosures prior to publication.