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Flagging new referrals, reserving appointments reduces wait time for peanut allergy testing

Nicholas L. Hartog

Automatically flagging new referrals and reserving clinic and challenge appointments for infants allowed for faster scheduling of peanut allergy evaluations than usual, according to a study presented at the American Academy of Allergy, Asthma and Immunology Annual Scientific Meeting.

“There is a nationwide shortage of allergists, and because of this, many have a waitlist that is multiple months long. There is concern that if a patient is referred appropriately to an allergist before peanut introduction, that they have to wait many months before they are seen and they may develop a new peanut allergy while on the waitlist,” Nicholas L. Hartog, MD, head of pediatric and adult primary immunodeficiency clinic at Michigan State University, told Healio Primary Care Today.

Hartog and colleagues marked all referrals for patients at their clinic aged younger than 12 months, regardless of the reason, as urgent. In addition, four new patient appointments and two challenge slots were set aside each week for these patients.

Researchers found that 69 patients met high-risk criteria as defined by National Institute of Allergy and Infectious Diseases guidelines. These patients were evaluated in the clinic an average of 18.9 days (range 2-62 days) after their referral. In addition, physicians determined that 31 patients needed an in-office peanut challenge for peanut introduction, with these challenges occurring an average of 31.7 days (range 7-56 days) after the referral. Overall, Hartog and colleagues’ method provided a systematic evaluation of children 75.4 days sooner than general referrals. During this time period, the next new patient slot for nonurgent appointments was an average of 94.3 days.

“Our approach was successful by all accounts,” Hartog said in the interview.

He addressed clinicians who may not want to change long-standing approaches to the same clinical situation.

“The LEAP study provided clear evidence on the benefit of introducing peanut early in patients who are at high risk for peanut allergy. This evidence is very convincing, and there is a lot of benefit to be had by referring high-risk patients. Our technique is a very effective way to get these patients evaluated quickly, even in a busy clinic,” Hartog said. – by Janel Miller

Reference: Hartog NL, et al. Abstract 829. Presented at: American Academy of Allergy, Asthma and Immunology Annual Scientific Meeting; Feb. 22-25, 2019; San Francisco.

Disclosures: Healio Primary Care Today was unable to determine the authors’ relevant financial disclosures prior to publication.