Most health care professionals still misunderstand peanut allergy guidelines
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Nearly 90% of health care professionals incorrectly answered questions based on the National Institute of Allergy and Infectious Diseases peanut allergy guidelines, survey results showed.
According to researchers, a National Institute of Allergy and Infectious Diseases (NIAID) guidelines for early introduction to peanuts recommends introducing peanuts to infants who are approximately 6 months old and have mild to moderate eczema. The guidelines further states that infants as early as 4 months of age with severe eczema and/or egg allergy be “strongly considered” for peanut sensitivity testing.
Priya Mehta, MD, first-year fellow in allergy, asthma and immunology at Nemours/Alfred I. duPont Hospital for Children in Delaware, and colleagues sent a two-part, voluntary, anonymous online survey to health care professionals at two hospitals. The first part evaluated respondents’ knowledge of NIAID guidelines. The second part, conducted approximately 8 months later, gauged pediatric residents’ knowledge of the NIAID guidelines immediately before and after an educational intervention that consisted of an in-person presentation on food allergy, including Learning Early About Peanut (LEAP) study results and NIAID guidelines.
Researchers reported that in the first part of the survey, the majority of health care professionals reported “confidence” in applying the NIAID guidelines. However, only 12% of 60 health care professionals — most of whom were pediatric attendings, nurse practitioners and residents answered all five questions about the NIAID guidelines correctly;17% answered four of the five questions correctly.
“It is notable that 28% of providers chose to refer an infant with severe eczema and/or egg allergy and negative peanut specific-IgE to an allergist, which could result in delayed introduction,” Mehta and colleagues wrote. “For an infant with severe eczema and/or egg allergy and positive specific-IgE, 23% of providers chose not to refer to an allergist and 3% opted for home introduction, raising concern for safety.”
These findings are the latest to suggest health care professionals have not completely grasped the nearly 4-year old NIAID guidelines for early introduction to peanuts.
Healio Primary Care previously reported that 11% of 369 pediatricians who answered an emailed survey did not use the guideline at all. A separate retrospective chart review of 81 infants aged 11 months or younger who were tested for peanut allergy at an outpatient allergy clinic showed that only 33 met NIAID screening recommendations.
“A brief in-person educational intervention may be effective in improving knowledge of the recommendations,” Mehta and colleagues wrote.
In second part of the Mehta study, only 21% of 33 pediatric residents correctly answered four or all five guidelines-based questions before the intervention. After the intervention, 83% of 30 residents answered four or all five questions correctly (OR = 17.7; 95% CI, 5.2-66.3). According to researchers, 93% of residents rated the intervention “very or extremely helpful” and all residents said it was “effective” in increasing their knowledge of the NIAID guidelines.
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Thomas B. Casale, MD
There has been sufficient time for physicians to adapt their ways. The LEAP study was published 5 years ago and consequent NIH guidelines more than 3 years ago. In addition, AAP published a statement in Pediatrics in August 2015 endorsing early peanut introduction.
The NIAID, AAP and all professional allergy societies have also provided easy-to-follow resources on these guidelines. The Food Allergy Research & Education Network has information for health care providers and patients as well.
The major consequences of not following these guidelines (besides possible hospitalization and death) will likely be a continued increase in the prevalence and incidence of peanut allergy. This allergy, estimated to affect 1% to 3% of the U.S. population, is one of the most common food allergies in the U.S. and is associated with an increased risk for severe anaphylactic reactions. With Palforzia (arachis hypogaea, Aimmune Therapeutics) the only FDA-approved product to treat food allergy, patients have immense anxiety and fear around the possibility of having an acute allergic reaction from an accidental exposure. Better treatments, especially those that are not allergen-specific, are desperately needed.
Reference: Fleischer DM, et al. Pediatrics. 2015;doi:10.1542/peds.2015-2394.
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