Barriers Prevent Pediatricians from Implementing Peanut Allergy Guidelines

Ruchi Gupta, MD, MPH

Findings of a new study demonstrate 93% of pediatricians are aware of the 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States.

Ruchi Gupta, MD, MPH, and a team of investigators measured the rates of guideline awareness and implementation, along with identified barriers to and factors associated with implementation among US pediatricians. Their findings suggested the need to understand barriers to increase adherence and reduce peanut allergy incidence among infants.

The Addendum Guidelines for the Prevention of Peanut Allergy in the United States, published in 2017, included 3 recommendations:

1. Infants with severe eczema and/or egg allergy should undergo evaluation for allergic sensitization to peanut through specific IgE test and/or skin prick testing
2. Infants with mild to moderate eczema should begin peanut consumption around 6 months old
3. Infants with no eczema or food allergy may consume peanuts when age appropriate

A population-based survey was administered to US pediatricians from June 2018 to December 2018. Participants were invited via email to complete the online survey. The survey comprised 29 fixed-response questions. Survey domains included demographic characteristics, guideline-related services and implementation, knowledge and training needs, barriers and facilitators of implementation, and participant and practice characteristics.

The survey was given in 2 waves. Those eligible to complete the survey were non-retired US pediatricians who provided general care to infants aged 12 months or younger. The investigators determined eligibility through the first 2 questions of the survey.

In the first wave of the survey, the team used a vendor database from the American Academy of Pediatrics and randomly selected 7200 pediatricians. There was a low survey response in wave 1, which led to another wave with the remaining 37,446 pediatricians in the database who were not included in the initial survey. The investigators offered a $10 gift card as incentive to potential respondents in wave 2 and those from the first 3 weeks of wave 1. Potential participants in the last 2 weeks of wave 1 were offered a $50 gift card.

Gupta and the team’s primary outcome was the prevalence of guideline implementation. Prevalence was assessed by an item that asked about guideline awareness and an item that asked about implementation among those who were aware of the guidelines. Additional outcomes included the guidelines-focused services provided by respondents, knowledge of the guidelines, barriers and facilitators to implementation, and need for training.

Overall, 1781 pediatricians were eligible and completed the full survey. A majority of the respondents self-identified as white (72.5%) and female (67.4%).

Most participants (93.4%; 95% CI, 92.2-94.5) reported being aware of the guidelines. Among knowledgeable respondents, 28.9% (95% CI, 26.8-31.1) reported full implementation and 64.3% (95% CI, 62-66.6) reported partial implementation.

Respondents noted common implementation barriers, including parental concerns about allergic reactions by 36.6% (95% CI, 34.3-39.1), uncertainty in understanding and correctly applying the guidelines by 33.2% (95% Ci, 30.9-35.6), and conducting in-office supervised feedings by 32.4% (95% CI, 30.1-34.8). A majority of the pediatricians (68.4%) said they needed further training on the guidelines.

The results ma inform future efforts to eliminate implementation barriers and improve adherence, which could reduce the incidence of peanut allergy in infants.

The study, “Assessment of Pediatrician Awareness and Implementation of the Addendum Guidelines for the Prevention of Peanut Allergy in the United States,” was published online in JAMA Network Open.