Intervention to Reduce Early (Peanut) Allergy in Children (iREACH) training is an effective educational tool for implementing guidelines that help prevent peanut allergy, according to a recent research letter.¹

This research letter was authored by Waheeda Samady, MD, from the Ann & Robert H. Lurie Children’s Hospital of Chicago. Samady and colleagues conducted their research to examine the use of iREACH training for allergy intervention.

The 2017 Addendum Guidelines for the Prevention of Peanut Allergy indicate that infants who are at high risk undergo peanut sensitization assessment before being introduced to peanuts early, and if necessary, they should be referred to an allergist based on the results.

“Successful guideline implementation falls on pediatric clinicians during 4- and 6-month well-child visits,” Samady and colleagues wrote. “However, previous studies reported high training needs, low implementation rates, and low knowledge of the guidelines among clinicians.”

The team’s research was conducted to determine changes in pediatricians’ guideline knowledge and eczema identification following the implementation of educational interventions.

Background and Findings

The investigators’ iREACH study involved 2-groups and was a cluster-randomized clinical trial conducted to improve pediatricians’ adherence to prevention guidelines. The experts developing the training constructed a 21-minute training video with PA interventional tools, guidelines, and eczema categorization.

The training video was given to 16 intervention practice locations found in urban, suburban, and rural areas, as well as both private practices and Federally-Qualified Health Centers. The team also gave a 34-item, online pre-training survey and 7-item post-training survey to the clinicians working at the intervention practice sites from 2020 to 2022.

The investigators included questions on demographic data, usage of guidelines, awareness, knowledge of allergy, and eczema identification. They used the McNemar test to assess proportional differences in 185 participating pediatricians’ knowledge both pre- and post-intervention training.

Overall, the investigators reported that 89.7% of the pediatricians were aware of the guidelines prior to the study, and among those who were aware, only 21.6% had fully implemented the guidelines, and 68.7% had not been given any previous training.

They noted that following the clinicians’ training, there was a substantial reported improvement in the percentage of study participants who correctly-answered all knowledge questions, with an increase from 72.6% to 94.5%.

The investigators also noted that visual eczema vignette questions showed the most improvement, with a significant increase in the identification and application of guidelines regarding severe eczema from 63.4% to 97.6% correct and moderate eczema from 53.1% to 78.1% correct.

Lastly, the team reported that the percentage of study participants who answered all guideline application questions correctly improved from 29.0% to 70.4% following the training.

“This study found that iREACH training is an effective and accessible method to improving guideline implementation while facilitating PA prevention,” they wrote. “This training can also be easily updated to reflect emerging evidence on prevention of other common food allergies.”

References

1. ^{Samady W, Bilaver LA, Jiang J, et al. Evaluation of Training to Increase Knowledge of the Addendum Guidelines for the Prevention of Peanut Allergy in the US. JAMA Netw Open. 2023;6(3):e234706. doi:10.1001/jamanetworkopen.2023.4706.}