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Early Peanut Introduction in Primary Care: Evaluation of a Multi-Component Intervention

Published:November 18, 2022DOI:https://doi.org/10.1016/j.acap.2022.11.007

      Abstract

      Objective

      To determine whether a multi-component intervention focused on early peanut introduction was associated with a lower peanut allergy incidence in young children.

      Methods

      The study cohort comprised all children born January 1, 2013 through December 31, 2018 receiving care at a large healthcare organization. Intervention activities occurred over 15 months and included provider educational programs, electronic health record tools, and new patient instructions. We used an interrupted time series design to assess whether peanut allergy incidence differed across three time periods (pre-intervention, interim, post-intervention) among high- and low-risk children. The primary outcome was incident peanut allergy by age 24 months, defined as peanut allergy in the allergy field or active problem list plus a positive supportive test. Severe eczema and/or egg allergy presence defined high-risk. Because the study was conducted as part of routine care, it was not feasible to measure what counseling clinicians provided, or how and when parents fed their children peanut-containing foods.

      Results

      In a cohort of 22571 children, the percent with peanut allergy by age 24 months was 17.3% (116 of 671) among high-risk and 0.8% (181 of 21900) among low-risk children. In multivariate analyses, the adjusted peanut allergy rate per 100 person-years was not significantly different across study periods among high-risk (9.6 pre-intervention, 11.7 interim, and 9.9 post-intervention, p=0.70) or low-risk (0.5 pre-intervention, 0.7 interim, and 0.5 post-intervention, p=0.17) children.

      Conclusions and Relevance

      In a community-based setting, the incidence of peanut allergy did not decline following a multi-component intervention focused on early peanut introduction.

      Key Words

      Abbreviations:

      CI (confidence interval), EHR (electronic health record), KPCO (Kaiser Permanente Colorado), mm (millimeters), PMCA (Pediatric Medical Complexity Algorithm), SD (standard deviation)
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      References

        • Gupta RS
        • Warren CM
        • Smith BM
        • et al.
        The public health impact of parent-reported childhood food allergies in the United States.
        Pediatrics. Dec 2018; 142https://doi.org/10.1542/peds.2018-1235
        • Begin P
        • Paradis L
        • Paradis J
        • Picard M
        • Des Roches A
        Natural resolution of peanut allergy: a 12-year longitudinal follow-up study.
        J Allergy Clin Immunol Pract. Sep-Oct 2013; 1 (e1-4): 528-530https://doi.org/10.1016/j.jaip.2013.05.008
        • Mahr TA
        • Lieberman JA
        • Haselkorn T
        • et al.
        Characteristics of peanut allergy diagnosis in a US health care claims database (2011-2017).
        J Allergy Clin Immunol Pract. Apr 2021; 9 (e5): 1683-1694https://doi.org/10.1016/j.jaip.2020.12.020
      1. Boyce JA, Assa'a A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. Nutrition. Feb 2011;27(2):253-67. doi:10.1016/j.nut.2010.12.001

        • Sicherer SH
        • Sampson HA.
        Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management.
        J Allergy Clin Immunol. Jan 2018; 141: 41-58https://doi.org/10.1016/j.jaci.2017.11.003
        • Lieberman JA
        • Weiss C
        • Furlong TJ
        • Sicherer M
        • Sicherer SH.
        Bullying among pediatric patients with food allergy.
        Ann Allergy Asthma Immunol. Oct 2010; 105: 282-286https://doi.org/10.1016/j.anai.2010.07.011
        • Cummings AJ
        • Knibb RC
        • King RM
        • Lucas JS.
        The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review.
        Allergy. Aug 2010; 65: 933-945https://doi.org/10.1111/j.1398-9995.2010.02342.x
        • Mikhail I
        • Stukus DR
        • Prince BT.
        Fatal anaphylaxis: Epidemiology and risk factors.
        Curr Allergy Asthma Rep. Apr 7 2021; 21: 28https://doi.org/10.1007/s11882-021-01006-x
        • Du Toit G
        • Roberts G
        • Sayre PH
        • et al.
        Randomized trial of peanut consumption in infants at risk for peanut allergy.
        N Engl J Med. Feb 26 2015; 372: 803-813https://doi.org/10.1056/NEJMoa1414850
        • Du Toit G
        • Katz Y
        • Sasieni P
        • et al.
        Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy.
        J Allergy Clin Immunol. Nov 2008; 122: 984-991https://doi.org/10.1016/j.jaci.2008.08.039
        • Du Toit G
        • Sayre PH
        • Roberts G
        • et al.
        Effect of avoidance on peanut allergy after early peanut consumption.
        N Engl J Med. Apr 14 2016; 374: 1435-1443https://doi.org/10.1056/NEJMoa1514209
        • Perkin MR
        • Logan K
        • Tseng A
        • et al.
        Randomized trial of introduction of allergenic foods in breast-fed infants.
        N Engl J Med. May 5 2016; 374: 1733-1743https://doi.org/10.1056/NEJMoa1514210
        • Fleischer DM
        • Sicherer S
        • Greenhawt M
        • et al.
        Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants.
        J Allergy Clin Immunol. Aug 2015; 136: 258-261https://doi.org/10.1016/j.jaci.2015.06.001
        • Togias A
        • Cooper SF
        • Acebal ML
        • et al.
        Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel.
        J Allergy Clin Immunol. Jan 2017; 139: 29-44https://doi.org/10.1016/j.jaci.2016.10.010
        • Hagan JF
        • Shaw JS
        • Duncan PM
        Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
        4th ed. American Academy of Pediatrics, 2017
        • Abrams EM
        • Shaker M
        • Greenhawt M
        • Mack DP.
        International peanut allergy prevention, 6 years after the Learning Early About Peanut study.
        J Allergy Clin Immunol Pract. Jan 2022; 10: 71-77https://doi.org/10.1016/j.jaip.2021.07.015
        • Arnold Rehring SM
        • Reifler LM
        • Seidel JH
        • Glenn KA
        • Steiner JF
        Implementation of recommendations for long-acting contraception among women aged 13 to 18 years in primary care.
        Acad Pediatr. Jul 2019; 19: 572-580https://doi.org/10.1016/j.acap.2019.03.009
        • Bernal JL
        • Cummins S
        • Gasparrini A.
        Interrupted time series regression for the evaluation of public health interventions: a tutorial.
        Int J Epidemiol. Feb 1 2017; 46: 348-355https://doi.org/10.1093/ije/dyw098
        • Hill DA
        • Grundmeier RW
        • Ram G
        • Spergel JM.
        The epidemiologic characteristics of healthcare provider-diagnosed eczema, asthma, allergic rhinitis, and food allergy in children: a retrospective cohort study.
        BMC Pediatr. Aug 20 2016; 16: 133https://doi.org/10.1186/s12887-016-0673-z
        • Abuabara K
        • Magyari AM
        • Hoffstad O
        • et al.
        Development and validation of an algorithm to accurately identify atopic eczema patients in primary care electronic health records from the UK.
        J Invest Dermatol. Aug 2017; 137: 1655-1662https://doi.org/10.1016/j.jid.2017.03.029
        • Simon TD
        • Haaland W
        • Hawley K
        • Lambka K
        • Mangione-Smith R.
        Development and validation of the Pediatric Medical Complexity Algorithm (PMCA) version 3.0.
        Acad Pediatr. Jul 2018; 18: 577-580https://doi.org/10.1016/j.acap.2018.02.010
        • Keet C
        • Pistiner M
        • Plesa M
        • et al.
        Age and eczema severity, but not family history, are major risk factors for peanut allergy in infancy.
        J Allergy Clin Immunol. Mar 2021; 147 (e5): 984-991https://doi.org/10.1016/j.jaci.2020.11.033
        • Fleischer DM
        • Chan ES
        • Venter C
        • et al.
        A consensus approach to the primary prevention of food allergy through nutrition: guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology.
        J Allergy Clin Immunol Pract. Jan 2021; 9 (22-43): e4https://doi.org/10.1016/j.jaip.2020.11.002
        • Mikhail I
        • Prince BT
        • Stukus DR.
        Update on early introduction of peanut to prevent allergy development: Challenges with implementation.
        Curr Allergy Asthma Rep. Nov 9 2019; 19: 51https://doi.org/10.1007/s11882-019-0884-0
        • Mikhail IJ.
        Implementation of early peanut introduction guidelines: It takes a village.
        Immunol Allergy Clin North Am. Nov 2019; 39: 459-467https://doi.org/10.1016/j.iac.2019.07.002
        • Fisher HR
        • Keet CA
        • Lack G
        • du Toit G.
        Preventing peanut allergy: Where are we now?.
        J Allergy Clin Immunol Pract. Feb 2019; 7: 367-373https://doi.org/10.1016/j.jaip.2018.11.005
        • Gupta RS
        • Bilaver LA
        • Johnson JL
        • et al.
        Assessment of pediatrician awareness and implementation of the Addendum Guidelines for the Prevention of Peanut Allergy in the United States.
        JAMA Netw Open. Jul 1 2020; 3e2010511https://doi.org/10.1001/jamanetworkopen.2020.10511
        • Greenhawt M
        • Chan ES
        • Fleischer DM
        • et al.
        Caregiver and expecting caregiver support for early peanut introduction guidelines.
        Ann Allergy Asthma Immunol. Jun 2018; 120: 620-625https://doi.org/10.1016/j.anai.2018.03.001
        • Perkin MR
        • Bahnson HT
        • Logan K
        • et al.
        Factors influencing adherence in a trial of early introduction of allergenic food.
        J Allergy Clin Immunol. Dec 2019; 144: 1595-1605https://doi.org/10.1016/j.jaci.2019.06.046
        • Soriano VX
        • Peters RL
        • Moreno-Betancur M
        • et al.
        Association between earlier introduction of peanut and prevalence of peanut allergy in infants in Australia.
        JAMA. Jul 5 2022; 328: 48-56https://doi.org/10.1001/jama.2022.9224
        • Stukus DR
        • Prince BT
        • Mikhail I.
        Implementation of guidelines for early peanut introduction at a pediatric academic center.
        J Allergy Clin Immunol Pract. Oct 2018; 6: 1784-1786https://doi.org/10.1016/j.jaip.2018.01.036
        • Tapke D
        • Prince B
        • Scherzer R
        • Stukus D
        • Mikhail I.
        A retrospective cohort study of pediatrician implementation of the 2017 United States early peanut introduction guidelines.
        Ann Allergy Asthma Immunol. Feb 2021; 126: 200-202https://doi.org/10.1016/j.anai.2020.10.015
        • Turner PJ
        • Campbell DE
        • Boyle RJ
        • Levin ME.
        Primary prevention of food allergy: Translating evidence from clinical trials to population-based recommendations.
        J Allergy Clin Immunol Pract. Apr 2018; 6: 367-375https://doi.org/10.1016/j.jaip.2017.12.015
        • Lo RM
        • Purington N
        • McGhee SA
        • Mathur MB
        • Shaw GM
        • Schroeder AR.
        Infant allergy testing and food allergy diagnoses before and after guidelines for early peanut introduction.
        J Allergy Clin Immunol Pract. Jan 2021; 9 (e9): 302-310https://doi.org/10.1016/j.jaip.2020.10.060
        • Peters RL
        • Guarnieri I
        • Tang MLK
        • et al.
        The natural history of peanut and egg allergy in children up to age 6 years in the HealthNuts population-based longitudinal study.
        J Allergy Clin Immunol. Sep 2022; 150 (e13): 657-665https://doi.org/10.1016/j.jaci.2022.04.008