Implementation of the 2017 guidelines for peanut allergy prevention by U.S. allergists

Published: July 31, 2020

Two percent of the U.S. population is allergic to peanut, and peanut and tree nut allergies are the leading causes of death related to food-induced anaphylaxis in the U.S. In 2015, the Learning Early about Peanut Allergy (LEAP) trial demonstrated that the early introduction of peanut-containing food into the diets of infants 4-11 months of age decreased the development of peanut allergy by over eighty percent. Following the publication of the LEAP study, in 2017, the National Institute of Allergy and Infectious Diseases (NIAID) convened an expert panel and developed three guidelines for the early introduction of dietary peanut in infants at various risk levels for the development of peanut allergy.

Johnson et al in The Journal of Allergy and Clinical Immunology (JACI) assessed implementation of the 2017 Guidelines by allergists via a web survey. A survey invitation and weekly follow-up emails to non- and partial- responders were sent to members of the American Academy of Allergy, Asthma and Immunology (AAAAI) membership database over a three-week period. Potential participants were offered a $25 eGift card to complete the survey.

Survey invitations were delivered to 3,281 of the 3,288 AAAAI members who met survey sample selection criteria. Of these, 946 (29%) answered at least one survey question, and 825 met all four eligibility criteria. An additional 36 participants exited during the survey, leaving 789 eligible respondents who completed the survey. Among eligible respondents, 97% were aware of the Guidelines prior to the survey. Of those aware, 65% stated they fully implemented the Guidelines, 34% implemented parts of the Guidelines, and 1% were not implementing the Guidelines. The two most common deviations from the Guidelines were considering additional factors not specified in the Guidelines such as family history (50.2%) and conducting allergy skin prick testing in non-high-risk children (43.9%). When asked about barriers to implementing the Guidelines, 48% of respondents identified parental concerns about allergic reaction, followed by lack of referrals (34%), parents who were not interested in the Guidelines (28%), provider concerns about allergic reaction (21%), and lack of clinic time (20%). Almost half (46%) of respondents who were aware of the Guidelines indicated a need for further education or training on the Guidelines.

This survey indicates that, approximately 21 months after publication, the vast majority of allergists are aware of the Guidelines for the Prevention of Peanut Allergy and most are fully implementing them. However, deviations do occur, some reflecting areas of controversy requiring additional research. Educational activities and processes to facilitate Guidelines implementation are needed. In addition to allergists, these should focus on primary care providers and parents of infants.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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