Guidelines for Early Food Introduction and Patterns of Food Allergy
Objective: We aimed to determine whether rates of peanut (or any) immunoglobulin E-mediated food allergy (IgE-FA) changed following the publication of early peanut introduction guidelines and/or addendum guidelines. Methods: Using electronic health record data from the multistate, primary care-based American Academy of Pediatrics Comparative Effectiveness Research through Collaborative Electronic Reporting (CER2) network, we defined preguidelines, postguidelines, and postaddendum guidelines cohorts (cohort entry during September 1, 2012, to August 31, 2014; September 1, 2015, to August 31, 2017; and February 1, 2017, to January 31, 2019, respectively). We determined the cumulative incidence of IgE-FA and/or atopic dermatitis (AD) in children aged 0-3 years, observed for either at least 1 or 2 years. Diagnosis rates during pre- vs postguidelines periods were compared using logistic regression, Cox proportional hazards modeling, and interrupted time series analysis. Results: The cumulative incidence and risk of development of peanut IgE-FA (0.79%-0.53%; hazard ratio [HR], 0.65; 95% CI, 0.55-0.77) and any IgE-FA (1.46%-1.02%; HR, 0.69; 95% CI, 0.61-0.78) decreased significantly (P < .0001) from the preguidelines to postguidelines period. Furthermore, the cumulative incidence and risk of development of peanut IgE-FA (0.79%-0.45%; HR, 0.55; 95% CI, 0.46-0.66) and any IgE-FA (1.46%-0.93%; HR, 0.63; 95% CI, 0.55-0.72) decreased significantly (P < .0001) from the preguidelines to postaddendum guidelines period. A decline in IgE-FA diagnosis postguidelines was confirmed in the interrupted time series analysis. Conclusion: We detected decreased rates of peanut or any IgE-FA in the period following the publication of early introduction guidelines and addendum guidelines. Our results are supportive of the intended effect of these landmark public health recommendations.
https://doi.org/10.1542/peds.2024-070516
Guidelines for Early Food Introduction and Patterns of Food Allergy
Objective: We aimed to determine whether rates of peanut (or any) immunoglobulin E-mediated food allergy (IgE-FA) changed following the publication of early peanut introduction guidelines and/or addendum guidelines. Methods: Using electronic health record data from the multistate, primary care-based American Academy of Pediatrics Comparative Effectiveness Research through Collaborative Electronic Reporting (CER2) network, we defined preguidelines, postguidelines, and postaddendum guidelines cohorts (cohort entry during September 1, 2012, to August 31, 2014; September 1, 2015, to August 31, 2017; and February 1, 2017, to January 31, 2019, respectively). We determined the cumulative incidence of IgE-FA and/or atopic dermatitis (AD) in children aged 0-3 years, observed for either at least 1 or 2 years. Diagnosis rates during pre- vs postguidelines periods were compared using logistic regression, Cox proportional hazards modeling, and interrupted time series analysis. Results: The cumulative incidence and risk of development of peanut IgE-FA (0.79%-0.53%; hazard ratio [HR], 0.65; 95% CI, 0.55-0.77) and any IgE-FA (1.46%-1.02%; HR, 0.69; 95% CI, 0.61-0.78) decreased significantly (P < .0001) from the preguidelines to postguidelines period. Furthermore, the cumulative incidence and risk of development of peanut IgE-FA (0.79%-0.45%; HR, 0.55; 95% CI, 0.46-0.66) and any IgE-FA (1.46%-0.93%; HR, 0.63; 95% CI, 0.55-0.72) decreased significantly (P < .0001) from the preguidelines to postaddendum guidelines period. A decline in IgE-FA diagnosis postguidelines was confirmed in the interrupted time series analysis. Conclusion: We detected decreased rates of peanut or any IgE-FA in the period following the publication of early introduction guidelines and addendum guidelines. Our results are supportive of the intended effect of these landmark public health recommendations.
https://doi.org/10.1542/peds.2024-070516
Early Peanut Introduction in Infants: Improving Guideline Adherence With EMR Standardization
Objectives: Peanut allergy in children is a population health problem. Evidence suggests early peanut introduction (EPI) for infants can reduce the development of peanut allergy. Primary care settings have not widely adopted guidelines recommending EPI. Peanut allergy prevention depends on primary care providers incorporating EPI guidelines into well-child check (WCC) encounters. We aimed to improve guideline adherence in a primary care setting by implementing a bundle of clinical decision support (CDS) tools. Methods: Using quality improvement methodology, the team developed a standardized work protocol and CDS tools within an electronic medical record (EMR) at 4, 6, and 9-month WCC encounters. The team executed changes and modifications through plan-do-study-act cycles and analyzed results with statistical process control charts. Results: We collected data from 445 WCC encounters from baseline through sustainability. EMR documentation of EPI guidance at 4, 6, and 9-month WCCs shifted from 13.9% to 83.5% over 12 months. Provider adoption of smart lists and templates increased from 2% to 73%, the distribution of home peanut introduction handouts increased from 5.2% to 54.1%, and caregiver-reported peanut ingestion increased from 0% to 34.6%. Diphtheria-tetanus-acellular pertussis vaccination rates remained at 100% for 6-month visits, and patient in-room time remained at 65 minutes. Conclusions: Quality improvement methodology improved documentation of EPI guidance and increased reported peanut ingestion at routine WCC encounters without impacting other measures. Broader use of bundled CDS tools and EMR standardization could further improve guideline adherence and increase early peanut introduction to prevent peanut allergy in infants.
https://doi.org/10.1542/peds.2023-062371
Food Allergy Among Children in the United States
Objectives: The goals were to estimate the prevalence of food allergy and to describe trends in food allergy prevalence and health care use among US children. Methods: A cross-sectional survey of data on food allergy among children <18 years of age; as reported in the 1997-2007 National Health Interview Survey; 2005-2006 National Health and Nutrition Examination Survey; 1993-2006 National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey; and 1998-2006 National Hospital Discharge Survey; was performed. Reported food allergies; serum immunoglobulin E antibody levels for specific foods; ambulatory care visits; and hospitalizations were assessed. Results: In 2007; 3.9% of US children <18 years of age had reported food allergy. The prevalence of reported food allergy increased 18% (z = 3.4; P < .01) from 1997 through 2007. In 2005-2006; serum immunoglobulin E antibodies to peanut were detectable for an estimated 9% of US children. Ambulatory care visits tripled between 1993 and 2006 (P < .01). From 2003 through 2006; an estimated average of 317000 food allergy-related; ambulatory care visits per year (95% confidence interval: 195000-438000 visits per year) to emergency and outpatient departments and physician's offices were reported. Hospitalizations with any recorded diagnoses related to food allergy also increased between 1998-2000 and 2004-2006; from an average of 2600 discharges per year to 9500 discharges per year (z = 3.4; P < .01); possibly because of increased use of food allergy V codes. Conclusion: Several national health surveys indicate that food allergy prevalence and/or awareness has increased among US children in recent years.