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Invited Commentary
July 15, 2020

Clinician Adoption of US Peanut Introduction Guidelines—A Case for Conditional Recommendations and Contextual Considerations to Empower Shared Decision-Making

Author Affiliations
  • 1Dartmouth-Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, New Hampshire
  • 2Department of Pediatrics, Medicine, and Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
  • 3Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
  • 4Department of Pediatrics, Section of Allergy/Immunology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora
JAMA Netw Open. 2020;3(7):e2011535. doi:10.1001/jamanetworkopen.2020.11535

Although screening before peanut introduction in infants is not an international standard of care, Gupta and colleagues1 provide valuable insights into clinician adoption of the 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States. More than 1700 pediatricians who completed the survey by Gupta and colleagues1 described their full (29% of respondents) or partial (64% of respondents) adoption of these guidelines. The authors concluded that more work is needed to increase guideline implementation; however, the broader question is whether screening infants with severe eczema and/or egg allergy should be viewed as a physician-directed requirement (and a quality metric) or as a contextual family preference–sensitive discussion. Within a shared decision-making framework, perhaps universal adherence to the 2017 guidelines is neither appropriate nor desired.

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