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    Original Investigation
    July 15, 2020

    Assessment of Pediatrician Awareness and Implementation of the Addendum Guidelines for the Prevention of Peanut Allergy in the United States

    Author Affiliations
    • 1Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
    • 2Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
    • 3Rho Federal Systems Division Inc, Durham, North Carolina
    • 4National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
    JAMA Netw Open. 2020;3(7):e2010511. doi:10.1001/jamanetworkopen.2020.10511
    Key Points español 中文 (chinese)

    Question  What is the current rate of implementation of the 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States, and what are the barriers to implementation among pediatricians who provide care for infants aged 12 months or younger?

    Findings  In this study survey of 1781 US pediatricians, 93% of respondents were aware of the guideline. Of those who had knowledge of the guidelines, 29% were fully implementing them and 64% were partially implementing them.

    Meaning  These findings suggest that understanding implementation barriers and needs among pediatricians is necessary to increase adherence and reduce peanut allergy incidence in infants.


    Importance  The 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States recommend that pediatricians assess infant peanut allergy risk and introduce peanut in the diet at age 4 to 6 months. Early introduction has the potential to prevent peanut allergy development.

    Objectives  To measure the rates of guideline awareness and implementation and to identify barriers to and factors associated with implementation among US pediatricians.

    Design, Setting, and Participants  This population-based study survey used a 29-item electronic survey instrument that was administered to pediatricians practicing across the United States from June 1, 2018, to December 1, 2018. Invitations to complete a survey were emailed to all pediatricians in the American Academy of Pediatrics vendor database. Eligible participants were nonretired US-based pediatricians providing general care to infants aged 12 months or younger.

    Main Outcomes and Measures  The primary outcome was the prevalence of guideline implementation, which was measured by 1 survey item about awareness followed by a second item about implementation. Secondary outcomes included identification of guidelines-focused services provided by pediatricians, knowledge of the guidelines (measured with 3 clinical scenarios), barriers to guideline implementation, need for training, and facilitators of guideline implementation.

    Results  A total of 1781 pediatricians were eligible to participate and completed the entire survey. Most respondents self-identified as white (1287 [72.5%]) and female (1210 [67.4%]) individuals. Overall, 1725 (93.4%; 95% CI, 92.2%-94.5%) pediatricians reported being aware of the guidelines. Of those pediatricians who had knowledge of the guidelines, 497 (28.9%; 95% CI, 26.8%-31.1%) reported full implementation and 1105 (64.3%; 95% CI, 62.0%-66.6%) reported partial implementation. Common barriers to implementation included parental concerns about allergic reactions (reported by 575 respondents [36.6%; 95% CI, 34.3%-39.1%]), uncertainty in understanding and correctly applying the guidelines (reported by 521 respondents [33.2%; 95% CI, 30.9%-35.6%]), and conducting in-office supervised feedings (reported by 509 respondents [32.4%; 95% CI, 30.1%-34.8%]). Many pediatricians (1175 [68.4%; 95% CI, 66.1%-70.5%]) reported a need for further training on the guidelines.

    Conclusions and Relevance  This survey found that most pediatrician respondents appeared to know of the 2017 guidelines, but less than one-third of respondents reported full implementation. Results of this study may inform future efforts to eliminate barriers to guideline implementation and adherence, thereby reducing the incidence of peanut allergy in infants.