Dr Ruchi Gupta on Getting Peanut Introduction Feeding Guidelines Into Wider Practice

In 2017, guidelines about when to feed peanuts to infants changed to recommend early feeding by 4 to 6 months of age depending on 3 risk levels, but these allergy prevention strategies are still not widespread, according to Ruchi Gupta, MD, MPH, professor of pediatrics and medicine, Northwestern Feinberg School of Medicine, who discussed the topic at the 2021 ACAAI Annual Scientific Meeting.

In 2017, guidelines about when to feed peanuts to infants changed to recommend early feeding by 4 to 6 months of age depending on 3 risk levels, but these allergy prevention strategies are still not widespread, according to a presentation at the 2021 ACAAI Annual Scientific Meeting by Ruchi Gupta, MD, MPH, professor of pediatrics and medicine, Northwestern Feinberg School of Medicine; clinical attending, Ann & Robert H. Lurie Children's Hospital of Chicago; director, Center for Food Allergy and Asthma Research.

Transcript

What is the best way to communicate the 2017 peanut introduction guidelines to pediatricians so they can inform their patients?

So that is such a good question. And this is pretty much my passion, because pediatricians, being one, I know how those 4- and 6-month visits go, so we need to support them. We have a grant we're working on with the [National Institutes of Health] right now. It's called iREACH, where we are putting in a clinical decision support tool in the [electronic medical records] of pediatricians to see if we can remind them at those visits about the guidelines, because they're doing 100 things, right? It's sleeping, feeding, every development; there's a laundry list. So if we can help remind them that this is the 4-month visit, check for eczema; if eczema, order a specific IgE or send to an allergist; if not, encourage peanut introduction.

And then what we also do is we have handouts that automatically print out for them in their after-visit summary that they can hand the family because, as we know, in that visit, they may remember 3 things, right, and they're talking about a ton in the span of 10 minutes. So another really great thing that we've done that we've gotten great feedback from pediatricians is give them something to give to parents, which clearly delineates when to start, what signs and symptoms to look for, how to mix the peanut butter if they're using peanut butter with breast milk or formula or water to make it not as sticky. How much—you know, giving them the 2 teaspoons—a lot of times people forget [to give it] at least 2 to 3 times a week.

One big thing that happens is a caregiver will introduce it once and the child has [no reaction], and then they say, “OK, I'm done.” And then the next time, they have a massive reaction. So, if those things are all written out clearly and given to the caregiver, hopefully then they can follow that when they do go to start introduction. So things like that I think pediatricians really appreciate.

Also, just links on where to go—the [National Institute of Allergy and Infectious Diseases] has great materials; organizations—[Food Allergy Research & Education] has a whole website right now where they're trying to get the information to families. I know I personally have talked to a lot of the BabyCenter [sites] and those type of things where parents go, to be able to put accurate information on their websites.

I think what we can do to support pediatricians is try to get the information to places caregivers go, and then specifically for the pediatrician, we're hoping that a clinical decision support tool in their [electronic medical record] helps them and then, you know, what they asked us for is parent-facing materials for caregivers and also information for them. They wanted more education on this. So I encourage allergists to talk to their referring pediatricians about this and see how they can best support them.