Clinical Documentation of Peanut Allergy Prevention in an Academic Learning Health System

Abstract

Consensus guidelines recommend early peanut introduction (EPI) as an effective strategy for preventing peanut allergy. Real-world practice patterns of EPI guidance are poorly understood. We aimed to described EPI practice patterns within an academic learning health system. We queried the health system’s central data repository to identify individuals eligible to receive EPI guidance from 1/6/2017 - 03/30/2020: persons less than 12 months of age at the time of a clinical encounter for either a health supervision visit or a problem-based visit related to eczema. We used the Electronic Medical Record Search Engine (EMERSE) to search clinical notes for the word “peanut.” These were manually reviewed for EPI documentation and other practice pattern characteristics. Of a total of 18,149 individuals, 152 (0.8%, mean age 6.4 months) had clinical documentation of EPI guidance (72% clinical note, 20% patient instructions, 5% both, 3% telephone note). EPI guidance was performed by 61 providers among 6 specialties (43% pediatrics, 40% family medicine, 15% allergy/immunology, 2% other) in 24 unique practices. Of those who received EPI guidance, the following comorbid diagnoses and/or characteristics were documented: 35% eczema, 11% egg allergy, 21% family history of food allergy, 31% topical corticosteroid use. Twenty percent were referred to an allergist for peanut allergy risk assessment and 12% had a peanut IgE obtained. Clinical documentation of EPI counseling is low. Further dissemination and implementation efforts are needed to encourage providers to prioritize EPI and increase standard utilization of consensus guidelines.