Natural Progression of Incorporating NIAID Guidelines Into General Practice

The National Institute of Allergy and Infectious Diseases (NIAID) addendum guidelines in 2017 outline screening practices for early peanut introduction based on an infant’s risk level. We hypothesized there has been a change in practice over time to incorporate guidelines. Two cohorts of infants aged 4-11 months within Kaiser Permanente Southern California were compared, 2017 and 2019. The electronic medical record identified infants with early-onset moderate-severe eczema and/or egg allergy. The proportion of infants managed per standard of care was determined by manual chart review. The rates of screening with serum peanut IgE, peanut skin prick tests (SPT), allergy referral, and peanut oral food challenges (OFC) were compared. For infants with early-onset moderate-severe eczema, the odds of standard of care was 6.6 times higher in 2019 than 2017 (P-value <0.0001). From 2017 to 2019, there were statistically significant increases in rates of screening with serum peanut IgE (5.9% to 25%), peanut SPT (5.9% to 18.4%), and allergy referrals (7.1% to 45.6%) for infants with early-onset moderate-severe eczema; and rates of allergy referrals (33.3% to 70%) for infants with egg allergy. Rates of peanut OFCs remained low over time, with the highest (19.5%) in infants with both risk factors. Clinicians are practicing standard of care for infants with early-onset moderate-severe eczema, with higher rates of screening tests, but there has not been a significant change in practice for infants with egg allergy only or those with both risk factors.