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Reasons for Peanut Specific IgE Ordering Among Community Physicians
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Kaitlyn Spears, B.S., Alyssa Drosdak, Elizabeth A. Erwin, MD, Irene Mikhail, MD
Rationale: In light of studies suggesting the importance of early introduction and exposure to peanut in sensitized individuals, this study seeks to understand how serum allergy tests are used by community physicians and the implications for patients.

Methods: A retrospective chart review was performed of new patient visits to a pediatric, tertiary care referral allergy clinic between January 2009 and May 2015 with a diagnosis suggesting food allergy. From a total of 2,694 charts identified, 1743 were randomly selected.  Of these, 927 met inclusion criteria.

Results: Of the 631 patients evaluated for peanut allergy, 196 had serum testing prior to allergy evaluation. Only 61 patients (31%) had testing because of a suspected IgE mediated peanut reaction. Other reasons for testing included eczema (29.6%), other food allergy (20.9%), chronic rash (6.1%), gastrointestinal symptoms (4.6%), or relative with food allergy (2.5%). Of the patients diagnosed with peanut allergy based on serum testing, 32 (23.7%) were previously tolerating peanut. After the allergy evaluation, 96 were avoiding, 21 were told to introduce at home, 8 passed an office food challenge, 3 deferred a food challenge, 3 were told to avoid for other reasons, and 1 failed an office food challenge. After allergy evaluation the majority of patients (76%) continued to have a peanut allergy diagnosis, including 40% of the people who had previously tolerated peanut.

Conclusions: Education is needed to guide allergy testing ordering practices among community doctors in order to i) eliminate testing that is not needed and ii) prevent potentially unnecessary diagnosis of peanut “allergy”.