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Characterizing Pediatricians' Management of Food Allergy to Improve Care Coordination
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Alana Otto, MD, Ashley Dyer, MPH, Bridget Smith, PhD, Ruchi Gupta, MD, MPH
Rationale: Pediatricians are often first-line providers for children with food allergy. The role of the pediatrician in the diagnosis and management of food allergy has not been well defined. We therefore sought to characterize pediatricians’ adherence to published best practice guidelines for the diagnosis and management of childhood food allergy

Methods: Medical records of children ages 0-18 years were obtained from three urban primary care pediatric practices. Patients were included if they had an encounter between January 2012 and January 2015 containing an ICD-9-CM code for an initial food allergy diagnosis. Records were analyzed to describe provider adherence to NIAID guidelines, including documentation of clinical reaction history; diagnostic testing; prescription of injectable epinephrine; caregiver counseling and/or education; and referral to an allergist. 

Results: Patients (n = 123) had a mean age of 4 years and were most commonly allergic to egg (22%) and tree nut (17%). Clinical reaction history was documented in 99% of encounters. Allergen-specific IgE was ordered for 24% of patients. Epinephrine prescription was documented for 67% of patients. Emergency action plans were documented in 24% of encounters, caregiver counseling in 70%, and referral to an allergist in 68%.

Conclusions: Adherence to best practice guidelines varied between specific recommendations. Improving partnerships and role delineation between allergists and pediatricians is critical to improve coordination of care.