Differences in Peanut Allergy Management Between Allergists and Primary Care Providers
Monday, March 5, 2018
South Hall A2 (Convention Center)
Jasmyn E. Atalla, Michelle G. Manious, David R. Stukus, MD FAAAAI, Elizabeth Erwin, MD, Irene Mikhail, MD
RATIONALE: Peanut allergy (PA) affects approximately 1-2% of children, many of whom lack access to sub-specialty allergy care. We sought to characterize PA management by general pediatricians compared with allergists.

METHODS: We performed a retrospective chart review of all patients with at least one well child check (WCC) within the primary care clinic of a tertiary care medical center between January 1 and December 31, 2016. Children with PA on their problem/allergy list or with a primary visit diagnosis of PA were included in analysis.

RESULTS: Among 926 patients meeting criteria, 477 (52%) had been evaluated by a pediatric allergist. Age (mean 9.9 years) and gender (61% male) were similar between the two groups. Children with other atopic conditions, African American race, and public insurance were more likely to have been evaluated by an allergist (p<.01 for each). Children evaluated by an allergist were more likely to have a weight appropriate epinephrine prescription (OR 7.5, p<.0001), to have discussed peanut avoidance at annual visit (OR 21, p<.0001), to have documentation of a food allergy action plan (OR 126, p<.0001) and to have had PA testing (OR 45, p<.0001). Pediatricians were more likely to document asthma management than PA during WCC (OR 1.7, p<.0001). Of note, pediatricians recommended peanut as a healthy snack at 52% of WCC, even when PA was discussed.

CONCLUSIONS: Within an academic center primary care population, there is wide discrepancy in PA management by pediatricians and allergists. Routine pediatric appointments represent a missed opportunity for patient education about PA management.