Differences in Peanut Allergy Management Between Allergists and Primary Care Providers

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.