Caregiver and Expecting Caregiver Support for Early Peanut Introduction Recommendations
Monday, March 5, 2018
South Hall A2 (Convention Center)
Matthew J. Greenhawt, MD MBA MSc, David R. Stukus, MD FAAAAI, Carina Venter, PhD RD, David M. Fleischer, MD FAAAAI, Edmond S. Chan, MD, FRCPC, Allison Hicks, MD
RATIONALE: Recent clinical guidelines recommend early peanut introduction (EPI) beginning around 4-6 months in infants with either severe eczema and/or egg allergy, and around 6 months for all other infants. Caregiver preferences for such practices have not been explored.

METHODS: We explored preferences for EPI and in-office peanut allergy risk assessment (IPRA) through a nationally-representative survey of expecting caregivers(n=1000) and new caregivers of infants under age 1 (n=1000).

RESULTS: Among a primarily female (99.7%), married (80.3%), and white (74.4%) sample, 29% had no/vague awareness of the new guidelines, 61% had no/minimal concern for their child developing food allergy, but 54% felt that timing of introduction has moderate/strong importance for developing food allergy. Only 31% expressed willingness to introduce peanut before or around 6 months of life, with 40% reporting willingness to introduce after 11 months of life, similar to nuts and seafood. In contrast, 60% reported willingness to introduce egg before 8 months. 51% and 56.8% were unwilling to allow IPRA methods such as skin testing and oral challenge before 11 months of life, respectively. However, both odds of willingness to introduce peanut and undergo challenge after 6 months of life were lower among expecting caregivers (OR 0.79, CI 0.65-0.96; and OR 0.67, CI 0.54-0.82, respectively).

CONCLUSIONS: Among new and expecting caregivers, there is poor current support for EPI recommendations, including methods for IPRA. Support was better among expecting caregivers, though still poor. These trends underscore a tremendous need for a formal implementation plan to facilitate EPI and maximize its associated preventive benefits.