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Report grades clinicians on implementation of guidelines to avoid peanut allergies


Peanut allergies are a big concern for parents when it comes to infant feeding. How can clinicians help?

Time and resources are a problem for clinicians when it comes to implementing new guidelines on peanut allergy prevention.

A recent report published in the Journal of Allergy and Clinical Immunology reviews how clinicians have fared when it comes to implementing new recommendations on ways to prevent the development of peanut allergies.1 The recommendations, released in 2017, were developed as a result of new data on allergy prevention, but there have been some roadblocks when it comes to putting these guidelines into practice.

About the guidelines

In 2017, the Addendum Guidelines for the Prevention of Peanut Allergy were published by the National Institute of Allergy and Infectious Diseases (NIAID). Since these guidelines were released, however, there has been no follow-up to examine how clinicians are using them in practice. A team of researchers sought to answer that question by sending a 33-item electronic survey to pediatricians and allergists in 2018—just 1 year after the new guidelines were released. Of the eligible responders to the survey, 97.1% were aware of the guidelines. How the guidelines were used differed by specialty.

Who is using them and how?

According to the report, 30% of pediatricians used the guidelines as published, and 64% used only a portion of the guidelines. Seven percent of pediatricians were not using the guidelines in their practice at all. Almost the exact opposite was true for allergists. Out of all the allergists surveyed, 64% of them were using the guidelines exactly as they were published, whereas only 34% were using portions of the guidelines and not others. Only 1% of allergists were not using the guidelines at all.

When pressed further on why the guidelines were or were not used, the surveys revealed several trends.

Barriers to implementation

Some of the barriers to implementing the guidelines included pushback on the methods and concern about allergic reactions from parents (47.6%), clinician concerns about allergic reactions (21.8%), a lack of referral to allergists (33.6%), parents who were not interested in early feeding (28.2%), and a lack of clinic time to review the guidelines with parents (20.9%). Clinicians also reported some factors that were not specified in the guidelines that caused them to deviate from full implementation, and these were family histories of allergies and skin prick test results in children who were not at high risk. Nearly half of all the clinicians who completed the survey—45.7%—said they would also like more education or training on implementing the new guidelines.

The report also uncovered a great need by clinicians for more education material to provide to parents and caregivers when discussing the guidelines. Clinic visits during the time period that early feeding should begin are notoriously packed with vaccinations, education, assessments, and more. Electronic sources or printouts that could be given to parents at these visits to further explain the new guidelines and early feeding strategies were requested by many the survey respondents. Clinicians asked for scripts to use when talking to parents about the guidelines, guidance on how to introduce peanut-containing foods in the clinic, advice on how to conduct assessments or give recommendations, a frequently-asked-questions handout, instruction on feeding peanut-containing foods at home, and a more detailed explanation of the guidelines overall.

Moving forward

Although the release of the guidelines in 2017 was a good first step at combating the development of peanut allergies, the report made it clear that clinicians need more help when it comes to full implementing the recommendations. Moving forward, the report identify some key areas for continued work.

  • Pediatricians should discuss early peanut introduction in practice with parents and caregivers of low-risk infants.
  • Clinicians should be ordering immunoglobulin E testing and making referrals to allergists for infants who are at high risk of developing peanut allergies.
  • Stakeholders need to help clinicians develop and use more resources on early introduction feeding methods to help parents implement these changes at home.


1. Johnson J, Gupta R, Bilaver L, et al. Implementation of the addendum guidelines for peanut allergy prevention by US allergists, a survey conducted by the NIAID, in collaboration with the AAAAI. Journal of Allergy and Clinical Immunology. 2020;146(4):875-883. doi:10.1016/j.jaci.2020.07.020

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