Training tools and EHR prompts boosted pediatricians’ adherence to early peanut introduction guidelines in a new trial.
Since 2017, the US Addendum Guidelines for the Prevention of Peanut Allergy have encouraged clinicians to introduce peanut-containing foods to infants aged 4 to 6 months to reduce the risk of peanut allergy (PA). Despite these recommendations, clinician adherence has remained low.
Peanut allergy is the most common pediatric food allergy and affects more than 2% of children in the United States. Early peanut introduction can reduce allergy risk by more than 80%, according to previous clinical studies.
To address low adherence, researchers from Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago conducted the Intervention to Reduce Early Peanut Allergy in Children (iREACH) Trial. The goal was to determine whether simple educational and electronic health record (EHR) tools could increase clinician adherence to the national guidelines.
The iREACH trial was a practice-based, cluster-randomized study including 30 pediatric practices in the Chicago and Peoria, Illinois, regions. Sites included federally qualified health centers, private clinics, and academic practices.
Clinics in the intervention group received clinician education through a brief training video, EHR clinical decision support (CDS) prompts, visual handouts for families, and a scorecard to identify severe eczema. Control clinics continued usual care without these tools.
A total of 18,480 infants were seen by 290 clinicians during 4- or 6-month well-child visits. The primary outcome was clinician adherence to the 2017 peanut allergy prevention guidelines, as documented in EHR data.
Clinicians were considered adherent if they:
The results demonstrated a significant improvement in adherence among intervention practices:
Lead author Ruchi Gupta, MD, MPH, professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine and pediatrician at Lurie Children’s, emphasized the importance of structural supports for busy practices:
“We found that supporting pediatricians with training, electronic health record prompts and educational materials for parents significantly improved their ability to counsel families on early peanut introduction,” said Gupta.
She added, “Because pediatric visits at 4 and 6 months are so busy, this support is critical to ensure families receive clear guidance. Our hope is that these conversations will help parents feel confident introducing peanut products early. We want to reverse the trend of increasing food allergies in the United States through prevention.”
Lucy Bilaver, PhD, associate professor of pediatrics at Feinberg and lead statistician for the study, highlighted the use of EHR data. “We were able to measure the primary outcome by making use of the clinical notes and structured data that pediatric clinicians generate during these well-child visits,” she said.
The findings demonstrate that simple, low-cost interventions can meaningfully improve clinician adherence to evidence-based allergy prevention guidelines.
Implementing standardized prompts within the EHR and providing clear educational materials for families can enhance pediatrician counseling and support timely peanut introduction. These approaches may be especially valuable in busy practice settings where preventive discussions are often condensed.
According to Gupta, “While more work is needed, the success of this intervention supports wider dissemination to prevent peanut allergy in children.”
Long-term outcomes from the iREACH Trial will be tracked until participating children reach 2.5 years of age to determine whether increased clinician adherence results in lower rates of peanut allergy.
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