481 - Reduction of Peanut Allergy in High-Risk Infants Through Early Onset Peanut Introduction, A Quality Improvement Project

Publication Number: 481.6177

Miriam Samstein, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Itzel Nino, Weill Cornell Medicine, Brooklyn, NY, United States; Evan Sholle, Weill Cornell Medicine, New York, NY, United States; Charlene Thomas, Weill Cornell Medicine, New York, NY, United States; Linda M. Gerber, Weill Cornell Medicine, New York, NY, United States; Johanna Calo, Brooklyn Methodist Hospital, Brooklyn, NY, United States; Theresa Hetzler, Weill Cornell Medicine, New York, NY, United States; Snezana Osorio, Weill Cornell Medicine, New York, NY, United States

Background: IgE mediated peanut allergy is estimated to effect 1-2% of children in the United States. It is associated not only with the risk for morbidity and mortality, but also economic and psychologic burden on children and their caregivers. Based on the Learning Early About Peanut Allergy (LEAP) Trial, the NIAID released 2017 addendum guidelines for early peanut introduction and the prevention of peanut allergy. Implementation of these guidelines varies in our primary care pediatric clinic.

Objective: Increase compliance with NIAID Addendum Guidelines for the Prevention of Peanut Allergy in our primary care pediatric clinic to 80% by July 2025. We define compliance as referring infants aged 4-9 months with severe eczema or history of egg allergy to an allergist and providing counseling on home peanut introduction to caregivers of all other infants.

Design/Methods: The Model for Improvement was used over a one-year period in a predominantly Medicaid primary care clinic affiliated with a tertiary academic medical center. A Key Driver Diagram was used to identify interventions that were then tested via multiple PDSA cycles (Figure 1). All patients aged 4-9 months capable of tolerating food by mouth were included. Process measures included referrals placed for high-risk infants, documentation of counseling, and time to allergist appointment. Successful completion of evaluation process was used as an outcome measure. Considering the burden on primary care physicians to screen and counsel, length of appointment was a balancing measure. Data analysis was performed using statistical process control charts. API rules were applied to detect special cause variation.

Results: From September 2023 to September 2024 rate of peanut counselling at the 6-month visit increased from 12% to 85% (Figure 2). Although high risk patients were rare, referrals which were almost nonexistent increased to 60% over the course of the project (Figure 3). All patients referred were accommodated within 60 days of referral. There was no reported increase in appointment time by the primary care providers.

Conclusion(s): The most successful intervention was a change in the 6-month visit note template. We successfully improved our counseling and referral rates, surpassing our goal for counseling and approaching our goal for referral. Despite initial concerns about access, all patients were accommodated in allergy clinic within a reasonable time frame. Next steps include providing targeted education on the definition of high-risk infants and educating our new staff members.

Figure 1: Key Driver Diagram


Figure 2: Percent of Low-risk patients Receiving Peanut Counselling at the 6-month Well Child Check


Figure 3: Percent of High-Risk Patients Referred for Allergy Evaluation


Figure 1: Key Driver Diagram


Figure 2: Percent of Low-risk patients Receiving Peanut Counselling at the 6-month Well Child Check


Figure 3: Percent of High-Risk Patients Referred for Allergy Evaluation