Early Peanut Introduction in Primary Care: Evaluation of a Multicomponent Intervention.

Autor: Daley MF; Institute for Health Research (MF Daley, LM Reifler, KA Glenn, PJ Cvietusa, JF Steiner), Kaiser Permanente Colorado, Aurora, Colo; Department of Pediatrics (MF Daley, SM Arnold Rehring), University of Colorado School of Medicine, Aurora, Colo. Electronic address: matthew.f.daley@kp.org., Reifler LM; Institute for Health Research (MF Daley, LM Reifler, KA Glenn, PJ Cvietusa, JF Steiner), Kaiser Permanente Colorado, Aurora, Colo., Glenn KA; Institute for Health Research (MF Daley, LM Reifler, KA Glenn, PJ Cvietusa, JF Steiner), Kaiser Permanente Colorado, Aurora, Colo., Cvietusa PJ; Institute for Health Research (MF Daley, LM Reifler, KA Glenn, PJ Cvietusa, JF Steiner), Kaiser Permanente Colorado, Aurora, Colo; Department of Asthma (PJ Cvietusa), Allergy and Immunology, Colorado Permanente Medical Group, Denver, Colo., Steiner JF; Institute for Health Research (MF Daley, LM Reifler, KA Glenn, PJ Cvietusa, JF Steiner), Kaiser Permanente Colorado, Aurora, Colo; Department of Medical Education (JF Steiner, SM Arnold Rehring), Colorado Permanente Medical Group, Denver, Colo; Department of Medicine (JF Steiner), University of Colorado School of Medicine, Aurora, Colo., Arnold Rehring SM; Department of Pediatrics (MF Daley, SM Arnold Rehring), University of Colorado School of Medicine, Aurora, Colo; Department of Medical Education (JF Steiner, SM Arnold Rehring), Colorado Permanente Medical Group, Denver, Colo.
Jazyk: angličtina
Zdroj: Academic pediatrics [Acad Pediatr] 2023 Mar; Vol. 23 (2), pp. 279-286. Date of Electronic Publication: 2022 Nov 19.
DOI: 10.1016/j.acap.2022.11.007
Abstrakt: Objective: To determine whether a multicomponent intervention focused on early peanut introduction was associated with a lower peanut allergy incidence in young children.
Methods: The study cohort comprised all children born January 1, 2013 through December 31, 2018 receiving care at a large health care organization. Intervention activities occurred over 16 months and included provider educational programs, electronic health record tools, and new patient instructions. We used an interrupted time series design to assess whether peanut allergy incidence differed across 3 time periods (preintervention, interim, postintervention) among high- and low-risk children. The primary outcome was incident peanut allergy by age 24 months, defined as peanut allergy in the allergy field or active problem list plus a positive supportive test. Severe eczema and/or egg allergy presence defined high-risk. Because the study was conducted as part of routine care, it was not feasible to measure what counseling clinicians provided, or how and when parents fed their children peanut-containing foods.
Results: In a cohort of 22,571 children, the percent with peanut allergy by age 24 months was 17.3% (116 of 671) among high-risk and 0.8% (181 of 21,900) among low-risk children. In multivariate analyses, the adjusted peanut allergy rate per 100 person-years was not significantly different across study periods among high-risk (9.6 preintervention, 11.7 interim, and 9.9 postintervention, P = .70) or low-risk (0.5 preintervention, 0.7 interim, and 0.5 postintervention, P = .17) children.
Conclusions: In a community-based setting, the incidence of peanut allergy did not decline following a multicomponent intervention focused on early peanut introduction.
(Copyright © 2022 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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