A new clinical study led by Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago found that a set of simple tools significantly increased pediatricians’ adherence to guidelines recommending early introduction of peanut-containing foods to infants. The research, which will be published in the journal Pediatrics on October 6, involved 30 pediatric practices and 18,480 infant visits across the Chicago and Peoria regions.
The intervention included a clinician training video, electronic health record (EHR) prompts, handouts for families, visual aids for parents, and a scorecard to identify severe eczema. These tools aimed to support pediatricians during busy well-child visits at four and six months of age.
Since 2017, national guidelines have advised introducing peanut products between four and six months old to reduce the risk of developing peanut allergies. However, surveys indicate that many pediatricians do not consistently follow these recommendations. Peanut allergy is currently the most common food allergy among children in the United States and affects more than two percent of children nationwide.
The study showed that guideline adherence among low-risk infants—those without eczema or egg allergy—was 84% in practices using the new tools compared with 35% in clinics without them. Infants seen by clinicians who used these interventions were nearly fifteen times more likely to receive care aligned with current guidelines.
“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 lead author Dr. Ruchi Gupta, professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine and pediatrician at Lurie Children’s.
“Because pediatric visits at 4 and 6 months are so busy, this support is critical to ensure families receive clear guidance,” Gupta added. “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 U.S. through prevention.”
For high-risk infants—those with eczema or egg allergy—adherence was lower but still improved: 27% in intervention practices versus 10% in controls. Additionally, referral rates for allergist evaluation or allergy testing among high-risk infants were higher in intervention clinics (36%) compared with controls (10%).
Lucy Bilaver, lead statistician for the study and associate professor of pediatrics at Feinberg noted the importance of leveraging EHR data for this pragmatic trial. “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.
Outcomes from this trial will continue to be tracked until participating children reach two-and-a-half years old to determine if increased guideline adherence results in reduced prevalence of peanut allergies.
“While more work is needed, the success of this intervention supports wider dissemination to prevent peanut allergy in children,” Gupta said.
The study was funded by the National Institute of Allergy and Infectious Diseases (NIAID U01AI138907).
Since national guidelines changed in 2017 following evidence from a landmark clinical trial showing early introduction reduces risk by over eighty percent, parents are now encouraged to introduce peanuts when their baby is developmentally ready for solids.