Document text
Principal Investigator: Julie Flom
Organization: YALE UNIVERSITY
Fiscal Year: 2024
Award: $194,911
Funding agency: National Institute of Allergy and Infectious Diseases
PROJECT SUMMARY/ABSTRACT
Peanut allergy affects one in fifty children in the US. There is no cure, and while progress is being made in treatment, the standard of care is peanut avoidance and ready access to injectable epinephrine which can adversely impact quality of life. Based on solid evidence in the last decade that early peanut exposure reduces allergy risk, current guidelines recommend screening (with allergy referral or serum IgE level) followed by early peanut introduction, around age 4-6 months in infants considered high-risk for peanut allergy, specifically those with severe eczema or egg allergy. However, barriers at the caregiver, pediatrician and allergist levels have challenged the implementation of these guidelines. In response to these challenges, our colleagues developed and evaluated the Intervention to Reduce Early (Peanut) Allergy in Children (iREACH), a decision support tool integrated into the electronic health record (EHR), in a multi-site cluster randomized trial. Compared with usual care, iREACH led to a 2-fold increase in pediatrician guideline-concordant care among high-risk infants with severe eczema or egg allergy. Evidence supports that the timing of peanut introduction in infancy is crucial, with the most substantial protective effect for introduction prior to 6-7 months. Some guidelines recommend peanut introduction in high-risk infants without screening, in part due to concern that screening, which can necessitate a visit to an allergist, may delay introduction. However, determinants of delays in this population have yet to be well characterized. To facilitate timely peanut introduction in high-risk infants, it is critical to understand determinants of screening and management.
In the proposed study and using iREACH data, we will explore patient and provider-level determinants of peanut introduction in high-risk infants (Aim 1). Then, using sequential mixed methods, we will further examine facilitators of and barriers to guideline adherence from the perspective of clinicians (Aim 2). This information will inform a pilot intervention utilizing virtual medical visits to facilitate peanut introduction by 6-12 months of age in infants at high-risk (Aim 3). The results of this study will lay the groundwork for a future multi-site trial to facilitate timely, guideline-concordant care among infants at high-risk of peanut allergy.
We have assembled a team of experts in the field of implementation science and health services research, qualitative and mixed methods, intervention development, pragmatic trial design, maternal-child nutrition, and telemedicine to support the project aims and training goals. We will leverage data from a large multisite trial. The PI, Julie Flom, MD MPH, is a Pediatrician and Allergist/Immunologist with experience in epidemiology and a current K12 in implementation science. The advanced training proposed in this K23 will prepare her for a successful transition into an independent investigator focused on adaptation, evaluation, and implementation of interventions for food allergy and asthma.
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