A recent study presented at the 2017 American Academy of Allergy, Asthma and Immunology annual meeting shows that some pediatricians are not embracing the latest National Institute of Allergy and Infectious Diseases (NIAID) guidelines that recommend the early introduction of peanut foods to prevent peanut allergies. In fact, in a survey with 79 pediatrician respondents, 38% of scored very low on compliance with the latest recommendations. To better understand the hesitancy, Sherry Coleman Collins, MS, RDN, LD, registered dietitian and food allergy expert, reached out to Dr. Todd Mahr, MD, board-certified allergist and pediatrician, for his take on why these barriers exist and how to overcome them.
SCC: Can you shed light on why pediatricians may be hesitant to recommend the new guidelines?
TM: I think this is a tough question to answer. It is very complex and multifactorial. We have parents reluctant to do something different than they may have done with past children, or do something that differs from what they hear from other family members (usually grandparents!) For providers, I think change is always hard, we tend to get set in our routines, and adjusting information is not easy. We, as professional societies need to do a better job of informing members of these new guidelines. All too often we assume everyone has read or heard about changes, and that just isn’t the case.
SCC: On the other hand, what are some reasons that pediatricians and other health professionals should promote the new guidelines to their families?
TM: The data speaks for itself. Delaying introduction of these “allergenic” foods is not helpful, and in fact may be harmful as a cause of MORE food allergies.
SCC: Our consumer research shows that more than 40% of millennial parents are unaware of the new guidelines and those that are familiar want to know more. For instance, parents in our survey want to know more about why the guidelines once recommended avoidance and now they recommend early introduction. How would you recommend that pediatricians address these questions? Are there any specific things pediatricians and other health professionals should tell parents to help them confidently incorporate the new guidelines?
TM: I like what Dr. David Stukus, an allergist from Nationwide Children’s has stated: – One way is to tell the peanut story, which started more than a decade ago.George Du Tois, MD, a pediatric allergy consultant in London and colleagues, recognized that the prevalence of peanut allergy in the Israeli population was 10-fold less than that in the United Kingdom. The researchers discovered that many infants in Israel were snacking on a peanut snack called Bamba,, and were thus being introduced to peanuts in infancy, whereas infants in the UK were kept from peanut products until they were a year old. This epidemiologic and association data led to the landmark Learning Early About Peanut (LEAP) study, which showed that early introduction was a good thing.
SCC: What else should pediatricians and health professionals know about recommending the new guidelines?
TM: The big key is to become familiar with the recommendations, understand where they come from, and then look at your interactions with parents at age specific time, so that you can better inform them. I think providers should also review any printed materials they provide, to make sure they are up to date with the most current guidelines.