614 - Knowledge, Attitudes and Behaviors Regarding Peanut Protein Introduction During Infancy—a US population-based survey of parents/caregivers

Poster Number: 614
Publication Number: 614.200

Christopher M. Warren, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Waheeda Samady, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Sai Nimmagadda, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Justin M. Zaslavsky, Northwestern University The Feinberg School of Medicine, New York, NY, United States; Haley Hultquist, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Carina Venter, University Of Colorado, Denver, CO, United States; Ruchi S. Gupta, Northwestern University The Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Peanut allergy affects approximately 1 in 50 US infants and imposes substantial physical, psychosocial, and economic burden on affected patients and their families. The National Institute of Allergy and Infectious Disease (NIAID)-sponsored addendum guidelines for the Primary Prevention of Peanut Allergy (PPA) were released in 2017, and mark a shift towards earlier recommended introduction of peanut—particularly among eczematous infants. However, much remains unknown about US parent/caregiver attitudes, knowledge, and behaviors regarding peanut introduction.

Objective: To characterize current attitudes, knowledge, and behaviors regarding introduction of peanut protein during infancy among US parents/caregivers.

Design/Methods: A survey was developed by a team of pediatricians, pediatric allergists and survey methodologists to assess current parent/caregiver attitudes, knowledge and behaviors around introduction of common food allergens. Data about family allergy history and demographics were also collected. Surveys were administered 1/21/2021--2/15/2021, to a US population-based sample of parents/caregivers of children aged 7-42 months.  Complex survey weighting was conducted to improve population-level inference.

Results: Responses were obtained from 3062 households, whose demographic characteristics are representative of the general US parent/caregiver population. Among infants, 11% had eczema, among whom 26% had been prescribed a cream/ointment—an indicator of more severe disease. Overall, 58% of surveyed parents/caregivers reported that their child’s primary care doctor (PCP) discussed peanut introduction vs. 69% of parents/caregivers of eczematous children. Among all parents whose PCP discussed peanut introduction, only 40% reported receiving a recommendation to introduce peanut by 11 months of age, vs. 46% of parents of eczematous children.  Only 44.7% of parents/caregivers reported introducing peanut protein to their infant by 11 months.  Parents/caregivers who reported strong belief that feeding peanut-containing foods will decrease the risk of their child developing peanut allergy were much more likely to introduce peanut by 11 months of age (71.3% of parents/caregivers) compared to those who did not believe early peanut exposure was protective (33.0%), or did not know (31.3%).    Thirteen percent of all respondents reported awareness of expert recommendations that babies with eczema should be fed peanut-containing foods around 4-6 months of age in order to prevent peanut allergy vs. 18% of parents of eczematous children.  Conclusion(s): PPA guideline implementation is suboptimal in the US.
Parent/caregiver report of whether PCP ever discussed when to introduce peanut-containing foods to their infantMany parents/caregivers do not report discussing when to introduce peanut-containing foods with their PCP
Parent/caregiver report of specific PCP guidance regarding when to introduce peanut into their infant's dietFewer than half of US parents/caregivers reported receiving PCP guidance to feed peanut protein during their infant's first year of life