Table 2. Pre– and Post–Intervention to Reduce Early (Peanut) Allergy in Children Training Responses for Guidelines Knowledge Questionsa.
| Questions and answers | Clinicians, No. (%) | P valueb | |
|---|---|---|---|
| Pretraining survey | Posttraining survey | ||
| For an infant aged 6 mos who does NOT have eczema or any food allergies, what would you typically do next with respect to peanut allergy prevention? (n = 165) | |||
| Order a peanut-specific IgE/RAST test | 1 (0.6) | 0 | NAc |
| Refer to an allergist for consultation and testing | 0 | 0 | |
| Recommend avoidance of peanut-containing foods | 0 | 0 | |
| Offer an in-office feeding of a peanut-containing food | 0 | 0 | |
| Recommend the introduction of peanut-containing food, in accordance with family preferences and cultural practicesc | 159 (96.4) | 165 (100.0) | |
| I would not take any additional steps with respect to peanut allergy prevention | 4 (2.4) | 0 | |
| Other | 1 (0.6) | 0 | |
| For an infant aged 6 mos who has mild-to-moderate eczema, what do the Guidelines recommend next with respect to peanut allergy prevention? (Select only one.) (n = 164) | |||
| Order a peanut-specific IgE/RAST test | 7 (4.3) | 7 (4.3) | <.001 |
| Refer to an allergist for consultation and testing | 11 (6.7) | 0 | |
| Recommend avoidance of peanut-containing foods | 3 (1.8) | 0 | |
| Offer an in-office feeding of a peanut-containing food | 4 (2.4) | 0 | |
| Recommend the introduction of peanut containing foodsc | 132 (80.5) | 156 (95.1) | |
| I would not take any additional steps with respect to peanut allergy prevention | 6 (3.7) | 1 (0.6) | |
| Other | 1 (0.6) | 0 | |
| For an infant aged 6 mos who has severe eczema and/or egg allergy, what do the Guidelines recommend next with respect to peanut allergy prevention? (Select all) (n = 165) | |||
| Order a peanut-specific IgE testc | 55 (33.3) | 160 (97.0) | .002 |
| Conduct peanut-specific skin prick testing in my office | 1 (0.6) | 3 (1.8) | |
| Recommend the introduction of peanut containing foods | 7 (4.2) | 0 | |
| Refer to an allergist for consultation and testingc | 126 (76.4) | 93 (56.4) | |
| Recommend avoidance of peanut-containing foods | 20 (12.1) | 11 (6.7) | |
| Offer an in-office feeding of a peanut-containing food | 3 (1.8) | 3 (1.8) | |
| Recommend the introduction of peanut-containing food | 11 (6.7) | 3 (1.8 | |
| I would not take any additional steps with respect to peanut allergy prevention | 1 (0.6) | 0 | |
| Other | 1 (0.6) | 0 | |
| Knowledge of Guidelines Question Summary (n = 164) | |||
| 3 correct answers | 119 (72.6) | 155 (94.5) | <.001 |
| Eczema identification and guideline application questions | |||
| A four-month-old infant presents with dry itchy skin lesions on the face and upper extremities. You quickly recognize this as atopic dermatitis. The lesions are erythematous (dull red) and indurated, and you note lichenification. There is also some crusting. The lesions are primarily on the face and arms. How would you rate the severity of the atopic dermatitis? (n = 165) | |||
| Atopic dermatitis | |||
| Mild | 9 (5.5) | 9 (5.5) | .03 |
| Moderatec | 139 (84.2) | 150 (90.9) | |
| Severe | 17 (10.3) | 6 (3.6) | |
| A two-month-old African American infant presents with deep purple skin lesions on their face, scalp, extremities, and trunk. The lesions are pruritic, with lichenification, induration, oozing, and crusting. What is your diagnosis? (n = 163) | |||
| Bruising, secondary to a bleeding disorder | 1 (0.6) | 0 | .02 |
| Atopic dermatitis | |||
| Moderate | 14 (8.6) | 5 (3.1) | |
| Severec | 148 (90.8) | 158 (96.9) | |
| [After viewing pictures of infant with severe eczema] In following the NIAID peanut prevention guidelines, what is the appropriate next step? (n = 165) | |||
| Obtain a peanut sIgE/RASTc | 104 (63.4) | 160 (97.6) | <.001 |
| Start peanut containing products in the infant’s diet immediately | 10 (6.1) | 3 (1.8) | |
| Advise the family to wait until the child is at least 9 mos old before starting peanut containing products | 1 (0.6) | 1 (0.6) | |
| Diagnose patient with a peanut allergy | 0 | 0 | |
| I don’t know | 49 (29.9) | 0 | |
| A4. [After viewing pictures of infant with moderate eczema] When should this infant's parent add peanut containing foods to the baby's diet? (n = 164) | |||
| Around 6 months of agec | 87 (53.1) | 128 (78.1) | <.001 |
| They should wait until after 11 mos of age | 0 | 0 | |
| Only after they have been tested and cleared by an Allergist | 18 (11.0) | 7 (4.3) | |
| Peanut-containing foods can be introduced based on family preferences and cultural practices | 38 (23.2) | 29 (17.7) | |
| I don't know | 21 (12.8) | ||
| Eczema Identification and Application Question Summary (n = 162) | |||
| 4 correct answers | 47 (29.0) | 114 (70.4) | <.001 |
Abbreviations: NA, not applicable; NIAID, National Institute of Allergy and Infectious Diseases; RAST, radioallergosorbent test.
a
Pre- and postresponse frequencies are only presented for respondents who answered the question in both surveys.
b
P values are from the McNemar test of the null hypothesis of no treatment effect.
c
There was no variation in responses pre- and posttraining as 100% of clinicians answered correctly at posttraining. Therefore, a P value could not be calculated.