Design of the Intervention to Reduce Early Peanut Allergy in Children (iREACH): A practice‐based clinical trial

• Published in: Pediatric allergy and immunology Vol. 35; no. 4; pp. e14115 - n/a
• Main Authors: Bilaver, Lucy A., Ariza, Adolfo J., Binns, Helen J., Jiang, Jialing, Cohn, Rich, Sansweet, Samantha, Hultquist, Haley, Panza, Joy Laurienzo, Togias, Alkis, Gupta, Ruchi S.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.04.2024
• Subjects: Allergies; Arachis; Caregivers; Child; Child, Preschool; Children; clinical trial; Clinical trials; Eczema; Egg Hypersensitivity; Electronic health records; Electronic medical records; Food allergies; Health care policy; Health risk assessment; Humans; Immunoglobulin E; Infant; Infants; Medical education; Natural language processing; peanut allergy prevention; Peanut Hypersensitivity - epidemiology; Peanut Hypersensitivity - prevention & control; pediatric primary care; Pediatrics; practice‐based research; Primary care; United States; United States; clinical trial; peanut allergy prevention; pediatric primary care; practice‐based research
• ISSN: 0905-6157; 1399-3038; 1399-3038
• DOI: 10.1111/pai.14115

Background Introducing peanut products early can prevent peanut allergy (PA). The “Addendum guidelines for the prevention of PA in the United States” (PPA guidelines) recommend early introduction of peanut products to low and moderate risk infants and evaluation prior to starting peanut products for infants at high risk for PA (those with severe eczema and/or egg allergy). Rapid adoption of guidelines could aid in lowering the prevalence of PA. The Intervention to Reduce Early (Peanut) Allergy in Children (iREACH) trial was designed to promote PPA guideline adherence by pediatric clinicians. Methods A two‐arm, cluster‐randomized, controlled clinical trial was designed to measure the effectiveness of an intervention that included clinician education and accompanying clinical decision support tools integrated in electronic health records (EHR) versus standard care. Randomization was at the practice level (n = 30). Primary aims evaluated over an 18‐month trial period assess adherence to the PPA guidelines using EHR documentation at 4‐ and 6‐month well‐child care visits aided by natural language processing. A secondary aim will evaluate the effectiveness in decreasing the incidence of PA by age 2.5 years using EHR documentation and caregiver surveys. The unit of observation for evaluations are individual children with clustering at the practice level. Conclusion Application of this intervention has the potential to inform the development of strategies to speed implementation of PPA guidelines.