Infant Peanut Allergy Prevention: Understanding and Supporting Caregivers to Achieve Adherence

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PROJECT SUMMARY Peanut allergy (PA) is the most common food allergy in the US; it is also one of the least frequently outgrown and the leading cause of fatal food-allergic reactions. The landmark Learning Early About Peanut study found that the ingestion of peanut products in infancy can decrease PA development by over 81%. Thus, in 2017 the NIAID published the Prevention of Peanut Allergy (PPA) Guidelines. However, implementation of these guidelines is unique in that they are a reversal of previous guidelines, posing additional challenges for all stakeholders. For caregivers of young infants specifically, compliance with the PPA guidelines requires them to understand the changing science around food allergy development, participate in early peanut feeding during short time window (4-6 months of age), and accept the risks involved with feeding their infant a potentially allergenic food. While studies involving pediatricians and allergists have been conducted, our current understanding of caregiver opinions PPA guidelines and our interventions to support caregivers to adhere to early peanut introduction are limited. Utilizing an established clinical network of over 30 pediatric clinics in Illinois (primary mentor’s parent grant iREACH), this proposal will evaluate caregiver barriers and facilitators to the PPA guidelines and investigate the key driving factors for adherence and nonadherence by conducting qualitative interviews with caregivers of young children. This data will be incorporated into building a distinct interactive intervention: iCARE (Intervention to Improve Caregiver Adherence Regarding Early Peanut Introduction). Using web-, mobile-, and/or video-based applications, the goal of iCARE will be to address caregiver barriers and unmet needs to facilitate early peanut introduction. After following an iterative prototyping process to develop iCARE with stakeholders and experts, it will be tested among caregivers to understand its efficacy, acceptability, and feasibility. This will provide preliminary data for an R01 proposal studying the effectiveness of iCARE in a randomized clinical trial. As caregivers are the ultimate drivers of PPA guideline implementation, this project addresses a gap in our current approach to PA prevention. This K23 proposal addresses multiple gaps in Dr. Samady’s research skillset, providing additional training in: 1) qualitative data analysis, 2) behavioral science training, 3) development and evaluation of novel behavioral interventions. Her primary mentor, Dr. Gupta is a national leader in food allergy prevention studies, her co- mentor Dr. McGee is a leading expert in qualitative research and professional development, and her co- mentors Drs. Van Horn, and Pongracic have additional expertise in developing and evaluating behavioral interventions. Completion of these aims and training goals will support Dr. Samady’s long-term goal of become an independent investigator and national leader studying infants with atopic disease, focused on improving the implementation of current food allergy prevention efforts and identifying new prevention strategies.