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

项目总结 花生过敏(PA)是美国最常见的食物过敏，也是最不常见的过敏之一 也是致命性食物过敏反应的主要原因。具有里程碑意义的关于花生的早期学习研究发现 婴儿时期摄入花生产品可使PA发育减少81%以上。因此，在2017年， NIAID发布了预防花生过敏(PPA)指南。然而，这些措施的实施 指导方针的独特之处在于，它们是对以前指导方针的颠覆，对所有 利益相关者。特别是对于幼儿的照顾者来说，遵守PPA指南要求他们 了解有关食物过敏发展的变化科学，参与花生早期喂养 短时间窗口(4-6个月大)，并接受给婴儿喂奶可能涉及的风险 过敏性食物。虽然涉及儿科医生和过敏症专家的研究已经进行，但我们目前的 了解照顾者的意见、PPA指南和我们的干预措施，以支持照顾者遵守 早期花生的引种是有限的。利用伊利诺伊州30多家儿科诊所建立的临床网络 (初级导师的父母赠款iReach)，这项提案将评估照顾者障碍和促进者对 PPA指南，并通过开展以下活动来调查遵守和不遵守的关键驱动因素 对幼儿照顾者的定性访谈。这些数据将被合并到构建一个不同的 互动干预：ICARE(提高早期花生照顾者依从性的干预措施 引言)。使用基于Web、移动和/或视频的应用程序，ICARE的目标将是满足 照顾者的障碍和未得到满足的需求促进了花生的早期引种。在遵循迭代之后 与利益相关者和专家一起开发ICARE的原型过程，它将在照顾者中进行测试，以 了解其有效性、可接受性和可行性。这将为R01提案提供初步数据 在随机临床试验中研究icare的有效性。因为照顾者是PPA的最终驱动力 为了实施指南，该项目解决了我们目前预防PA方法中的一个空白。 这项K23提案解决了Samady博士研究技能中的多个空白，在以下方面提供了额外的培训： 1)定性数据分析，2)行为科学培训，3)新行为的开发和评估 干预措施。她的主要导师古普塔博士是食物过敏预防研究的全国领先者，她的合作伙伴 导师McGee博士是定性研究和专业发展方面的领先专家，她的合作伙伴- 导师Van Horn博士和Pongracic博士在开发和评估行为学方面拥有额外的专业知识 干预措施。完成这些目标和培训目标将支持Samady博士的长期目标 成为研究婴儿特应性疾病的独立调查者和国家领导者，专注于 改进现有食物过敏预防工作的执行情况，并确定新的预防措施 战略。

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.