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313 Needs Assessment for an Infant and Toddler Food Allergy J ALLERGY CLIN IMMUNOL Abstracts AB99 VOLUME 147, NUMBER 2 Needs Assessment for an Infant and Toddler participants were unaware of the LEAP study and 51 (61%) did not know 313 Food Allergy Curriculum for Pediatric Residents about the addendum guidelines. CONCLUSIONS: This preliminary data demonstrates that there is a Marielle Young1, Ariel Frey-Vogel, MD1, Kristina Dzara, PhD, MMSc1, knowledge gap in pediatric residents and more education is necessary. This Michael Pistiner, MD MMSc2; 1MassGeneral Hospital for Children, is an ongoing project that will use didactic tools to ensure future 2MassGeneral Hospital for Children, Harva. implementation of the guidelines. RATIONALE: The prevalence of pediatric food allergies is increasing. Approximately 6% of children ages 0 to 2 years have a food allergy. A Quality Improvement Initiative to Improve Pediatric residents are frontline providers for children with food allergies, 315 Resident- Physician Practices Regarding Flu but little is known about their educational experiences and comfort Vaccine Administration in Individuals with Egg managing infant/toddler food allergies. Allergy METHODS: An anonymous online needs assessment survey was created 1 1 2 and distributed to pediatric residents in one residency program. The survey Aishwarya Navalpakam , Shweta Saini, MD , Chi- Lan Tran , Jenny Huang, MD1, Divya Seth2, Pavadee Poowuttikul, MD FAAAAI2; 1Chil- explored residents’ knowledge sources, experience and comfort diag- 2 nosing, treating and counseling patients regarding infant/toddler food dren’s Hospital of Michigan, Wayne State University. allergies. RATIONALE: Individuals with any severity of egg allergy, including RESULTS: Forty-nine pediatric residents (77%) responded. Prior to anaphylaxis, should receive the influenza vaccine annually per CDC residency, most residents (94%) did not have any formal training on infant/ guidelines. This recommendation has evolved over the past ten years. We toddler food allergies. The most common sources of information on infant/ performed a quality improvement initiative to assess and improve resident toddler food allergies included outpatient pediatric clinicians (74%), other physician practices regarding flu vaccine administration in egg allergic pediatric residents (59%) and emergency department clinicians (55%). individuals. Nearly all residents were uncomfortable (69%) evaluating food allergies. METHODS: Residents rotating through the allergy clinic of a free- Most residents were very uncomfortable (20%) or uncomfortable (65%) standing children’s hospital were provided with a pre-survey, educational managing food allergies. Most residents were very uncomfortable (16%) or intervention, and post-survey over the course of a year. The educational uncomfortable (65%) counseling families about food allergy diagnosis. intervention was a brief informational session on influenza vaccine by the The majority of residents were very uncomfortable (14%) or uncomfort- allergy fellow in clinic. Data was analyzed using descriptive statistics. Chi- able (53%) counseling families about food allergy prevention. In contrast, square test was performed. most residents were very comfortable (16%) or comfortable (53%) RESULTS: Pre-intervention survey was completed by 34 residents and diagnosing anaphylaxis. Similarly, most were very comfortable (20%) or post-intervention survey by 22 residents. Prior to the intervention, 14% of comfortable (49%) treating anaphylaxis. residents believed that the flu vaccine is contraindicated in patients with CONCLUSIONS: While pediatric residents feel comfortable diagnosing history of anaphylaxis to egg. After receiving education, none of the and treating infant/toddler anaphylaxis, there is a lack of comfort residents believed that the flu vaccine was contraindicated in these patients 5 surrounding infant/toddler food allergy evaluation, management, and (p 0.16). Only 44% of residents pre-intervention would administer the counseling for families. Pediatric residents may benefit from a compre- vaccine in the usual manner with egg allergic patients intervention when hensive infant/toddler food allergy curriculum which focuses on these compared to 90% post- intervention (p <0.005). specific areas of need. CONCLUSIONS: This study revealed room for improvement in resident training and practice in influenza vaccine administration in egg allergic Assessment of Early Peanut Introduction individuals. A focused educational intervention led to increased resident 314 Guidelines Among Pediatricians In An Inner- knowledge and better adherence to influenza vaccine administration city Hospital guidelines. Sumeet Sandhu, MD1, Monique Hanono, MD2, Carly Rabin, MD2, Rob Harriz, MD2, Sairaman Nagarajan, MD MPH1, Maria-Anna Vastardi, MD1; 1Center for Allergy and Asthma Research, SUNY Brooklyn Health Sciences University, 2SUNY Downstate Medical Center. RATIONALE: Peanuts are the leading cause of death from food-induced anaphylaxis. The 2015 Learning Early About Peanut Allergy (LEAP) landmark study led to the 2017 Addendum Guidelines, which recommends early peanut introduction to infants at increased risk of developing peanut allergy. It is unclear to what extend general pediatricians follow these guidelines. Educating pediatric residents and attendings will result in an increased knowledge of these evidence-based early peanut introduction guidelines, leading to reduced development of peanut allergy in the pediatric population. METHODS: In this multicenter study, an anonymous voluntary survey was used to assess knowledge and practice of early peanut introduction in pediatric house staff and attendings. RESULTS: Currently, we have collected 83 completed surveys. Of these, 73 (88%) survey participants were residents. 43 (52%) participants start discussing peanut introduction at age 6 months and 73 (88%) participants have never ordered serum specific peanut IgE. Only 5 (6%) participants were comfortable with interpreting lab results to diagnose peanut allergy, 42 (51%) were somewhat comfortable and 36 (43%) were not comfortable. Most common reason parents reported to doctors for not introducing peanuts early was that they were unaware (23 participants). 35 (42%) AB100 Abstracts J ALLERGY CLIN IMMUNOL FEBRUARY 2021 Dietary Normalization Following A Successful guardians screened positively for worry (82%, N518) or stress (59%, 316 Oral Food Challenge In Children With Food N513). Of those who screened positively for worry or stress, 11% (N52) Allergies and 8% (N51) responded that their child had been bullied/teased, respectively. Elizaveta Rakhmanova, BSc1, Kuang-Chih Hsiao, MBChB2; 1Univer- CONCLUSIONS: Based on the results of this survey study, allergists and sity of Auckland School of Medicine, Auckland, New Zealand, 2Starship pediatricians are infrequently screening for food allergy-related bullying/ Hospital, Auckland District Health Board, Auckland, New Zealand. teasing and parents are receptive to screening and resources. RATIONALE: Oral food challenge (OFC) is a resource-intensive yet invaluable investigation for diagnosing food allergy (FA) and confirming Systematic Development of a Patient-centered FA resolution. Some recent case series report low rates of regular dietary 318 Outcomes Measure to Assess the Psychosocial consumption of previously implicated allergen despite successful OFC, Impact of Food Allergy in Routine Clinical with no local data available to date. We hypothesized that continued Practice ingestion rates post successful OFC may be influenced by patient and 1 2 procedure-related factors Katherine Tison , Kaitlin Proctor, PhD , Hayley Estrem, PhD, MSN, RN3, Jinhee Park, PhD, RN4, Brian Vickery, MD FAAAAI1, William METHODS: We identified 195 children who passed an OFC (peanut, 1 1 2 mixed/multiple tree nuts, baked egg, baked milk, hen’s egg, cow’s milk) Sharp, PhD ; Emory University School of Medicine, Center for Advanced Pediatrics, Children’s Healthcare of Atlanta, 3UNCW School and were followed up by the paediatric immunology service at a university- 4 affiliated tertiary hospital in Auckland, New Zealand, from March 2016 of Nursing, Boston College. through February 2019. Relevant data were retrieved from a prospectively RATIONALE: A recently conducted patient-centered outcomes study maintained OFC service database and patients’ electronic medical records. identified assessment and treatment of food allergy (FA)-related psycho- Effects of exposure variables on ingestion status were examined using Chi- social issues a top research priority. Most currently available instruments Square tests. are designed for use in research settings and focus primarily on FA-related RESULTS: Passing an OFC enabled continued ingestion in the majority quality of life. Our team sought to systematically develop a measure of FA (86%,169/195) of our population at a median follow-up of 10.95 psychosocial impact on caregivers that is sensitive to change with (IQR:5.95-14.76) months. Ingestion status post-OFC was associated with treatment. the allergen tested but not with past atopy, gender, ethnicity, or age at OFC METHODS: Eighteen caregivers of children with FA recruited from the and follow-up. The rate of ongoing consumption was significantly lower CHOA Food Allergy Center participated in focus groups centered on (p50.002) in those who passed mixed nut OFC (69.7%,23/33) as compared exploring caregiver perception of the psychosocial impact FA had on to other challenged foods (90.1%,146/162). themselves and their families. Interviews were transcribed and entered into
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