Pediatricians may have a new aid to better predict peanut allergies among infants with atopic dermatitis (AD).
Researchers from the Northwestern University Feinberg School of Medicine in Illinois have developed a scorecard to help pediatricians identify and assess the severity of AD in infants of various skin tones and to then predict risk of allergies to peanuts. Their study of the implementation of the scorecard was presented at the Pediatric Academic Societies (PAS) 2023 Meeting in Washington, DC.
Infants with AD or eczema are six times more likely to have an egg allergy and eleven times more likely to have a peanut allergy at age 12 months than are infants without AD.
The scorecard reflects recent directives from the National Institute of Allergy and Infectious Diseases (NIAID) to help combat the public health problem.
Dr Waheeda Samady
“When the NIAID prevention of peanut allergy guidelines first came out, it asked pediatricians to serve as frontline practitioners in implementing them by identifying children at risk for peanut allergy and guiding families on what to do next,” Waheeda Samady, MD, professor of pediatrics at Northwestern University Feinberg School of Medicine, said. “The impetus for the study was to further support pediatricians in this role.”
Although pediatricians are trained to identify and even treat mild to moderate cases of AD, little emphasis has gone to categorizing the condition on the basis of severity and to correlating peanut allergy risk.
The scorecard captures fourteen images from thirteen infants: one infant of mixed race, two White infants, two Black infants, and two Hispanic infants.
To create the card, two in-house pediatric dermatologists assessed 58 images from 13 children and categorized images from 0 (no signs of AD) to 4 (severe signs of AD). After a first pass on categorization, the doctors agreed on 84% of images.
Of 189 pediatricians who used the card, fewer than half reported that they “sometimes,” “very often,” or “always” used the scorecard for AD evaluation. A little fewer than three quarters reported that their ability to diagnose and categorize AD improved.
Dr Kawaljit Brar
“Severity staging of atopic dermatitis is not something that the general pediatrician necessarily performs on a day-to-day basis,” Kawaljit Brar, MD, professor of pediatrics in the Division of Allergy and Immunology at Hassenfeld Children’s Hospital in New York, said.
Brar explained that children who are identified as being at high risk are often referred to specialists such as her, who then perform allergy screenings and can determine whether introduction of food at home is safe or whether office feedings supervised by an allergist are necessary. Researchers have found that early introduction to peanuts for children with moderate to severe AD could prevent peanut allergy.
“This represents a wonderful initiative to educate pediatricians so that they understand which patients require screening for peanut allergy and which patients don’t and can just get introduced to peanuts at home,” Brar said.
The AD scorecard reflects a growing recognition that varying skin tones show levels of severity incongruously.
“Many of us in clinical practice have recognized that our education has not always been inclusive of patients with varying skin tones,” Samady said. “When we looked for photos of patients with different skin tones, we simply could not find any that we thought were appropriate. So we decided to take some ourselves, and we’re currently continuing to take photos in order to improve the scorecard we currently have.”
The study was funded by the National Institute of Health and Food Allergy Research and Education (FARE). Samady and Brar report no relevant financial relationships.
Pediatric Academic Societies (PAS) 2023 Meeting: Poster 380.
Brittany Elyse Vargas is a freelance writer who covers breaking news and medicine.
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