The Intervention to Reduce Early (Peanut) Allergy in Children (iREACH) is a clinical decision support tool that may facilitate pediatrician guideline adherence for the prevention of peanut allergy, according to study results published in JAMA Pediatrics.

In 2017, the National Institute for Allergy and Infectious Diseases created guidelines that recommend screening infants aged 4 to 6 months for peanut allergy risk. As a result, pediatricians designed the iREACH, which includes pediatrician training and clinical decision support tools that are implemented in the electronic medical record for infant well-child visits. The tools include an order set for peanut-specific immunoglobulin E or allergy referral for infants at high risk for peanut allergy, a prompt to evaluate peanut allergy risk, a prompt indicating peanut product introduction counseling, an instructional handout for caregivers, and a best-practice advisory for infants with known eczema or egg allergy.

Researchers compared adherence to the guidelines between pediatricians in an iREACH clinic (n=151 infants) and pediatricians in a non-iREACH clinic (n=312 infants).

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Among infants at low to moderate risk for peanut allergy, the researchers found that pediatricians were fully adherent to the guidelines in 52.4% (n=75 of 143) of infants in the iREACH clinic vs 14.1% (n=44 of 311) of infants in the comparison clinic (P <.001).

In addition, pediatricians were partially adherent to the guidelines for 93.0% (n=133 of 143) of these infants in the iREACH clinic (data not applicable in the non-iREACH clinic). Among infants at high risk, pediatrician adherence was 62.5% (n=5 of 8) in the iREACH clinic. In the non-iREACH clinic, the sample size was not sufficient enough to detect a difference (n=1).

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The authors concluded that, “Since well-child visits for infants aged 4 to 6 months focus on a range of preventative and anticipatory guidance, an effective [clinical decision support] tool such as iREACH may facilitate pediatrician guideline adherence.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Bilaver LA, Martusiewicz MN, Jiang J, Gupta RS. Effectiveness of clinical decision support tools on pediatrician adherence to peanut allergy prevention guidelines [published online October 14, 2019]. JAMA Pediatrics. doi:10.1001/jamapediatrics.2019.3360