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Helio Interview


Information disclosure: Fisher does not disclose related financial information. Providence is an investor in Ready, Set, Food!


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In 2020, guidance has changed to encourage parents and guardians to give peanuts and eggs to babies between 4 and 6 months of age to prevent food allergies. However, many parents still refrain from these early introductions.

Education is the key to improving these outcomes, Danel M. Fisher, MD, a pediatrics specialist at Providence St. Johns Health Center in Los Angeles, Healio said.

“We need to talk to the families about this,” Fischer said. “We want to share our knowledge and want families to understand that there is actually good science behind our recommendations.”

How to educate parents

The American Academy of Allergy, Asthma, and Immunology supports the introduction of peanuts and eggs at 4 to 6 months of age, with earlier introduction at 4 months recommended for those at high risk, as does the American College of Allergy, Asthma, and Immunology, American Academy of Pediatrics (AAP ) and the FDA.

Ready, Set, Food!, which sells supplements and infant formulas including peanuts, eggs, milk, cashews and other allergens to infants, is providing educational resources in the form of Early Entry Electronic Health Records that Providence will share with families at birth and throughout time of visits to the doctor. at 2, 4, 6 and 9 months.

Danel M. Fisher

“The first part of the partnership is really about education so that families can understand from an early age that early allergen introduction is beneficial and important in preventing food allergies, that they are going to partner with their doctor on this journey. try new products,” Fischer said.

When families have problems, Fisher continued, service providers deal with them immediately and appropriately.

“I’ve had a lot of families saying, ‘I’m allergic to peanuts’ or ‘My husband is allergic to fish.’ How are we going to act? And then we discuss with them how we are going to apply the phased approach,” Fisher said.

For the first few months, healthcare providers work with families to introduce dairy, eggs, and peanuts to infants before trying other allergens. The goal is to introduce solid food in addition to breast milk or formula at 4 to 6 months of age.

For example, during a 2-month doctor visit, healthcare professionals will begin discussing the specific goals of introducing various foods at 4 months of age to help families prepare. During the 4-month visit, the targets for the 6-month benchmark will be discussed and so on.

Iron is also a concern, as the iron content of breast milk declines after 6 months.

“Babies who are breastfed have the potential to become anemic,” Fischer said. “We recommend that families introduce oatmeal at 4 to 6 months of age, or any cereal. But I recommend oatmeal because rice cereal causes constipation.”

In addition to printed materials, families can access information at preventallergies.org, a Ready, Set, Food! In addition, Providence offers content to families through the Circle app and CME webinars.

These resources are needed because many parents are afraid to introduce their children to these products, Fisher said, because they have been exposed to the idea that these products are dangerous for years.

“I can’t tell you how many times my family members have said to me, ‘I would be more comfortable if I took a jar of peanut butter and a spoon and drove to your office parking lot and gave it to my kids the first time there just in case anything something will happen,” she said.

“I have to laugh because I see my parents come to my office with a can of Skippy. I always tell them to relax. The situation will not be so dramatic,” she continued, adding that allergies occur after repeated exposure.

“I’m not worried that someone tries peanut butter, they go into anaphylactic shock and die,” she said.

Supplier training

Fisher acknowledges that recommendations have changed a lot over her 21-year career. When she first trained in 2001, she advised families to refrain from giving their children nuts until they were 2 or 3 years old.

“But what happened was that we had so many children with food allergies,” she said.

The landmark 2015 LEAP study found that early exposure to peanut products helped protect against food allergies, she said, adding that tracking changes like this can be challenging for many suppliers.

“We have to ask, ‘Does everyone know the right information?'” she said. “When you’re dealing with a large healthcare system like Providence that cares for many, many people, it’s helpful to have that training built into the electronic health record.”

Clinicians also need to be aware of the scientific evidence behind these recommendations, she continued. Dissemination of the studies on which these recommendations were based is a key part of the process.

“We have to take the advice we used to give without thinking, think about it again, read about why it changed, and then make recommendations accordingly,” she said.

“We’re not just talking about doctors. We are talking about everyone who provides care – nurses, paramedics, everyone who intersects with these families. We want messages to be the same for everyone,” she said.

That’s why Providence’s partnership with Ready, Set, Food! includes components that help the entire team stay on the same wavelength with the latest scientific data and make the same recommendations.

In addition to Providence, Fisher said that all service providers would benefit from additional training, not only about these changing rules, but also in communicating with families. For example, Done, Done, Food! noted that only about 30% of pediatricians educate families on food allergy prevention.

Fisher said she and her colleagues are looking to engage healthcare providers through lectures on food allergy prevention at pediatric and family medicine conferences. However, providers who cannot participate in conferences can use online resources.

Fisher encourages health care providers to visit the AAP websites, which she calls the “gold standard” of resources for clinicians and families, with information on early weaning, links to important research, and educational resources for clinicians and families.

In addition, Fisher recommended the AAAAI, ACAAI, and NIH websites.

“The National Institutes of Health is a great resource for clinicians, especially because they do a lot of research,” Fisher said. “They publish studies that show how we come to these conclusions.”

In addition to the materials on preventallergies.org Ready, Set, Food! offers information and resources on its website that providers can share with families looking for explanations and information about food allergies.

“It’s good to have more than one website. It’s good to have different sources of information,” Fischer said. “There are a lot of great resources online that clinicians and families can access.”

With these resources, Fischer says, health professionals can discuss food allergies early and overcome many families’ concerns about introducing solid foods to their infants’ diets.

“For some families, it’s just excitement, and for others, it’s a little unnerving. I think we need to present to these families the safety of introducing these products early and that it can be done not to create fear, but to promote tolerance,” Fisher said.

“I would like to change this way of thinking so that families are happy about it, because this is a happy time,” she said.

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