Developing an Intervention to Promote Early Introduction of Peanut and Egg to Reduce Food Allergy Risk

/ABSTRACT This K23 Career Development Award will support the applicant’s long-term career goal of becoming an independent researcher creating behavioral interventions to promote preventive care and improve disease management among pediatric allergic diseases. The proposed study will develop an adaptive, behavioral intervention to support caregivers with the early introduction of peanut and egg in infants’ diets: the Supportive Training in the Early Presentation of Food Allergens (STEP-FA) intervention. Randomized controlled trials (RCTs) have demonstrated a reduction in the onset of certain food allergies (FAs) from introducing allergenic foods early. Adhering to early introduction recommendations is challenging; less than 20% of infants are estimated to have consumed peanuts or eggs before 7 months. Modifiable barriers to early introduction guidelines include practical problems (e.g., food preparation challenges), infant feeding difficulties (e.g., food refusal), and caregiver anxiety about allergic reactions. An intervention approach that does not increase clinic burden and is tailored to the dynamic process of early introduction is needed. The objective of this proposal is to develop, refine, and evaluate the feasibility and acceptability of an adaptive, behavioral intervention to improve adherence to the early introduction of peanut and egg. Community partners from a range of racial, ethnic, and socioeconomic backgrounds will guide the development of intervention content to ensure that STEP-FA meets families’ needs regardless of family resources or health care barriers. The aims of the study are to: 1) develop intervention components promoting early introduction of peanut and egg with ongoing feedback from key community partners, 2) refine the intervention with caregiver input, 3a) evaluate the feasibility and acceptability of the intervention, and 3b) create a comprehensive action plan for the preparation of STEP-FA for a future clinical trial. The long-term goals of the project are to decrease barriers to the early introduction of food allergens and to improve the clinical capacity to reduce the onset of FAs. A comprehensive training plan will enable the applicant to conduct the proposed research and receive individualized training to facilitate her development as an independent investigator. Through the mentorship and training activities provided by this K23 award, the applicant will 1) build intervention development skills, 2) develop methodological expertise in adaptive and tailored interventions, 3) gain specialized training in developing community partnerships and conducting community-engaged research, and 4) gain increased knowledge of emerging areas of FA prevention and treatment approaches. The applicant’s training plan is an excellent fit with the career development opportunities at Rhode Island Hospital and Brown University’s Alpert Medical School. Findings from the proposed study will support a future RCT examining the efficacy and optimal implementation of the STEP-FA intervention with the long-term goal of reducing the prevalence of pediatric FA. Project Number: 1K23AI192506-01 | Fiscal Year: 2025 | NIH Institute/Center: National Institute of Allergy and Infectious Diseases (NIAID) | Principal Investigator: Grace Cushman | Institution: RHODE ISLAND HOSPITAL, PROVIDENCE, RI | Award Amount: $195,696 | Activity Code: K23 | Study Section: Allergy, Immunology, and Transplantation Research Committee[AITC] View on NIH RePORTER: https://reporter.nih.gov/project-details/1K23AI19250601