Why do few food-allergic adolescents treat anaphylaxis with adrenaline? reviewing a pressing issue

TY - JOUR

T1 - Why do few food-allergic adolescents treat anaphylaxis with adrenaline? reviewing a pressing issue

AU - Marrs, Tom

AU - Lack, Gideon

PY - 2013/5

Y1 - 2013/5

N2 - Food allergic adolescents are at higher risk of fatal anaphylaxis than other children. Both allergen avoidance and maintaining access to adrenaline auto-injectors (AAI) are key goals in effective food allergy management, for which written guidance is often supplied. However, adolescents are rarely sufficiently prepared to use adrenaline during anaphylaxis. It is likely that further didactic education would bring limited improvement in management in this population. Focused discussion of each adolescent's perspectives and current management practice may allow more effective behavioural strategies to be adopted. Key areas for appraisal include subjects' experiences after previous allergen exposure with reference to worst response, recognising specific symptoms requiring AAI administration, and appropriate priority being given to timeliness of administering adrenaline. Behavioural strategies should be discussed to increase AAI accessibility. Rigor of allergen avoidance should not be compromised by false reassurance of proximity to emergency medication or medical services. Food allergic adolescents are motivated by the psychological impact of their condition, which often makes them feel different to their peers and may result in bullying. Methods of appropriately empowering adolescents may be considered, such as involvement of close friends and lay organisations to support appropriate management. Open discussion is crucial in engaging with adolescents' reasoning for adopting their chosen management strategies. Further research is warranted to identify cognitive patterns associated with high-risk behaviour, and to design appropriate interventions for the augmentation of adolescent self-management skills.

AB - Food allergic adolescents are at higher risk of fatal anaphylaxis than other children. Both allergen avoidance and maintaining access to adrenaline auto-injectors (AAI) are key goals in effective food allergy management, for which written guidance is often supplied. However, adolescents are rarely sufficiently prepared to use adrenaline during anaphylaxis. It is likely that further didactic education would bring limited improvement in management in this population. Focused discussion of each adolescent's perspectives and current management practice may allow more effective behavioural strategies to be adopted. Key areas for appraisal include subjects' experiences after previous allergen exposure with reference to worst response, recognising specific symptoms requiring AAI administration, and appropriate priority being given to timeliness of administering adrenaline. Behavioural strategies should be discussed to increase AAI accessibility. Rigor of allergen avoidance should not be compromised by false reassurance of proximity to emergency medication or medical services. Food allergic adolescents are motivated by the psychological impact of their condition, which often makes them feel different to their peers and may result in bullying. Methods of appropriately empowering adolescents may be considered, such as involvement of close friends and lay organisations to support appropriate management. Open discussion is crucial in engaging with adolescents' reasoning for adopting their chosen management strategies. Further research is warranted to identify cognitive patterns associated with high-risk behaviour, and to design appropriate interventions for the augmentation of adolescent self-management skills.

KW - anaphylaxis

KW - adolescent

KW - adrenaline

KW - epinephrine

KW - food allergy

KW - preparedness

KW - self-efficacy

KW - EPINEPHRINE AUTOINJECTOR

KW - PSYCHOSOCIAL IMPACT

KW - SELF-EFFICACY

KW - CHILDREN

KW - MANAGEMENT

KW - HYPERSENSITIVITY

KW - TEENAGERS

KW - RISK

KW - COMMUNITY

KW - EPIDEMIOLOGY

U2 - 10.1111/pai.12013

DO - 10.1111/pai.12013

M3 - Literature review

SN - 0905-6157

VL - 24

SP - 222

EP - 229

JO - Pediatric Allergy and Immunology

JF - Pediatric Allergy and Immunology

IS - 3

ER -