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

Pediatric Allergy and Immunology - Tập 24 Số 3 - Trang 222-229 - 2013
Tom Marrs1, Gideon Lack2,1
1Department of Paediatric Allergy; Division of Asthma, Allergy and Lung Biology, King's College; London; UK
2Children's Allergies, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK

Tóm tắt

AbstractFood 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.

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Tài liệu tham khảo

10.1016/j.jaci.2007.01.021

10.1016/j.jaci.2005.05.047

Office for National Statistics.Population Estimates for UK England and Wales Scotland and Northern Ireland Mid‐2010.http://www.ons.gov.uk/ons/re-reference-tables.html?edition=tcm%3A77-231847. Published 30 June 2011. [Accessed 25th April 2012].

10.1016/j.jaci.2010.03.029

10.1136/thx.2004.038844

10.1016/j.jaci.2008.09.043

10.1111/j.1365-2222.2011.03930.x

10.1111/j.1398-9995.2010.02342.x

10.1097/ACI.0b013e32814a569b

10.1016/j.jaci.2006.12.622

10.1111/j.1398-9995.2007.01421.x

10.1111/j.1398-9995.2005.00909.x

10.1111/j.1398-9995.2008.01926.x

10.1097/ACI.0b013e32833bc670

10.1046/j.1365-2222.2000.00864.x

10.1067/mai.2001.112031

10.1016/j.jaci.2009.03.050

10.1016/j.jaci.2005.03.039

10.1111/j.1365-2222.2005.02257.x

10.1016/S0140-6736(00)03543-1

10.1186/2045-7022-2-3

10.1002/0470861193.ch10

10.1111/j.1365-2222.2007.02758.x

10.1016/S0033-3506(03)00034-9

10.1046/j.1398-9995.2003.00365.x

10.1016/S1054-139X(99)00042-7

10.1136/adc.2009.175125

10.1111/j.1365-2222.2011.03912.x

10.1016/j.jaci.2010.06.022

10.1016/j.jaci.2004.12.1122

10.1046/j.1365-2222.2003.01671.x

10.1016/j.jaci.2009.05.028

10.1067/mai.2000.106041

10.1111/j.1365-2222.2010.03586.x

10.1542/peds.105.2.359

10.1136/bmj.d6180

10.1067/mai.2002.123305

Simons FE, 2004, First‐aid treatment of anaphylaxis to food: focus on epinephrine, J Allergy Clin Immunol, 113, 837

10.1067/mai.2002.127860

10.1016/S1081-1206(10)60810-1

10.1111/j.1399-543X.2004.00048.x

10.1002/(SICI)1096-9136(199704)14:4<321::AID-DIA356>3.0.CO;2-H

10.1016/S0168-8227(11)70027-4

10.1097/ACI.0b013e3282ffb168

10.1097/00004703-200604000-00003

10.1111/j.1399-3038.2009.00938.x

10.1016/S0033-3506(01)00414-0

10.1016/j.jadohealth.2009.06.026

10.1093/jpepsy/jsq088

10.1136/adc.2006.114975

10.1136/adc.86.1.26

10.1136/adc.2011.212662.

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Pediatric Allergy and Immunology

Tập 24 Số 3

222-229

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