Allergy and Transition

Although transition is usually meant to describe a process of passing on medical care to an adult service for a chronic condition, with allergy things are a bit different. Firstly, the diagnosis is often made at a very young age and the child may have lived with it for many years before the age where transition processes generally kick in (around 11-13yrs, often coinciding with move to high school), so they may already be very aware of their condition.

Secondly, there is often no need for adult allergy service input, and in some areas eg Eastern Scotland there is no adult allergy service anyway.

The challenge is that young people want independence from their parents, self – determination, at the same time they want to fit in with their peers. It is the developmental task of adolescence to have new experiences (even if they are not as bullet proof as they might imagine), including sexual/intimate relationships. It is normal, indeed appropriate, for them to challenge authority/norms, take risks, experiment, demand rights.

When it comes to allergies, bad eczema may already have affected self-image, self-esteem, caused social isolation.  Asthma may have reduced participation in sports, and has its own negative stereotypes.

It’s sometimes productive to go back in the history, especially where there is a history of anaphylaxis – how much is chronic parental anxiety, how much terror of further reaction. 

Non-judgmental approach important.  Particularly important for a young people to be treated as an individual.  When it comes to risks and safety, key in allergy, it’s all about balance – fear of reaction vs being “normal”.  Requires negotiation.

“I have found the best way to give advice to children is to find out what they want and then advise them to do it.” [Harry Truman]  “When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years”. [Mark Twain]

EAACI has 2020 guidance, combined allergy and asthma, by Graham Roberts in Southampton. Key points are:

  • Do you use a structured multidisciplinary transition programme for allergy?
  • Do you use a checklist of skills and knowledge to assess readiness for transition?
  • Do you communicate with your young persons via text or other mobile technology?
  • Do you discuss exams and impact of allergic rhinitis?
  • Have you had any specific teaching or training in transitional care (generic and/or allergy specific)?
  • Do you recommend any specific websites or apps for allergy advice/support?
  • Do you focus consultation on areas where young person says they are not confident?
  • Do you provide (“formulate”)  a personal allergy plan?
  • Do you offer information about any peer-led interventions?
  • Do you discuss exams and impact of allergic rhinitis?
  • Do you recommend any specific websites or apps for allergy advice/support?
  • Do you focus consultation on areas where young person says they are not confident?
  • Do you provide (“formulate”)  a personal allergy plan?
  • Do you identify psychosocial issues, using a tool such as YouthCHAT (online, 8 mins) – includes physical inactivity, eating disorder, problems at home, sexual health etc.
  • Do your friends understand you have an allergy and how to manage an emergency?
  • Do your teachers understand you have an allergy?
  • Do you signpost to high quality online resources?  Do you discuss the role of social media [ie how moderation is desirable, to keep chat positive]
  • [other stuff more relevant probably to asthma]

CYANS is similar, suggesting bite sized topics including:

  1. Do you confirm that they know their diagnosis accurately, and are not avoiding any foods unnecessarily?
  2. Do you discuss specific foods/cuisines that they need to be careful with?
  3. Do you discuss the potential risk from foods labelled “May contain…” or with similar precautionary labels?
  4. Do you discuss experience of food shopping and cooking?
  5. Do you check how confident they feel explaining their allergy to others?
  6. Do you discuss the potential for alcohol to increase the risk of anaphylaxis?
  7. Do you discuss the potential risk from kissing?
  8. Do you present a scenario of an unexpected reaction, to check their understanding of anaphylaxis symptoms and appropriate self management?
  9. Do you see them alone (with parental agreement)?

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