ANAFILASSI
NELL’ADOLESCENTE
(UN MONDO A PARTE?)
Marco Caminati
Referente Nazionale JMs SIAAIC
EAACI Food Allergy Interest Group JM Representative
Unità Operativa di Allergologia
Centro di riferimento regionale per la prevenzione, la diagnosi
e la cura delle malattie allergiche
Azienda Ospedaliera Universitaria di Verona
Responsabile G. Senna
WHY WE SHOULD CARE ABOUT IT
ANAPHYLAXIS IN ADOLESCENTS
☞
Pediatrician
Allergist
☞ clinical relevance
☞ many unmet needs despite increasing interest in the topic
MATTER OF AGE OR A DIFFERENT PHENOTYPE?
ANAPHYLAXIS IN ADOLESCENTS
☞ epidemiology
☞ triggers
☞ symptoms profile
☞ (self) management and perception
MATTER OF AGE OR A DIFFERENT PHENOTYPE?
EPIDEMIOLOGY
Decker, JACI 2008
MATTER OF AGE OR A DIFFERENT PHENOTYPE?
EPIDEMIOLOGY - ITALIAN DATA
• Piemonte, anno 2010
Su una popolazione di circa 4.400.000
persone, 778 casi di anafilassi
582 anafilassi da alimenti (75%)
221 casi 0-17 anni (29/100.000 persone-anno)
 361 casi ≥18 anni (9,9/100.000 persone-anno)
Rolla, Intern Emerg Med 2013
MATTER OF AGE OR A DIFFERENT PHENOTYPE?
TRIGGERS
1.
2.
3.
4.
5.
6.
7.
FOOD: peanuts, nuts, fish, shellfish
Drugs: β lactams, NSAIDs..
Hymenoptera venom
Cause di anafilassi
Inhalants
(tutte le età)
Latex
Chemicals
33%
34%
exercise
alimenti
punture
d'insetto
farmaci
14%
19%
altro
Decker, JACI 2008
MATTER OF AGE OR A DIFFERENT PHENOTYPE?
TRIGGERS – FATAL ANAPHYLAXIS
Liew, JACI 2008
MATTER OF AGE OR A DIFFERENT PHENOTYPE?
SYMPTOMS PROFILE
Rolla, Intern Emerg Med 2013
MATTER OF AGE OR A DIFFERENT PHENOTYPE?
(SELF) MANAGEMENT AND PERCEPTION
SCUOLA
Necessità
individuali
Formazione del
personale
Legislazione
COETANEI
Pressione del
gruppo
Senso di vergogna
Timore
dell’isolamento
AUTONOMIA
Comportamenti a rischio e
di sfida
Passaggio della gestione
dall’adulto al ragazzo
Più tempo lontano dalla
famiglia
Marrs et al, PAI 2013
Sampson, JACI 2012
Gupta, Am J Med 2014
(SELF) MANAGEMENT AND PERCEPTION
RELEVANT ISSUES
La maggior parte
delle reazioni letali
avviene fuori casa
Gupta, Am J Med 2014
Sommer et al, Ann Allergy Asthma Immunol 2014
25% dei primi
episodi di anafilassi
tra bambini e
adolescenti avviene
a scuola
(SELF) MANAGEMENT AND PERCEPTION
PRACTICAL IMPLICATIONS
• 174 patients (13-21 yo)
with food allergy
• 87% epinephrine
autoinjector
• 61% declare they
always carry on the
auto-injector
Sampson MA, JACI 2006
(SELF) MANAGEMENT AND PERCEPTION
PRACTICAL IMPLICATIONS
• 466 children and adolescents in UK: 245 cases of
anaphylaxis
• 83% did not use the autoinjector
Noimark, CEA 2012
(SELF) MANAGEMENT AND PERCEPTION
OUR EXPERIENCE - MULTICENTER ITALIAN SURVEY
✏ knowledge and awareness about epinephrine autoinjector
✏ 12 items questionnaire
✏ 4-steps test with a simulator
✏ 251 patients provided with epinephrine autoinjector
Comparative analysis of the young adults
subgroup (m 15.63, SD 4.3)
Personal data, Submitted to Intern J Emerg Med
(SELF) MANAGEMENT AND PERCEPTION
OUR EXPERIENCE - MULTICENTER ITALIAN SURVEY
✏ triggers overview
90
80
70
60
50
adult
40
young adults
30
20
10
0
food
Hym venom
latex
drug
Personal data, Submitted to Intern J Emerg Med
(SELF) MANAGEMENT AND PERCEPTION
OUR EXPERIENCE - MULTICENTER ITALIAN SURVEY
✏ 4-steps test and questionnaire
Personal data, Submitted to Intern J Emerg Med
(SELF) MANAGEMENT AND PERCEPTION
OUR EXPERIENCE - MULTICENTER ITALIAN SURVEY
*
40
35
30
*
25
20
adults
15
young adults
10
5
0
need to rely
on others for
"self"
administration
* p < 0.05
not safer
not more
protected
not able to
manage
anaphylaxis
not trained
enough by
doctor
Personal data, Submitted to Intern J Emerg Med
(SELF) MANAGEMENT AND PERCEPTION
OUR EXPERIENCE vs LITERATURE
✏ better knowledge
✏ better preparedness
☞ empowerment
☞ beliefes
Marrs et al, PAI 2013
ANAPHYLAXIS IN ADOLESCENTS
AGENDA FOR SIAIP-SIAAIC JMS???
☞ epidemiology
☞ triggers
No recente data
Few Italian data
☞ symptoms profile
☞ (self) management and perception
Web tools & apps
Pediatrician
Allergist
Food Allergy In Adolescents And Adults
24/09/2015
- 26/09/2015
Euroforum, El Escorial, Madrid, Spain
Organising Committee
- IG Food Allergy:
Montserrat Fernandez Rivas ( ES) Clare Mills (UK)
Barbara Ballmer-Weber (CH)
Karin Hoffmann-Sommergruber (AT) Bodo Niggemann (DE)
Rodrigo Rodrigues Alves (P)
Tasos Konstantinopoulos (GR)
Marco Caminati (IT)- JMA
GRAZIE
[email protected]
[email protected]