GP6 Poor control of allergic disease among adolescents

Abstract

<h3>Background</h3> The prevalence of food allergy in adolescents varies with estimates of 2.3–4.5% in different populations (1,2). This group are a vulnerable population. They are at greater risk of fatal anaphylaxis and fatal asthmatic episodes. In Ireland, they have a potential further risk in that most have not had an opportunity to see an allergist through childhood due to extremely limited access. <h3>Aims</h3> To examine the presence of risk factors for poorly controlled allergic disease identifiable in adolescent patients on the routine waiting list (WL) in the allergy department. <h3>Methods</h3> Adolescents attending their first allergy clinic appointment who were on the routine outpatient WL were included between September- December 2017. Clinical data pertaining to each adolescent’s allergic disease was collected at this appointment. A scoring system was utilised to numerically grade the cause for concern for each adolescent after review in clinic. A 1A point was awarded for each major concern identified and a 1B point was awarded for each moderate concern identified. <h3>Results</h3> Data was collected on 17 adolescents over the 3-month period. The primary reason for referral in all patients was investigation of food allergy. Ten were referred by GPs, 5 by general paediatricians and 2 by dermatologists. 15/17 adolescents had between 1–3 criteria for major concern; uncontrolled asthma (n=6), recurrent reactions while on the WL (n=11), anaphylaxis while on WL (n=3), no AAI prescribed (n=4). 14/17 had criteria for moderate concern; not carrying a prescribed in date AAI (n=9), poorly controlled allergic rhinitis (n=10), social isolation (n=3). The highest score was 3A+1B in 2 adolescents. <h3>Conclusion</h3> This study shows that adolescents are at significant risk of allergic reactions, uncontrolled asthma and recurrent food reactions prior to review by a specialist allergist. 10/17 (59%) had a reaction while on the WL. Three cases were anaphylaxis. This study has prompted design of a specific information leaflet for GPs referring adolescents to the allergy clinic as well as review of criteria for urgent review in clinic. <h3>References</h3> Pereira B, Venter C, Grundy J, Clayton CB, Arshad SH, Dean T. Prevalence of sensitization to food allergens, reported adverse reaction to foods, food avoidance, and food hypersensitivity among teenagers. <i>J Allergy Clin Immunol</i> 2005;116(4):884–92. Sasaki M, Koplin JJ, Dharmage SC, Field MJ, Sawyer SM, McWilliam V, et al. Prevalence of clinic-defined food allergy in early adolescence: The SchoolNuts study. J Allergy Clin Immunol 2018 Jan;141(1):391–398.e4.