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 Allergist Pediatrician Young adult 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 FOOD: peanuts, nuts, fish, shellfish Drugs: β lactams, NSAIDs.. Hymenoptera venom Inhalants Latex Chemicals exercise 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 25% dei primi episodi di anafilassi tra bambini e adolescenti avviene a scuola Gupta, Am J Med 2014 Sommer et al, Ann Allergy Asthma Immunol 2014

(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 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 * * * p < 0.05 Personal data, Submitted to Intern J Emerg Med

(SELF) MANAGEMENT AND PERCEPTION OUR EXPERIENCE vs LITERATURE better knowledge better preparedness empowerment Italian adolescents seem to have different characteristic in comparison with International studies Italian YA are technically prepared to use adrenaline GOOD KNOWLEDGE Few are uncertain whether to use adrenaline GOOD PREPAREDNESS NEED FOR MORE EMPOWERMENT AND BELIEFES 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 Allergist Pediatrician Young adult Web tools & apps

Euroforum, El Escorial, Madrid, Spain 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 ma.caminati@gmail.com GRAZIE ma.caminati@gmail.com