A practical toolbox for the effective transition of adolescents and young adults with asthma and allergies: An EAACI position paper

Abstract

Adolescence is a challenging time for patients, their parents and their healthcare professionals (HCP). 1 Although Adolescent and Young Adult (AYA) patients are generally not seen as a vulnerable or 'in need' group, they have an unexpectedly high risk of morbidity and mortality. This includes a surprisingly high rate of asthma death and fatal anaphylaxis, which peaks in AYA. 2,3 The inclusion of adolescent health in the United Nations secretary general's Global Strategy for Women's and Children's Health in 2015 reflects a growing awareness of the importance and specificity of this stage of development. Adolescence is a critical stage of life characterized by rapid biological, emotional and social development, during which skills for a productive, healthy and satisfying life are developed. As part of this period of growth and development, the status of primary relationships and level of autonomy also shifts. The need to take on responsibility for behaviours and learn to cope with everyday events and challenges falls increasingly on the adolescent. 4 Together with these usual developmental tasks, adolescents with an allergic disease face additional challenges that may render them more vulnerable to adverse outcomes. This may include psychological issues (such as poor quality of life) and difficulties around adherence and self-management (such as risk-taking behaviours). These are common as AYA explore their boundaries and are influenced by peer pressure as parents 'let go'. They may include exposure to smoking, alcohol, other recreational drugs or food allergens in social contexts, which that may impact on their asthma control or risk of accidental exposures to foods. 1 Support is therefore vital for this age group. However, a recent European survey found that most HCP have not received training in how to support adolescents and young adults (AYA) with allergic conditions and do not have an established paediatric to adult healthcare transition process. 5 Ensuring that every adolescent has the knowledge and skills to self-manage their allergy with confidence is essential for achieving good mental and physical health and development goals and lower risk of adverse outcomes. This is equally necessary when patients stay within the same service as adults, as well as when they are transferred into an adult service, in which case the responsibility for an effective transition is shared by the paediatric and adult teams.The European Academy of Allergy and Clinical Immunology (EAACI) transition guideline was developed by a multi-stakeholder Task Force from across Europe using evidence-based principles and published to support HCP in effectively managing AYA. 4 Its recommendations have been favourably reviewed by AYA and parents from across Europe. 6 This paper aimed to provide HCP (both paediatric and adult, as well as those seeing all ages), AYA and families with practical and targeted resources to support successful selfmanagement of asthma and allergic conditions.

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