Aims This systematic review aims to understand the challenges faced by adolescents and young adults (11-25 years) with allergic diseases, including asthma.
Methods A search strategy was constructed using Cochrane Database of Systematic Reviews, MEDLINE, Embase and Psychinfo. Databases were searched to February 10, 2019. Quality assessments and data extraction were undertaken independently by two reviewers.
Results 108 papers describing 106 studies were included. Most were from USA (n=50), Netherlands (n=12), Sweden (n=11) and UK (n=11). Most focused on asthma (n=69) or food allergy (n=19). They were qualitative, cross-sectional or longitudinal quantitative studies. There were five themes.1 Quality of life, as a measure of patients’ experience of life. Factors associated with impaired quality of life: symptomatic disease, impaired psychological health, onset in adolescence, poor adherence, female sex and multiple allergies. Protective factors were exercise and increasing age.2 Psychological factors. Social anxiety has been associated with asthma and food allergy; it may inhibit patients from using medication in front of peers. Depression has also be associated with asthma and food allergy while suicidal ideation has been associated with eczema. Emotional support from family and friends has been found to be protective for asthma control.3 Adherence. Factors associated with poor adherence are older age; barriers to using medication such as lack of time, forgetfulness, cost, competing demand and accessibility, over reliance on short-acting rescue medication or poor knowledge; lack of perception of symptoms; and lack of personal responsibility. Factors associated with good adherence were routine, good self-efficacy, simple medication regimes and good knowledge about their disease. Patients who need to carry self-injectable adrenaline seem to be particularly non-adherent; the burden of these and incorrect knowledge around risks leading to poor decision making.4 Self-management. This extended from the previous theme and involved a series of barriers and corresponding facilitators.5 Supportive relationships. Key ones were identified as families, peers, friend and schools and healthcare professionals.
Conclusion The current evidence base to support the planned European guidelines for managing allergic disease in this age group is weak. Large longitudinal cohort and interventional studies are required to strength the evidence base.
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