Allergies and Adolescents Transitioning Towards Independent Living David R. Stukus Editor 123 Allergies and Adolescents David R. Stukus Editor Allergies and Adolescents Transitioning Towards Independent Living Editor David R. Stukus Nationwide Children’s Hospital The Ohio State University College of Medicine Columbus, OH USA ISBN 978-3-319-77484-8 ISBN 978-3-319-77485-5 (eBook) https://doi.org/10.1007/978-3-319-77485-5 Library of Congress Control Number: 2018942955 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifcally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microflms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland I would like to thank all of my adolescent patients and their families for their knowledge and insight; this book is a testament to how each of you successfully navigates every day. Special thanks to Lee Budin, MD, for showing me the importance of questioning old mantras, to David Lang, MD, for instilling in me the importance of using evidence to base our decisions, and to Bryan Martin, DO, for inspiring me to pursue endeavors both challenging and worthwhile. Finally, none of this would be possible without the never-ending love and support of my wife, Kristin, and our children, Jackson and Harper. Foreword Adolescence is a time of travel during which children stretch across the borders of their childhood, gain insights from irreverent and novel sources, and dip their toes in new waters. Teens gradually come to rely more upon themselves than ever before. It is therefore a time of differing risk not only for teens with life-threatening condi- tions, like food allergy-provoked anaphylaxis, but also for children with conditions that at frst glance are seemingly benign, such as allergic rhinitis. Because the tra- verse of the teenage years comes with elevated risk, it is an obvious time of terror for those who care deeply about the well-being of a teen they love. This includes friends and family, but also physicians, nurses, and care teams who work hard to ensure a child thrives as that child emancipates out of childhood. We all want adolescence to go so very well, but there are successes and failures as teens navigate their worlds and the elevated stakes. No longer are the risks a skinned knee, and no longer do children defer their environment and choices to their protective parents. Teens with allergic conditions have unique healthcare needs, and unique consequences occur when they are not included in their own care and not empowered to protect themselves. The beauty here is that pediatric care teams and parents can help identify ways to enhance a teen’s experience, knowledge, and know-how. This collection of evi- dence, wisdom, and practice advice can help you help an adolescent thrive. All transitions in life come with a bit of heartache, just as all hand-offs in and out of the hospital come with risk. As teens’ needs in their care change, as puberty takes hold, as sleep timing and sleep needs shift, as moods become more labile, as risk- taking advances, and as allergic symptoms morph, there are specifc interventions— and noninterventions—that may not only improve the quality of life for a teen with allergies but also allow for a sense of control and an opportunity for a higher quality of care. This collection of words and data, expertise, and insight proves a hearty tool with which to understand the unique opportunity we have with teens who have allergies. The overlay of depression, tobacco use, driving, sports involvement, and psychoso- cial stresses and demands of school during the teen years all deserve specifc atten- tion and care. Data supporting the “growing out of” and the “not growing out of” vii viii Foreword allergies can help pediatric care teams and families surround a teen with bolsters of support. The twenty-frst century has offered a new medium for medicine. I see this opti- mistically. More than ever before, teens, parents, and clinical teams are learning about their health and about themselves online. We share and connect and learn now in novel ways from apps, online educational sites like FARE, teen-targeted media, social and traditional media, and content that arrive on our virtual doorstep every day. Dr. David Stukus leads the way here for children, teens, and their families part- nering in health care and wrestling with allergic conditions. Through his myth- busting and dedication to providing accurate information online and on Twitter to his illuminating the research specifc to adolescence in this book, we are all afforded a new opportunity to do better. May these words here and the research, experience, and expertise that brought them together reduce suffering for those you love and those for whom you care. I do not think adolescence will ever feel steady per se, but I am certain the knowledge housed here can help reduce the unease we all feel while supporting teens amid it. Wendy Sue Swanson Chief of Digital Innovation Seattle Children’s Hospital Seattle, WA, USA Preface All adolescents face unique challenges when they leave home for the frst time. Whether attending college or joining the work force, living independently can be a daunting task. Learning how to cook, do laundry, and manage a busy schedule con- stitute enough new “real life” experiences for the average teenager. Now imagine also being responsible for taking medications consistently, arranging medical appointments, and managing acute illness. This is diffcult for most adults to man- age, let alone adolescents learning how to juggle all the other aspects of living independently for the frst time. As a practicing allergist for the past 10  years, I have cared for thousands of patients with asthma, allergic rhinitis, eczema, food allergy, and immune defciency. These are all chronic conditions that patients must learn to live with daily. As a pediatrician, I also help parents navigate the nuances of caring for children of vari- ous ages. Successful management strategies for toddlers are vastly different from those that apply to children in grade school and even more challenging in teenagers. Unfortunately, there are very few, if any, evidence-based resources readily avail- able for teenagers with allergic conditions and their parents to reference to as they prepare for leaving home. In addition, primary care providers and specialists caring for adolescents are rarely provided education regarding this topic and thus are often unprepared to help their patients transition to independence. My experiences in working with these families along with the lack of resources and research in this area inspired the development of this book. Throughout this book, readers will learn about factors that are unique to the nor- mal cognitive and social development of adolescents as well as be exposed to effec- tive strategies for involving them in their own self-management. The many faces of nonadherence will be discussed in detail, including specifc aspects pertaining to adolescents. Allergic rhinitis, asthma, food allergy, and eczema each have a chapter devoted to an in-depth discussion of basic concepts surrounding diagnosis and man- agement; each of these chapters is then followed by a separate chapter providing details as to how that condition can specifcally impact adolescents. Finally, the last ix x Preface chapters of the book aim to provide practical tips that can be immediately imple- mented by adolescents and their families as well as clinicians. The authors of each chapter are all experts within their respective felds and have graciously devoted their time to provide invaluable contributions. In addition, sev- eral of the authors are accomplished researchers, and all have experience working with adolescents. Throughout this book, the collective knowledge and understand- ing of our authors have been eloquently translated into a discussion written at a level that any reader can understand. References are provided throughout for those who desire more in-depth discussion of key topics. This book was specifcally designed for multiple audiences with varying levels of knowledge, and each chapter can also stand alone as its own text. Any healthcare provider who treats adolescents (especially adolescents with allergic conditions) will learn a comprehensive approach not available elsewhere that will help prepare patients for independent living. In addition, adolescents themselves may learn about their own conditions and ways to improve their self-management. Parents, caregiv- ers, school personnel, and family members will fnd these chapters useful as well. Thank you for taking the time to read this book. If even one life is positively impacted by our work, then this undertaking will be deemed a success. David R. Stukus Columbus, OH, USA Contents 1 T he Allergy Epidemic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Kathleen Grisanti and Mitchell H. Grayson 2 A dolescent Brain Development and Implications for Adolescents with Allergies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Amy Hahn and Jessica L. Hoehn 3 H ow Can We Best Communicate with Adolescents? . . . . . . . . . . . . . . 31 R. Claire Roden and Elise D. Berlan 4 T he Many Faces of Nonadherence in Adolescents . . . . . . . . . . . . . . . . 43 Michael R. Gionfriddo 5 A llergic Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Margaret Redmond 6 A llergic Rhinitis Pertaining to Adolescents . . . . . . . . . . . . . . . . . . . . . 81 Mervat Nassef and Marc L. Rubin 7 A sthma: A Heterogeneous and Challenging Chronic Condition . . . . 95 David R. Stukus and William C. Anderson III 8 M anaging Adolescent Asthma: More than Just Medications . . . . . . . 119 William C. Anderson III 9 F ood Allergies: An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Jialing Jiang, Lauren M. Kao, Ozge N. Aktas, and Ruchi S. Gupta 1 0 F ood Allergies and the Teenager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Nancy S. Rotter and Michael Pistiner 1 1 A topic Dermatitis: Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Benjamin T. Prince and Rekha Raveendran 1 2 A topic Dermatitis Pertaining to Adolescents . . . . . . . . . . . . . . . . . . . . 187 Rekha Raveendran and Benjamin T. Prince xi