000762 - Transition: the future starts earlier

The transition from pediatric to adult health care services is a crucial process for young patients. The significant changes in physical and mental health during adolescence, increasing independence and individuation, can complicate or impede transition with poor adherence or interruption of treatment. This is important especially in some conditions as Food allergy (FA), potentially life-threatening. 

Food allergy affects approximately up to 8% of children and 10.8% of adults. Food is the most common trigger for severe anaphylaxis resulting in admission to hospitals which mortality results in 0,03-0,32 for million people. 

FA has a negative impact on HR-QoL (Health related quality of Life) of pediatric patients and their care-givers, because it may be associated with social isolation, fear of accidental exposure and depression, especially among teenagers. 

OIT( oral immunotherapy) is actually recommended (grade A) as a treatment option for persistent cow’s milk, hen’s egg or peanut allergies for children from around 4–5 years of age. It can provide desensitization, increasing the threshold of reaction to food allergen while on treatment and represents potentially a curative therapy and may be effective also in improving HR-QoL of patients. The transition becomes a crucial moment for adherence and continuation therapy prime importance for patient safety but also to minimize health-care costs of emerging treatments. It should begin in the pediatric office when pediatrician starts to mention to the adolescent and the family that soon will be followed by the adult’s specialist.The process begins with a joint evaluation of the patient and family by the pediatrician, immunologist and case manager. Necessary moment to introduce the new doctor to the family, but also to introduce the new doctor to the patient's active problems and those to be monitored. Then, 2-4 meetings will be scheduled in the pediatric office, with both the pediatric and the adult specialist being present. The presence of a psychologist during the transition may be very important to provide useful advice to both the patient and the adult specialist, aiming to prevent therapy discontinuation promoting better and more effective communication about the importance of continuation therapy in the holistic perspective of improving the quality of patients’life, but also of their families, friends and partners, and break down possible barriers about doubts of treatment or feelings of shame that often affect adolescent patients, especially regarding drug use sexual habits that can influence the therapeutic process. The adult specialist should encourage meetings without parents to increase patient's independence, consciousness and responsibility searching for personalized therapy approach following patient’s profile and desire for a better compliance.