Study evaluates self-management strategies for allergies

Teenagers and young adults are a group that is notoriously behind when it comes to compliance with medical regimens and self-management of conditions like asthma and allergies. A new study reviewed some self-management techniques that might be successful in helping this group take better control of their conditions.

The new study,¹ published in Allergy, evaluated how well interventions focused on well-being and self-management worked in teenagers and young adults with asthma and other allergic conditions. The European Academy of Allergy and Clinical Immunology Task Force on Allergic Diseases in Adolescents and Young Adults conducted a systemic literature review across 8 databases to complete the study, reviewing a total of 30 papers from 27 studies. Some of the self-management interventions covered by those studies included psychological interventions, e-health, educational programs, peer-led programs, and breathing exercises or retraining. All of these interventions were geared specifically toward asthma management.

Part of the reason teenagers and young adults don’t do well with self-management of allergies and asthma is in part due to the independence they are starting to have from parents and old routines, as well as perhaps peer pressure and a lack of education on their disease. The result of this poor self-management, however, is an increased risk of fatal anaphylaxis resulting from exposure to allergen-containing foods or asthma-related deaths. These increased risks are also a high source of depression and anxiety in these age groups, according to the research team.

Teaching better self-management might be the key to improving quality of life and reducing risks in these age groups. The report reviewed a number of self-management techniques, dividing them into 4 groups—psychological, e-health, education, and peer-led. All of these focused on asthma management over allergies, according to the report. There were also a small number of studies that focused on breathing retraining techniques. Follow-up on the success of these interventions was performed 2 to 12 weeks afterwards, the report notes.

Psychological interventions

Psychological intervention for asthma management focused on the management of stress, anxiety, and depression. Participants were also taught coping and problem-solving skills. Each of the interventions also included at least some education on asthma, as well. Although this group overall reported improved overall health outcomes, there was a lack of replication in the studies and it wasn’t clear how clinically significant any improvements were, the report notes.

E-health interventions

E-health interventions used a number of computer-based applications, videos, and mobile apps to offer instruction on medication use, personalized action plans for asthma exacerbations, computer-aided decision-making programs, and individualized counseling. These interventions showed significant improvement in overall health outcomes, especially in those with moderate to severe asthma. Specifically, there were improvements in inhaler use techniques, more questions asked about medications and asthma control. Despite the overall health improvements, the research team found that there was little significant improvement in overall asthma scores of self-efficacy.

General education interventions

These interventions included a number of education types, including programs led by nurses, group sessions, and individual education. Each program was focused on improving outcomes related to asthma knowledge, identifying symptoms, how to prevent asthma attacks, and how to manage the disease. A reduction in symptoms and improvements in management techniques and medication use were noted among participants for each education method. However, long-term benefits of these education program were not clear, with mixed results on improvement across all the studies reviewed.

Peer-led interventions

In the review of peer-led education groups, there was significant improvement noted in outcomes over results after adult-led education groups, the report notes. Researchers saw an 80% to 82% drop in acute office visits in one study evaluating participants from a peer-led group, and there were also drops in missed school days. However, only one study that reviewed peer-led groups really evaluated the impact on asthma management from a health outcome perspective, noting no overall improvement in FEV1 between intervention and control groups.

Overall, the research team noted at least some improvement in intervention groups over control groups for each intervention. Quality of life, self-esteem, coping methods, moods, device use techniques, and reduction in asthma symptoms were among the area improved by the interventions. However, while most of the intervention types showed at least some improvement, these programs focused on asthma over other types of allergic conditions, and certain interventions types yielded more improvement than others. The research team suggests that before evidence-based recommendations be made, that better research is needed. The studies examined were small feasibility or pilot studies, and large longitudinal studies would provide better evidence on the efficacy of any of these interventions, the report team notes.

Reference

1. Knibb R, Alviani C, Garriga, Baraut T, et al. The effectiveness of interventions to improve self‐management for adolescents and young adults with allergic conditions: a systematic review. Allergy. 2020;75(8):1880-1897. doi:10.1111/all.14269