Knowledge on asthma, food allergies, and anaphylaxis: Assessment of elementary school teachers, parents/caregivers of asthmatic children, and university students in Uruguaiana, in the state of Rio Grande do Sul, Brazil
Main Article Content
Keywords
Students, Teachers, Parents, Caregivers, Knowledge, Asthma, Food allergies, Anaphylaxis
Abstract
Introduction: Allergic diseases have become an increasingly common reality in the last years, extending beyond the family context.
Objective: Assessing the level of knowledge on asthma, food allergies and anaphylaxis of asthmatic children’s parents/caregivers (PC), elementary school teachers (EST) and university students (US) in Uruguaiana, RS, Brazil.
Method: 577 individuals (PC - N = 111; EST - N = 177; US - N = 299) took part in the study, answering the Newcastle Asthma Knowledge Questionnaire (validated for Portuguese) and another questionnaire on Food Allergy (FA) and anaphylaxis.
Results: Although PC have asthmatic children, their asthma knowledge level was average, slightly above that of EST and EU. The lack of knowledge on passive smoking, use of medications and their side effects should be highlighted. US have shown to be better informed about FA and anaphylaxis. However, even though a significant proportion of respondents know the most common symptoms of FA and anaphylaxis, few named subcutaneous adrenaline as the drug of choice for treating anaphylaxis. Although a significant number of respondents know about the possibility of anaphylactic reactions happening at school or in activities outside the school, we were surprised by the absence of conditions in schools to provide emergency care to such students.
Conclusion: Despite the high prevalence of allergic diseases in childhood, asthmatic children’s parents/caregivers, elementary school teachers and university students have inadequate levels of knowledge to monitor these patients.
References
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14. Lucas T, Anderson MA, Hill PD. What level of knowledge do elementary school teachers possess concerning the care of children with asthma? A pilot study. J Pediatr Nurs. 2012;27: 523-7.
15. Varela AL, Esteban SR, Díaz SP, Murúa JK, Fernández-Oliva CR, Jiménez JS, et al. Knowledge of asthma in school teachers in nine Spanish cities. Pediatr Pulmonol. 2016;51:678-87.
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17. Vardavas CI, Hohmann C, Patelarou E, Martinez D, Henderson AJ, Granell R, et al. The independent role of prenatal and postnatal exposure to active and passive smoking on the development of early wheeze in children. Eur Respir J. 2016;48:115-24.
18. Programa Nacional de Controle ao Tabagismo. Available from: http://dab.saude.gov.br/docs/eventos/2a mostra/programanacional controle tabagismo.pdf (accessed 20.03.17).
19. Thomas RE, McLellan J, Perera R. Effectiveness of school-based smoking prevention curricula: systematic review and meta-analysis. BMJ Open. 2015;5, e006976.
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23. Pbert L, Farber H, Horn K, Lando HA, Muramoto M, O’Loughlin J, et al. State-of-the-art office-based interventions to eliminate youth tobacco use: the past decade. Pediatrics. 2015;135:734-47.
24. Praena-Crespo M, Lora-Espinosa A, Aquino Llinares N, Sanchez Sanchez AM, Jime1nez Cortés A. Versión espanola ˜ del NAKQ, Adapatación transcultural y análisis. An Pediatr (Barc). 2009;70:209-17.
25. Roncada C, Oliveira SG, Cidade SF, Rafael JG, Ojeda BS, Santos BRL, et al. Asthma treatment in children and adolescents in an urban area in southern Brazil: popular myths and features. J Bras Pneumol. 2016;42:136-42.
26. López-Silvarrey Varela A, Pértega Díaz S, Rueda Esteban S, Korta Murúa J, Iglesias López B, Martínez-Gimeno A. Validation of a questionnaire in Spanish on asthma knowledge in teachers. Arch Bronconeumol. 2015;51:115-20.
27. Stepney C, Kane KBA, Bruzzese JM. My child is diagnosed with asthma, now what? Motivation Parent to help their children control asthma. J Sch Nurs. 2011;27:340-7.
28. Baiardini I, Sicuro F, Balbi F, Canonica GW, Braido F. Psychological aspects in asthma: do psychological factors affect asthma management? Asthma Res Pract. 2015;1:7, http://dx.doi.org/10.1186/s40733-015-0007-1.
29. Lim J, Wood BL, Miller BD, Simmens SJ. Effects of paternal and maternal depressive symptoms on child internalizing symptoms and asthma disease activity: mediation by interparental negativity and parenting. J Fam Psychol. 2011;25:137-46.
30. Glazebrook C, McPherson AC, Macdonald IA, Swift JA, Ramsay C, Newbould R, et al. Asthma as a barrier to children’s physical activity: implications for body mass index and mental health. Pediatrics. 2006;118:2443-9.
31. Praena-Crespo M, Aquino-Llinares N, Fernández-Truan JC, Castro-Gómez L, Segovia-Ferrera C. GESA network, Asthma education taught by physical education teachers at grade schools: a randomized cluster trial. Allergol Immunopathol (Madr). 2017;45:375-86.
32. Gibson-Young L, Martinasek MP, Clutter M, Forrest J. Are students with asthma at increased risk for being a victim of bullying in school or cyberspace? Findings from the 2011 Florida youth risk behavior survey. J Sch Health. 2014;84:429-34.
33. Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry. 2013;70:419-26.
34. van Geel M, Vedder P, Tanilon J. Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: a meta-analysis. JAMA Pediatr. 2014;168:435-42.
35. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy. Allergy. 2014;69:1008-25.
36. Walkner M, Warren C, Gupta RS. Quality of life in food allergy patients and their families. Pediatr Clin N Am. 2015;62:1453-61.
37. Lau G, Patel N, Umasunthar T, Gore C, Wagner JO, Hanna H, et al. Anxiety and stress in mother of food-allergic children. Pediatr Allergy Immunol. 2014;25:236-42.
38. LEI N◦ 12.982, DE 28 DE MAIO DE 2014. Available from: http://www.planalto.gov.br/ccivil 03/ Ato2011-2014/2014/Lei/L12982.htm (accessed 15.04.17).
39. Gore C, Griffin TR, Rothenberg T, Tallet A, Howood B, Sizmur S. New patient-reported experience measure for children with allergic disease: development, validation and results from integrated care. Arch Dis Child. 2016;101:935-43.
40. Lieberman JA, Sicherer SH. Quality of life in food allergy. Curr Opin Allergy Clin Immunol. 2011;11:236-42.
41. Shemesh E, Annunziato RA, Ambrose MA, Ravid NL, Mullarkey C, Rubes M, et al. Child and parental reports of bullying in a consecutive sample of children with food allergy. Pediatrics. 2013;131:e10-7.
42. Lieberman JA, Weiss C, Furlong TJ, Sicherer M, Sicherer SH. Bullying among pediatric patients with food allergy. Ann Allergy Asthma Immunol. 2010;105:282-6.
43. Muraro A, Polloni L, Lazzarotto F, Toniolo A, Baldi I, Bonaguro R, et al. Comparison of bullying of food-allergic versus healthy schoolchildren in Italy. J Allergy Clin Immunol. 2014;134:749-51.
44. Polloni L, Dunn Galvin A, Ferruzza E, Bonaguro R, Lazzarotto F, Toniolo A, et al. Coping strategies, alexithymia and anxiety in young patients with food allergy. Allergy. 2017;72:1054-60.
45. Polloni L, Lazzarotto F, Bonaguro R, Toniolo A, Celegato N, Muraro A. Psychological care of food-allergic children and their families: an exploratory analysis. Pediatr Allergy Immunol. 2015;26:87-90.
46. Egan M, Sicherer S. Doctor, my child is bullied: food allergy management in schools. Curr Opin Allergy Clin Immunol. 2016;16:291-6.
47. Polloni L, Gini G, Fiore G, Lazzarotto F, Bonaguro R, Toniolo A, et al. Bullying risk in students with food allergy: schoolteachers’ awareness. Pediatr Allergy Immunol. 2016;27:225-6.
48. Juliá-Benito JC, Escarrer-Jaume M, Guerra-Pérez MT, ContrerasPorta J, Tauler-Toro E, Madronero-Tentor ˜ A, et al. Knowledge of asthma and anaphylaxis among teachers in Spanish schools. Allergol Immunopathol (Madr). 2017;45:369-74.
49. Urrutia-Pereira M, To T, Cruz AA, Solé D. The school as a health promoter for children with asthma: the purpose of an education programme. Allergol Immunopathol (Madr). 2017;45:93-8.
50. Papadopoulos NG, Savvatianos S. The vital need for allergy training: removing the doubts. Prim Care Respir J. 2013;22:5-6.
51. Bousquet J, Addis A, Adcock I, Agache I, Agusti A, Alonso A, et al. Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J. 2014;44:304-23.
52. Urrutia-Pereira M, Solé D. The Jerusalem Chapter: a new paradigm in the care of allergic children and adolescents in Latin-American schools. Rev Alerg Mex. 2017;64:3-6.
2. Muraro A, Clark A, Beyer K, Borrego LM, Borres M, Lodrup Carlsen KC, et al. The management of the allergic child at school: EAACI/GA2LEN Task Force on the allergic child at school. Allergy. 2010;65:681-9.
3. Bornemann R, Hagemeister K, Bresser HG, Hamelmann E. Allergy and school: nothing to be sneezed at! A primary school project in Bielefeld, Germany, on epidemiology and health promotion in allergic diseases. Allergol J Int. 2016;25:201-9.
4. Laleh Sharifi D, Heidarnazhad H, Mostafa Moin M. Asthma knowledge, attitude, and self-efficacy in Iranian asthmatic patients. Arch Iran Med. 2011;14:315.
5. Urrutia-Pereira M, Solé D. El nino˜ alérgico en la escuela, ¿Qué es lo que se necesita saber? Rev Alerg Mex. 2016;63:283-392.
6. Sclar DA, Lieberman PL. Anaphylaxis: underdiagnosed, underreported, and undertreated. Am J Med. 2014;127 Suppl.:S1-5.
7. Jaramillo Y, Reznik M. Do United States’ teachers know and adhere to the national guidelines on asthma management in the classroom? A systematic review. Sci World J. 2015;2015:624828.
8. Polloni L, Lazzarotto F, Toniolo A, Ducolin G, Muraro A. What do school personnel know, think and feel about food allergies? Clin Transl Allergy. 2013;3:39.
9. Polloni L, Baldi I, Lazzarotto F, Bonaguro R, Toniolo A, Celegato N, et al. School personnel’s self-efficacy in managing food allergy and anaphylaxis. Pediatr Allergy Immunol. 2016;27:356-60.
10. Munzenberger P, Secord E, Thomas R. Relationship between patient caregiver and asthma characteristics, responsibility for management and indicators of asthma control within an urban clinic. J Asthma. 2011;47:41-5.
11. Urrutia-Pereira M, Avila J, Solé D. The Program for the Prevention of Childhood Asthma: a specialized care program for children with wheezing or asthma in Brazil. J Bras Pneumol. 2016;42:42-7.
12. Cidade SF, Rocada C, Costa DD, Rafael JG, Pitrez PM. Validac¸ão linguística e psicométrica do questionário (NAKQ). Rev Ciên Méd. 2016;24:1-13.
13. American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, Transitions Clinical Report Authoring Group, Cooley WC, Sagerman PJ. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2011;128:182-200.
14. Lucas T, Anderson MA, Hill PD. What level of knowledge do elementary school teachers possess concerning the care of children with asthma? A pilot study. J Pediatr Nurs. 2012;27: 523-7.
15. Varela AL, Esteban SR, Díaz SP, Murúa JK, Fernández-Oliva CR, Jiménez JS, et al. Knowledge of asthma in school teachers in nine Spanish cities. Pediatr Pulmonol. 2016;51:678-87.
16. Halmø Hürdum S, Zhang G, Khoo SK, Bizzintino J, Franks KM, Lindsay K, et al. Recurrent rhinovirus detections in children following a rhinovirus-induced wheezing exacerbation: a retrospective study. Int J Pediatr Child Health. 2015;3:10-8.
17. Vardavas CI, Hohmann C, Patelarou E, Martinez D, Henderson AJ, Granell R, et al. The independent role of prenatal and postnatal exposure to active and passive smoking on the development of early wheeze in children. Eur Respir J. 2016;48:115-24.
18. Programa Nacional de Controle ao Tabagismo. Available from: http://dab.saude.gov.br/docs/eventos/2a mostra/programanacional controle tabagismo.pdf (accessed 20.03.17).
19. Thomas RE, McLellan J, Perera R. Effectiveness of school-based smoking prevention curricula: systematic review and meta-analysis. BMJ Open. 2015;5, e006976.
20. MPOWER: a policy package to reverse the tobacco epidemic. Geneva: World Health Organization; 2008. Available from: http://www.who.int/tobacco/mpower/mpower english.pdf (accessed 20.03.17).
21. Thomas RE, Baker PR, Thomas BC, Lorenzetti DL. Family-based programmes for preventing smoking by children and adolescents. Cochrane Database Syst Rev. 2015;27:CD004493.
22. The health consequence of smoking. 50 years of progress. A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Office on Smoking and Health; 2014. Available from: https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf (accessed 10.03.17).
23. Pbert L, Farber H, Horn K, Lando HA, Muramoto M, O’Loughlin J, et al. State-of-the-art office-based interventions to eliminate youth tobacco use: the past decade. Pediatrics. 2015;135:734-47.
24. Praena-Crespo M, Lora-Espinosa A, Aquino Llinares N, Sanchez Sanchez AM, Jime1nez Cortés A. Versión espanola ˜ del NAKQ, Adapatación transcultural y análisis. An Pediatr (Barc). 2009;70:209-17.
25. Roncada C, Oliveira SG, Cidade SF, Rafael JG, Ojeda BS, Santos BRL, et al. Asthma treatment in children and adolescents in an urban area in southern Brazil: popular myths and features. J Bras Pneumol. 2016;42:136-42.
26. López-Silvarrey Varela A, Pértega Díaz S, Rueda Esteban S, Korta Murúa J, Iglesias López B, Martínez-Gimeno A. Validation of a questionnaire in Spanish on asthma knowledge in teachers. Arch Bronconeumol. 2015;51:115-20.
27. Stepney C, Kane KBA, Bruzzese JM. My child is diagnosed with asthma, now what? Motivation Parent to help their children control asthma. J Sch Nurs. 2011;27:340-7.
28. Baiardini I, Sicuro F, Balbi F, Canonica GW, Braido F. Psychological aspects in asthma: do psychological factors affect asthma management? Asthma Res Pract. 2015;1:7, http://dx.doi.org/10.1186/s40733-015-0007-1.
29. Lim J, Wood BL, Miller BD, Simmens SJ. Effects of paternal and maternal depressive symptoms on child internalizing symptoms and asthma disease activity: mediation by interparental negativity and parenting. J Fam Psychol. 2011;25:137-46.
30. Glazebrook C, McPherson AC, Macdonald IA, Swift JA, Ramsay C, Newbould R, et al. Asthma as a barrier to children’s physical activity: implications for body mass index and mental health. Pediatrics. 2006;118:2443-9.
31. Praena-Crespo M, Aquino-Llinares N, Fernández-Truan JC, Castro-Gómez L, Segovia-Ferrera C. GESA network, Asthma education taught by physical education teachers at grade schools: a randomized cluster trial. Allergol Immunopathol (Madr). 2017;45:375-86.
32. Gibson-Young L, Martinasek MP, Clutter M, Forrest J. Are students with asthma at increased risk for being a victim of bullying in school or cyberspace? Findings from the 2011 Florida youth risk behavior survey. J Sch Health. 2014;84:429-34.
33. Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry. 2013;70:419-26.
34. van Geel M, Vedder P, Tanilon J. Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: a meta-analysis. JAMA Pediatr. 2014;168:435-42.
35. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy. Allergy. 2014;69:1008-25.
36. Walkner M, Warren C, Gupta RS. Quality of life in food allergy patients and their families. Pediatr Clin N Am. 2015;62:1453-61.
37. Lau G, Patel N, Umasunthar T, Gore C, Wagner JO, Hanna H, et al. Anxiety and stress in mother of food-allergic children. Pediatr Allergy Immunol. 2014;25:236-42.
38. LEI N◦ 12.982, DE 28 DE MAIO DE 2014. Available from: http://www.planalto.gov.br/ccivil 03/ Ato2011-2014/2014/Lei/L12982.htm (accessed 15.04.17).
39. Gore C, Griffin TR, Rothenberg T, Tallet A, Howood B, Sizmur S. New patient-reported experience measure for children with allergic disease: development, validation and results from integrated care. Arch Dis Child. 2016;101:935-43.
40. Lieberman JA, Sicherer SH. Quality of life in food allergy. Curr Opin Allergy Clin Immunol. 2011;11:236-42.
41. Shemesh E, Annunziato RA, Ambrose MA, Ravid NL, Mullarkey C, Rubes M, et al. Child and parental reports of bullying in a consecutive sample of children with food allergy. Pediatrics. 2013;131:e10-7.
42. Lieberman JA, Weiss C, Furlong TJ, Sicherer M, Sicherer SH. Bullying among pediatric patients with food allergy. Ann Allergy Asthma Immunol. 2010;105:282-6.
43. Muraro A, Polloni L, Lazzarotto F, Toniolo A, Baldi I, Bonaguro R, et al. Comparison of bullying of food-allergic versus healthy schoolchildren in Italy. J Allergy Clin Immunol. 2014;134:749-51.
44. Polloni L, Dunn Galvin A, Ferruzza E, Bonaguro R, Lazzarotto F, Toniolo A, et al. Coping strategies, alexithymia and anxiety in young patients with food allergy. Allergy. 2017;72:1054-60.
45. Polloni L, Lazzarotto F, Bonaguro R, Toniolo A, Celegato N, Muraro A. Psychological care of food-allergic children and their families: an exploratory analysis. Pediatr Allergy Immunol. 2015;26:87-90.
46. Egan M, Sicherer S. Doctor, my child is bullied: food allergy management in schools. Curr Opin Allergy Clin Immunol. 2016;16:291-6.
47. Polloni L, Gini G, Fiore G, Lazzarotto F, Bonaguro R, Toniolo A, et al. Bullying risk in students with food allergy: schoolteachers’ awareness. Pediatr Allergy Immunol. 2016;27:225-6.
48. Juliá-Benito JC, Escarrer-Jaume M, Guerra-Pérez MT, ContrerasPorta J, Tauler-Toro E, Madronero-Tentor ˜ A, et al. Knowledge of asthma and anaphylaxis among teachers in Spanish schools. Allergol Immunopathol (Madr). 2017;45:369-74.
49. Urrutia-Pereira M, To T, Cruz AA, Solé D. The school as a health promoter for children with asthma: the purpose of an education programme. Allergol Immunopathol (Madr). 2017;45:93-8.
50. Papadopoulos NG, Savvatianos S. The vital need for allergy training: removing the doubts. Prim Care Respir J. 2013;22:5-6.
51. Bousquet J, Addis A, Adcock I, Agache I, Agusti A, Alonso A, et al. Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J. 2014;44:304-23.
52. Urrutia-Pereira M, Solé D. The Jerusalem Chapter: a new paradigm in the care of allergic children and adolescents in Latin-American schools. Rev Alerg Mex. 2017;64:3-6.
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Urrutia-Pereira, M., Mocellin, L., de Oliveira, R., Simon, L., Lessa, L., & Solé, D. (2018). Knowledge on asthma, food allergies, and anaphylaxis: Assessment of elementary school teachers, parents/caregivers of asthmatic children, and university students in Uruguaiana, in the state of Rio Grande do Sul, Brazil. Allergologia Et Immunopathologia, 46(5), 421-430. https://all-imm.com/index.php/aei/article/view/380
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Urrutia-Pereira, M., Mocellin, L., de Oliveira, R., Simon, L., Lessa, L., & Solé, D. (2018). Knowledge on asthma, food allergies, and anaphylaxis: Assessment of elementary school teachers, parents/caregivers of asthmatic children, and university students in Uruguaiana, in the state of Rio Grande do Sul, Brazil. Allergologia Et Immunopathologia, 46(5), 421-430. https://all-imm.com/index.php/aei/article/view/380