Enf.ª Célia Nogueira

Immunology Nursing Consultation

The child at the center of immunotherapy

HPA Magazine 21 // 2024

Allergic diseases are very common pathologies, especially affecting children and young people, and have a significant impact on their quality of life. 
Allergic rhinitis and allergic asthma are the most common respiratory allergic diseases in childhood.
Allergy is an exaggerated reaction or response of the body to substances that are harmless to most people, called allergens. Most allergens are inhaled (aeroallergens), with the most common being dust mites, pollens, domestic animal epithelia, and moisture-related fungi.

Specific immunotherapy with allergens is recognized as the only treatment that modifies the natural history of allergic disease. It is a very effective tool for the treatment of allergic rhinitis and asthma, inducing tolerance in the body to the identified allergen(s).
The Immunology Nursing Consultation integrates its activity into what we consider the Immunotherapy Center. This provides a response to users diagnosed with respiratory allergy and indicated for subcutaneous immunotherapy, commonly known as "allergy vaccine."
 This treatment lasts 3 to 5 years, with administrations every 4 weeks. Currently, about 150 users, covering all age groups, many of whom are children, are in a regular immunotherapy administration program at our center.
In nursing care for immunotherapy, validated symptom scales are applied for children, but with the involvement of parents' perception. 
However, the child is always the focus of our care, taking into account their physical and cognitive abilities. Valuing their complaints, respecting their emotions and difficulties, and the information they provide are crucial in this process. 
In this age group, there is sometimes a mismatch between parents' assessment of a child with allergic rhinitis and/or asthma and the child's self-assessment, with parents overestimating the symptoms. For this reason, although parents must be involved, the child will always be the focus of our care, considering their physical and cognitive abilities. Valuing their complaints, respecting their emotions and difficulties, and the information they provide are crucial in this process. The specialty team in the outpatient immunology consultation comprises an allergist-immunologist and a nurse with skills in this area. 

The provision of care to the child and family is based on a holistic vision and technical-scientific knowledge directed towards the individual characteristics of the child, after assessing them. Communication skills, empathetic relationship, interpersonal and temporal availability, active listening, valuing complaints, doubts, and fears are factors that reinforce the relationship and facilitate the therapeutic alliance.
Confidence in healthcare professionals and the technique they execute is promoted, leading to treatment adherence and consequent satisfaction of users and the team. This multidisciplinary, responsible, and quality work generates recognition for the service and the institution.
This project was designed with well-defined objectives, structured, and implemented through the investment of the outpatient immunology specialty team, with the involvement of management and leadership.
Future prospects involve the constant improvement of care provided, service growth, and the continuation of internal and external training. The goal is to respond to our children and their families with a variety of innovative therapeutic schemes and differentiated communication strategies.