Living the Atopic March
When it’s not just eczema…adding allergies and asthma attacks to the mix!
Hello, I’m back! We’re going to deviate a bit from the regularly-scheduled programming of reviewing eczema purchases and how we measure what works best - more to come on that next week.
Right now, it seems most timely to share a bit about our experience learning firsthand about a pesky phenomenon known as the atopic march. (Check out Jordan’s handy summary of what this atopic march thing even is, right here.) Basically - eczema is sometimes a bit more than just eczema. For a lot of people, it can progress to include an additional set of related conditions, including allergies and asthma.
This is what has been happening to baby T (maybe we should promote to Toddler T as we’re now close to 16 months old, somehow). Since starting solid foods around 6 months old, we’ve uncovered a set of frustrating food allergies, including a peanut allergy, sesame allergy, and potentially also a strawberry allergy. As you’ve probably experienced yourself, it can be difficult to separate eczema from food allergy hives - we used to have tomatoes on the allergy list, until it became apparent that some foods are actually just too uncomfortably acidic for T’s skin - leading to significant redness and even bumps on his face, hands, and basically any exposed skin (hello, ankles!) after eating tomato sauce, oranges, and even fruits that seem a bit less acidic, such as watermelon.
So, how do you separate allergies from eczema, especially when you’re used to inflamed skin at a baseline?
The simplest method seems to be looking for other types of symptoms associated with food allergies, rather than relying solely on skin symptoms. Multi-system symptoms are unfortunately also a red flag for anaphylactic response, so if you do see these, you definitely should call or visit your doctor. For T, we have seen diarrhea in response to the allergies - but not every time.
If you are only seeing a skin reaction, it’s still possible that this is an allergy and not eczema. We’ve started to learn how to separate skin reactions due to allergies from skin reactions due to eczema with a few additional criteria that seem to work for T. We can tell that something is ultimately an allergy when Zyrtec relieves the new symptoms quickly. The following criteria seem to correlate well with a good Zyrtec response for T:
True hives - raised circular bumps that are lighter-colored in the middle than the surrounding redness
Swelling
Significant fussiness and discomfort - he seems different. In the case of the sesame exposure, he actually looked a bit scared.
A couple weeks ago, we added another component of the atopic march to our experience - T had an asthma attack at 4am on a Friday morning. Luckily, I have asthma (parents having asthma is another common characteristic among kids with these atopic conditions), so I recognized it pretty quickly. T had woken up a bit fussy, and after drinking some water, was still breathing hard - it seemed like he was using his whole chest to breathe, and there was a slight whistling sound. My husband stayed home with our eldest and I got in the car to drive to the Children’s ER, where they responded quickly and got T on an albuterol nebulizer. Now, we have one at home, which makes me sleep more soundly in the same way that having an epipen around gave me some additional peace-of-mind after the first allergic reactions.
But, I do wonder - why was it necessary to go through the experience of the 4am ER visit to get the nebulizer? For a kid with these pretty obvious atopic symptoms - eczema and food allergies, with a mom who has asthma - wouldn’t it have been cheaper and easier for everyone if we had been given a nebulizer and a small number of albuterol solution vials, just in case?
I’d love to hear your thoughts and about your experiences with the atopic march. Do you or someone you care for have eczema alongside other conditions like allergies or asthma? Share your experience in the comments below or by emailing our team - we’d love to learn from you.
Sleeping peacefully on Mom after some help from albuterol and Encanto