Why is Eczema Tied to Allergies, Asthma, and a Constant Runny Nose?
Here’s what you need to know about the atopic march, preventative measures you can consider, and what to ask your doctor.
What is the atopic march?
If you’re not familiar with the atopic march, it’s not the type of march you hope to be a part of. It’s essentially a progression of atopic (or allergic) diseases that develop in a sequential order throughout one’s infancy and childhood (1). It starts with atopic dermatitis (a specific type of eczema, but for ease of reading, we’ll be referring to atopic dermatitis as eczema throughout this post), one of the most common inflammatory skin conditions, affecting 15-30% of children, and then continues down a path of additional symptoms and conditions that are commonly experienced together (5). Below is the general progression:
Like most things with our health, the march can be different for everyone. However, research shows that those who experience eczema or food allergies in infancy are more likely than others to develop respiratory allergies and asthma later in life.
“It’s believed that the primary reason children start the atopic march journey is due to allergen exposure through weakened skin barriers. Many of these children have a heightened immune response due to elevated levels of immunoglobulin (Ig) E, which essentially makes them more sensitive to these allergens when they are exposed. (1)”
The early stages – atopic dermatitis (eczema) & food allergies
Eczema and food allergies are typically developed at a younger age, with eczema often being diagnosed in children as young as six months. We mentioned above that the first step toward the atopic march is through allergen exposure through weakened skin barriers. More specifically, eczema weakens the skin’s barrier, which allows environmental allergens to more easily get into the body. In other words, the skin is not able to protect the body from outside allergens as effectively, making the immune system more sensitive to these allergens.
Courtesy of the National Eczema Association
According to research, once a child is on the march with eczema, they are six times more likely to develop a food allergy than those who are not (2). Additionally, these children are likely to develop food allergies within their first year of life, which supports the belief that the allergy develops from exposure through the weakened skin barrier, not by eating the food itself (1). For example, studies show that skincare products containing peanuts or wheat could contribute to developing the respective food allergy (3,4). But even beyond this, some allergens may cause immune responses to a completely different allergen. For example, peanut exposure on the skin could cause the body to develop an allergic response to milk (1).
The later stages – asthma & allergic rhinitis (hay fever)
While eczema and food allergies often show up at a young age, asthma and allergic rhinitis typically develop a bit later in life. Research suggests there’s a correlation between the severity of eczema and likelihood of developing asthma. For example, about 20% of children with mild eczema develop asthma, but more than 60% of children with severe eczema develop asthma. Additionally, research shows that if someone has eczema and subsequently develops asthma, they are more likely to experience more severe asthma that also continues into adulthood (1).
Similar to the presence of eczema, research shows that those who have a food allergy, specifically those to peanuts, milk, and eggs, are much more likely to develop asthma and hay fever. The likelihood increases more if you have multiple food allergies (1).
If you’ve started on the path of the atopic march, can you stop it?
Each stage of the atopic march is due to an overactive immune response to allergens, starting with these allergens entering through the skin barrier and eventually through the respiratory tract. Children on the atopic march are constantly being exposed due to broken skin, causing uncomfortable symptoms and chronic inflammation, which negatively affect the body’s immune response, oftentimes causing the child to progress forward on the march.
Some research does suggest that there are early ways to respond that could help prevent a child from continuing to asthma or allergic rhinitis (5).
Using emollients and moisturizers to improve the skin barrier: Both of these products help maintain skin hydration and repair the skin barrier (as a reminder, a weakened skin barrier is what allows environmental allergens into the body). Typically, these are critical products to use when managing eczema, however, they may not be enough on their own for severe cases (5). When eczema symptoms are trending more severe, it is also important to take quick steps to halt the flare in its tracks, so that the skin has the chance to repair itself. Treatments that can help with flares include stronger, prescription topical steroids like triamcinolone; there are also more advanced therapies that can be prescribed if you have not responded to steroid use, or need to use steroids more than the recommended half-of-days-in-the-month.
Avoid the allergen – easier said than done: If someone knows what allergens are causing the inflammation and symptoms, avoiding these can of course reduce symptoms and prevent the exacerbation of eczema and subsequent allergic conditions. However, this can be difficult, as some allergens simply aren’t avoidable (5).
Early allergen exposure: On the flip side, some studies support the idea of introducing allergenic foods, such as peanuts, at an early age (around 4-6 months) to prevent the development of food allergies (5).
Breastfeeding for the first 3-6 months: Studies showed mixed findings, however, it is believed that breastfeeding provides important immune factors that could lower the risk of developing eczema and other allergic conditions, particularly for infants who have a family history of allergies (5).
Using probiotics and prebiotics to regulate the microbiome: Some research shows that using probiotic supplements in early infancy may reduce the risk of developing eczema and allergies, however the evidence is still premature (5).
What should I ask my doctor if my child is on the atopic march?
As some of you may know, our founder, Nell, has been on her own journey as a parent of a child with eczema. It’s an exhausting, seemingly endless experience full of doctor’s appointments and specialist visits. While we know everyone’s journey will be unique, below are some questions that could help if you’re feeling stuck.
What preventative measures would you recommend I take to reduce the chances of my child developing more allergic conditions?
How can I help my child improve their skin barrier?
At what point, if at all, would you recommend I consider allergy testing?
If you’re prescribed topical corticosteroids: What are long-term effects I should be aware of?
What alternative treatments, such as probiotics or prebiotics, would you recommend to help manage the allergies and improve my child’s immune health?
Are there any other lifestyle or diet changes I could make to help strengthen the immune system?
What signs should I look out for that might indicate the allergies are getting worse, or progressing further along the atopic march?
At what point would you consider more aggressive treatments, such as immunotherapy, if symptoms continue to worsen?
Being a caregiver to a child suffering from eczema or other allergic conditions can feel extremely overwhelming. If you want help keeping track of treatments you’re trying and how your child’s symptoms are progressing, read more about Folia for eczema here.
Sources:
Hill DA, Spergel JM. The Atopic March: Critical Evidence and Clinical Relevance. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2018;120(2):131-137. doi:https://doi.org/10.1016/j.anai.2017.10.037
Tsakok T, Marrs T, Mohsin M, et al. Does atopic dermatitis cause food allergy? A systematic review. Journal of Allergy and Clinical Immunology. 2016;137(4):1071-1078. doi:https://doi.org/10.1016/j.jaci.2015.10.049
Lack G, Fox D, Northstone K, Golding J, Avon Longitudinal Study of Parents and Children Study Team. Factors associated with the development of peanut allergy in childhood. The New England Journal of Medicine. 2003;348(11):977-985. doi:https://doi.org/10.1056/NEJMoa013536
Fukutomi Y, Taniguchi M, Nakamura H, Akiyama K. Epidemiological link between wheat allergy and exposure to hydrolyzed wheat protein in facial soap. Allergy. 2014;69(10):1405-1411. doi:https://doi.org/10.1111/all.12481
Bawany F, Beck LA, Järvinen KM. Halting the March: Primary Prevention of Atopic Dermatitis and Food Allergies. The Journal of Allergy and Clinical Immunology: In Practice. 2020;8(3):860-875. doi:https://doi.org/10.1016/j.jaip.2019.12.005
