What is the Triad of Asthma, Eczema, and Allergies: Dr Badran Answers

Eczema, asthma, and allergies sometimes occur together. Doctors call this the atopic triad. Eczema, common in babies and children, is a risk factor for later developing asthma and allergies.

All three conditions cause inflammation, which may help explain the link. Moreover, both eczema and allergies happen when the immune system secretes inflammatory chemicals.

In the case of allergies, the immune system overreacts to harmless substances, while eczema may cause a person’s body to attack itself. The presence of one condition in the triad is a clear risk factor for another, which may help people with symptoms, their caregivers, and healthcare professionals anticipate symptoms and make treatment decisions.

The Atopic Triad

The atopic triad refers to the tendency of asthma, eczema, and allergies to occur together. The progression typically begins with eczema, followed by food allergies, and then the development of asthma and allergic rhinitis, which causes sneezing and a runny nose. Doctors also call this progression the atopic march.

Early research found that immunoglobulin E (IgE) plays a role in the triad. IgE is an antibody involved with the functions of the immune system, such as inflammation. While inflammation is important in these three conditions, we now know that IgE is not present in all cases of asthma, allergies, or eczema.

According to a 2018 paper, 20% of children with mild eczema develop asthma, while 60% with severe eczema develop asthma.A 2021 study similarly linked eczema to the later development of peanut allergies, especially if the eczema is severe. The study included 321 babies. Peanut allergies developed in 18% of the babies with eczema, 19% with other food allergies, and 4% who had a relative with a peanut allergy. This suggests that eczema and other allergies better predict peanut allergies than genetics.

Atopic March

The allergic march (also called atopic march) is a medical term used to explain the natural history of atopic manifestations. The allergic march is characterized by some antibody responses to IgE and clinical symptoms that may appear in childhood and continue for years or decades and often changing with age.

The atopic march is a term that describes the progression of atopic disorders, from eczema in young infants and toddlers to allergic rhinitis and finally to asthma in adulthood. Symptoms include atopic dermatitis, food allergy, allergic rhinitis and asthma.

While people with one symptom in the triad are more likely to develop other symptoms, having one symptom does not guarantee the development of others. Only about 7% of children with at least one symptom develop symptoms consistent with the atopic march.

Several underlying factors, such as genetic differences in immune response and inflammation, may help explain the atopic march.Some evidence suggests that exposure to allergens through eczema-damaged skin may trigger immune system responses that lead to inflammation and allergies. Data from mice, for example, show that certain kinds of peanut exposure on the skin increase the risk of sensitivity to milk.

Environmental factors may also play a role. Children exposed to farm animals, for example, have a lower risk of atopic march, while antibiotics seem to increase the risk.

Because atopic march begins with eczema, doctors have focused on how eczema might influence the development of later symptoms. Some evidence suggests that early eczema treatment may help prevent subsequent allergies and asthma, perhaps by preventing exposure to allergens through a damaged skin barrier.

Atopic Dermatitis

Atopic dermatitis is a pruritic chronic inflammatory skin disorder. Prevalence has increased up to 3-fold over the past 3 decades, and the disease now affects 10%-20% of children in industrialized countries, qualifying atopic dermatitis as the most common chronic childhood disease. However, the common concept that atopic dermatitis is limited to childhood is being abolished. Adult-onset atopic dermatitis is more frequent than previously appreciated, and childhood atopic dermatitis often persists until adulthood or might relapse after long periods with inactive disease. Thus, up to 10% of adults suffer from atopic dermatitis.

Increased Risk of Atrial Fibrillation in Patients with Atopic Triad

Patients with hospital-diagnosed (moderate-to-severe) atopic dermatitis have a 20% increased long-term risk of atrial fibrillation compared with the general population. Although the clinical implications are limited by a low absolute risk of atrial fibrillation, the typical early onset of atopic dermatitis could provide clinicians with a unique opportunity for promoting a heart-healthy lifestyle to reduce risk for cardiovascular disease, including atrial fibrillation

Atrial fibrillation is the most commonly sustained rhythm disorder with a prevalence of 4% in persons aged ≥ 60 years. This condition is associated with severe morbidity and mortality (e.g., death due to stroke). Inflammation is a recognized risk factor for atrial fibrillation, as supported by an increased occurrence of atrial fibrillation among patients with rheumatoid arthritis and elevated levels of inflammatory biomarkers. The persistent low grade systemic inflammation associated with atopic dermatitis or the increased prevalence of atrial fibrillation risk factors (e.g., obesity, hypertension, and diabetes) among atopic dermatitis patients might thus predispose these patients to atrial fibrillation.

Prevention Tips

An allergy management plan is key to preventing allergic reactions. It is also necessary to control your allergies. Work with your doctor to create your allergy management plan. Controlling your allergies and preventing allergic reactions depends on your type of allergy.

Avoid your allergens. This is very important but not always easy. Some allergens are easier to avoid than others. When you can’t avoid an allergen, try to reduce your contact with it.

Take your medicines as prescribed. They can be helpful for managing your symptoms. Take them while also avoiding allergens. Keep a diary. Track what you do, what you eat, when symptoms occur and what seems to help. This may help you and your doctor find what causes or worsens your symptoms.

Wear a medical alert bracelet (or necklace). If you have ever had a severe allergic reaction, please wear a medical alert bracelet. This bracelet lets others know that you have a serious allergy. It can be critical if you have a reaction and you are unable to communicate.

Know what to do during an allergic reaction. Have a written anaphylaxis emergency action plan. It tells you and others what to do in case you have allergic symptoms or a severe allergic reaction. Always ask your doctor if you have any questions.

It is crucial to recognize that you are having an allergic reaction and to respond quickly and properly. Do not try to take yourself or a family member or friend to the hospital. You might have to stop and render aid on the way. It is always best to stay where you are and have an ambulance transport you.