A Proactive Approach to Pediatric Atopy, Rhinitis, and Asthma

Chronic conditions in children are on the rise, including atopic dermatitis (AD).1 These conditions often reduce quality of life both physically and emotionally for the patient and create emotional and financial strain for the family. Common therapies for prevalent atopic conditions such as asthma, allergies, and hay fever involve use of steroids, anti-inflammatories, and topical medications. The Functional Medicine approach targets the underlying causes and modifiable lifestyle factors, which can lead to better outcomes.

Allergic conditions have common underlying etiologies, which can predispose children to multiple comorbidities. For example, a cross-sectional US study of children with atopic dermatitis found 71% also had asthma or allergic rhinitis.2 In addition, children with AD are likely to enter what is known as the atopic march, a commonly seen progression from AD to allergic rhinitis and asthma.1,2

As children grow into adulthood, childhood AD has been linked to clinical depression, anxiety disorders, and suicidal ideation in adults.3 Research has also found a high prevalence of obesity, cardiovascular risk, hypertension, adult-onset diabetes, and hypercholesterolemia in adults with AD. Adolescents with AD were more likely to engage in a sedentary lifestyle, which can increase cardiovascular risk in later years. Researchers conclude that additional study into the mechanisms of disease associations could lead to personalized treatment approaches.4

Management of environmental factors, along with lifestyle approaches such as behavioral modifications, changes in diet, exercise, and social engagement have proven beneficial. For example, specific strains of probiotics have been shown to reduce the severity of AD in children under the age of three and prevent its onset in infants.6 A small, experimental study indicated that oxidative stress in the skin could be induced by air pollutants, including tobacco smoke, volatile organic compounds, and particulate matter. Exposure of this type could lead to skin barrier malfunction.7 Skin barrier defects may play a major role in development of additional allergic conditions.8 These modifiable factors offer potential avenues to work with pediatric patients to decrease their health risks.

The rising tide of pediatric atopy can be stemmed by interventions that go beyond symptom management to instead address the underlying causes and triggers. In doing so, the progressive train of chronic diseases can be broken, promoting overall health.

Learn more about strategies to promote health and reduce illness in pediatric patients at IFM’s Pediatrics Advanced Clinical Training (ACT).

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  1. Dharmage SC, Lowe AJ, Matheson MC, Burgess JA, Allen KJ, Abramson MJ. Atopic dermatitis and the atopic march revisited. Allergy. 2014;69(1):17-27. doi:10.1111/all.12268.
  2. Kapoor R, Menon C, Hoffstad O, Bilker W, Leclerc P, Margolis DJ. The prevalence of atopic triad in children with physician-confirmed atopic dermatitis. J Am Acad Dermatol. 2008;58(1):68-73. doi:10.1016/j.jaad.2007.06.041.
  3. Thyssen JP, Hamann CR, Linneberg A, et al. Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with psychiatric hospitalization or suicide [published online June 20, 2017]. Allergy. doi:10.1111/all.13231.
  4. Zheng T, Yu J, Oh MH, Zhu Z. The atopic march: progression from atopic dermatitis to allergic rhinitis and asthma. Allergy Asthma Immunol Res. 2011;3(2):67-73. doi:10.4168/aair.2011.3.2.67.
  5. Brunner PM, Silverberg JI, Guttman-Yassky E, et al. Increasing comorbidities suggest that atopic dermatitis is a systemic disorder. J Invest Dermatol. 2017;137(1):18-25. doi:10.1016/j.jid.2016.08.022.
  6. Foolad N, Armstrong AW. Prebiotics and probiotics: the prevention and reduction in severity of atopic dermatitis in children. Benef Microbes. 2014;5(2):151-160. doi:10.3920/BM2013.0034.
  7. Ahn K. The role of air pollutants in atopic dermatitis. J Allergy Clin Immunol. 2014;134(5):993-999; discussion 1000. doi:10.1016/j.jaci.2014.09.023.
  8. Han H, Roan F, Ziegler SF. The atopic march: current insights into skin barrier dysfunction and epithelial cell-derived cytokines. Immunol Rev. 2017;278(1):116-130. doi:10.1111/imr.12546.

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