A Proactive Approach to Pediatric Atopy, Rhinitis, and Asthma

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Chronic conditions in children are on the rise, including atopic dermatitis (AD).1 These conditions often reduce quality of life 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 underlying causes, preconception and prenatal care, and modifiable lifestyle factors, which can lead to better outcomes.

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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 (AD) 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.1,2As 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.4 Adolescents with AD were more likely to engage in a sedentary lifestyle,5 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.6Management of environmental factors, along with lifestyle approaches such as behavioral modifications and changes in diet, exercise, and social engagement, have proven beneficial. For example, probiotic supplementation has a reported benefit for children with AD,7,8 with specific strains shown to reduce the severity of AD in children under the age of three and prevent its onset in infants.9 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.10 Skin barrier defects may play a major role in the development of additional allergic conditions.11 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 improving outcomes and reducing illness in pediatric patients in the following IFM-authored articles and IFM podcast episodes. For a deeper understanding of how early-life events may influence the development of chronic diseases in adulthood, hear from functional medicine experts at IFM’s Applying Functional Medicine in Clinical Practice (AFMCP).

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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. Allergy. 2018;73(1):214-220. doi:10.1111/all.13231
  4. 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
  5. Strom MA, Silverberg JI. Associations of physical activity and sedentary behavior with atopic disease in United States children. J Pediatr. 2016;174:247-253.e3. doi:10.1016/j.jpeds.2016.03.063
  6. 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
  7. Huang R, Ning H, Shen M, Li J, Zhang J, Chen X. Probiotics for the treatment of atopic dermatitis in children: a systematic review and meta-analysis of randomized controlled trials. Front Cell Infect Microbiol. 2017;7:392. doi:10.3389/fcimb.2017.00392
  8. Rusu E, Enache G, Cursaru R, et al. Prebiotics and probiotics in atopic dermatitis. Exp Ther Med. 2019;18(2):926-931. doi:10.3892/etm.2019.7678
  9. 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
  10. Ahn K. The role of air pollutants in atopic dermatitis. J Allergy Clin Immunol. 2014;134(5):993-1000. doi:10.1016/j.jaci.2014.09.023
  11. 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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