Atopic triad : Asthma, Allergic Rhinitis (Hayfever), and Atopic Dermatitis (Eczema)

Asthma, allergic rhinitis (Hayfever), and atopic dermatitis (eczema), constitute what we call the “atopic triad.”   These three things often travel together.   Many of our patients with asthma also have one or both of the two other members of the triad.   Most of us who take care of children with asthma consider asthma really an allergic disease of the airways.   People with Hayfever get itchy or runny noses when they run into allergies, people with eczema get itchy, swollen red skin when they have allergic problems, and asthma is a manifestation of having allergies in the airways.

These allergic reactions tend to happen in sequence during childhood.   You often see a child who early in infancy develops bad eczema and maybe associated food allergies, and while that’s very likely to settle down after time, having bad eczema in infancy gives you about a 50% higher chance of developing asthma, so that by the time that kid is two they might be developing intermittent episodes of wheezing and coughing.   Then a little later in life they might develop upper airway allergies, which is Hayfever.   That progression is called the atopic march, and it’s very common for kids to follow that pattern

Hans Oettgen, MD, PhD, Associate Chief, Division of Immunology


A package deal

Children who have asthma can also have Hayfever, eczema, or food allergies.   This combination of symptoms may be thought of as kind of a package deal.   It’s especially rare for a person to have asthma and not to have some nasal or sinus problems– the majority of people who have asthma also have Hayfever.

Frank Twarog, MD, PhD, Allergist



Allergies can have a profound effect

Allergies can have a profound effect on asthma. They sometimes will prompt an asthma exacerbation.  To test for allergies, we do prick skin testing and intradermal testing as well as a complete environmental history (i.e. dogs/cats/stuffed animals).   We give families an environmental control information sheet that reviews things they can do to avoid allergens.   I always recommend dust mite covers for pillows, mattresses and box springs, and removal of stuffed animals. Minimizing pet exposure and implementing environmental controls are other things I recommend.

Karol Timmons RN, MS, CPNP, Pediatric Nurse Practitioner



Environmental changes

A big thing that tends to be different about America than other cultures is the climate.   There are differences in humidity, and for some kids a change in the weather is an asthma trigger.   We work with kids who have lived in a warm tropical climate all their lives, and then they’re here where they’re getting blasts of cold air, and that can actually be a trigger for them and that might be part of the reason why they have asthma flares.   Also, in more tropical environments spaces tend to be more open.   When families from these places come here and are in enclosed houses, dust accumulates and whatever the allergen triggers are get contained in the house with the doors and windows closed most of the time and so they build up over time.

Shari Nethersole, MD, Pediatrician



Decluttering can help

A lot of times de cluttering can help decrease environmental triggers. Everyone (I struggle with clutter, too!) is living in cramped quarters with little storage space, so clutter builds up pretty quickly, gathers dust and gives pests lots of places to hide. I often supply the families I work with (the urban poor) with large plastic storage containers to store clothes, toys, etc. and small plastic containers to pest proof their food.

Susan Sommer, RNC, NP, Community Asthma Initiative



Avoiding the triggers

I really focus on avoiding the triggers. If pets really trigger a child’s asthma and the family has a pet, at a certain point you have to make a tough decision about what you want to do–either remove the pet or minimize the exposure to the pet. Maybe the cat doesn’t go into the child’s bedroom and the bedroom is a cat free zone, or there’s only one room in the house that the cat’s in. Dust is a trigger for a lot of kids, so I make sure they have the allergy proof covers for their mattresses and their pillows, and give instructions or information on how to minimize that exposure to dust in the household. For a lot of kids getting colds in the winter triggers them, so I focus on how you put the antenna up when you see your child’s getting a cold and recognize that that it could potentially tip them over the edge.

Shari Nethersole, MD, Pediatrician



Getting parents to stop smoking

It’s very hard to ask parents to stop smoking.   If the parents smoke, my advice to them is, number one: try to quit.   If they’ve tried before and it hasn’t worked, I tell them to try again, to keep trying to quit.   If they can’t do that, we work on trying to cut down on the number of cigarettes they smoke.   I tell them to try decrease the number of times they light up just out of habit’s sake, and to only smoke when they feel they can actually enjoy it, and sometimes that’s enough to cut back from a pack a day to seven a day.

I advise parents, too, that they shouldn’t smoke in the car while the children are with them, nor should they smoke in the house.   I encourage them to use a smoking coat or jacket when they go outside to smoke, and to leave it either right outside or right inside the door.   Most parents are surprised when I tell them that smoke can stick to their clothing, and that most kids of parents who smoke smell like smoke themselves.   It is well documented that children of smokers are more at risk for childhood illnesses such as ear infections and asthma than children of non smokers. It’s hard for a lot of people to eliminate smoking from their lives, and the people who have a really hard time with it are the people living in poverty who can’t always control their living situations.   If a family loses its home and has to move in with Uncle Joe and he smokes, for example, they have no control over that– he’s paying the rent!   I do try though to focus more on who the caregivers for the child are and get those caregivers to smoke responsibly.

Beth Klements, MS, APRN, BC, Asthma Clinical Nurse Specialist, Pediatric Nurse Practitioner