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RESEARCH

What I need to know: 

Essential Question: Why is there an association between eczema, asthma, and rhinitis (allergies) and what are the most effective ways to treat these conditions?

I needed to research the common connection in children having atopy like atopic dermatitis, allergic rhinitis and Asthma

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I wanted to research this topic because frequently I would see children with atopic dermatitis having asthma or allergies. I wanted to know the scientific reasoning or evidence based explanation.

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What I know or assume:

In the clinic, I noticed many pediatric patients that were diagnosed of having atopic dermatitis, allergic rhinitis and/or asthma. I always wondered what the connection was between these atopic diseases. My doctor would explain that there were many reasons as to why there is a connection or correlation between these conditions. I knew that genetics were a factor in the connection, but later I realized that environmental conditions also play a factor in the correlation as well. 

The story of my search:

I did extensive research in trying to find the explanation and connection the atopic diseases have in children. I read many articles and studies that have been done to improve and build upon the data I have already collected. I learned from the articles that there were studies being done to prove the existence of the Atopic March. The Atopic March is the natural history or progression of allergic diseases that frequently start from a young age. Scientists have been debating and arguing over this theory, because it has not been 100% proven. Another type of research that furthered my study was the interview with my mentor. I had conducted my interview by asking my mentor, who is a pediatrician, what she had noticed when diagnosing patients who had the conditions listed above. She shared with me that genetics and environmental factors are the main factors that contribute to the connection between the atopic diseases. 

Interview Questions with my mentor:

  1. How common is it for a patient to have at least one of these conditions?

-Up to 80% of kids with eczema gets hay fever or asthma later in childhood. 10-20% of children in the population has eczema and 70% of cases start in children younger than 5 years old.

-I was surprised when I learned that if a mom has allergies, there’s almost a 1 in 3 chance that the baby will have eczema.

2. Does the atmosphere and environment have a toll on the association between eczema, allergies, and asthma?

 

-Yes, you could have triggers that you are exposed to. If you have allergies, then the allergens that you are sensitive to may trigger a response within your body and skin. Some allergens like pollen, and dust may trigger a response if you are allergic to them.

- I have allergies to dust and pollen and my body gets irritated when I am exposed to these external factors.

 

3. Does a patient with severe asthma have severe eczema or rhinitis?

 

-They may have a higher probability of having eczema and rhinitis, but it isn’t always a direct causation.

- Correlation does not always mean causation.

 

4. How is there an association between eczema, asthma, and rhinitis?

 

-They are all atopy related. They are all coded by the same gene, so you may have more of a chance to develop the other conditions.

- There are many studies being done with the “atopic march” which are theories that provides and answer to the association of these three conditions. When a child has eczema, their skin barrier could be worn down from the inflammations and irritations which may lead the skin to being more prone to outside allergens and irritants. Also, when the skin is damaged, it may lead to the skin secreting TSLP (Thymic stromal lymphopoietin) which is a compound capable of releasing a powerful immune response. When this compound travels throughout the body via the blood, it may reach the lungs which triggers asthma. This is one possible theory and explanation, but there are many reasons and factors that contribute to the association between the three conditions.

 

5. If you treat one condition, will the rest be treated altogether as well?

 

-It is possible that if you treat allergies then the eczema will get better as well. The allergies may trigger eczema, so if you treat the allergies with avoidance and medication then your eczema may improve as well.

-There isn’t a direct link for correlation and causation.

 

6. What are some of the causes in receiving these conditions? Is it hereditary?

 

-Some of the causes of having these conditions may be hereditary, so children with these conditions may have relatives in the family that has these conditions also; they may be more prone in getting it. However, unless an external or internal factor triggers the condition, someone may never know that they have these conditions.

- In my family, my uncle has asthma, my cousin has eczema and my brother has tree nut allergies.

 

7. How do you effectively treat asthma?

 

-Medication and avoiding certain triggers like infection, allergy, smoke or exercise that causes a reactive response.

-Inhalers and daily medications may help reduce flare-up from happening.

 

8. How do you effectively treat rhinitis?

 

-Allergen avoidance and by taking antihistamines like Zyrtec and Claritin.

- I have allergies and it cannot fully be treated but it can be reduced from irritations

 

9. How do you effectively treat eczema?

 

-You can treat it with emollient creams and prescribed steroids.

-I was surprised to find out that it is better as a baby to put on creams and lotions, because it helps protect the skin from damaging and possibly developing eczema, allergies and asthma. Children are much more prone and more likely to outgrow it; sequence of these conditions are not always important.

 

10. What parts of the body are connected or associated with each other? Are there any other associations in the body like this?

 

-None of them are genetic. There are not many associations like these in the body.

- I was surprised, because I thought there may be more associations like this in the body, but there are not.

What I discovered at the end: 

Atopic March

The atopic march was developed in theory to describe the progression of atopic disorders which starts from atopic dermatitis in infants to the gradual development of allergic rhinitis and asthma in children. Atopic dermatitis (eczema) is a condition that causes the skin to get irritated, itchy and red. According to the study, Eczema starts the progression of the atopic march because, the skin serves as a barrier site for allergic sensitization to antigens and the colonizations of bacterial antigens; the skin functions as a protective barrier. When children have eczema, their skin barrier is damaged and leaves the body exposed to a variety or antigens and environmental factors that can lead to rhinitis and asthma. When the skin is damaged, this causes Th2 immunity which predisposes patients to allergic nasal responses and causes airway hyper activity. The body will try to identify and destroy the foreign antigens that may have gotten in through the broken skin barrier; when this happens, Antibodies will be formed in the body so that in the future the body will be able to automatically identify and destroy the antigens. Every environmental trigger that the body recognizes will cause the body to respond. There have been new research done to optimize the time frame in targeting the skin barrier with treatments that may prevent subsequent atopic disorders. A Polish study found that infants less than 6 months old to have atopic dermatitis; a population-based study in the US proves that eczema starts in the early years of life because of affected ages 3-11 years old, 85% suffered from atopic dermatitis before age 5. The ability for patients to outgrow their disease is still unknown, but it may be influenced by both genetic and environmental factors. Furthermore, if a patient is not exposed to a "trigger" than the atopic responses will not be as prevalent as when a patient is exposed to triggers frequently.

Genetics

Another factor that greatly contributes is genetics. It has been well established that the prevalence of atopic dermatitis is increasing. The number of serum IgE and specific IgE to common allergens can help determine the presence of atopy. Genetic studies shows that multiple genes are involved in the pathogenesis of atopy and that different genes regulate IgE. Researchers have widely accepted the fact that atopy creates a genetic disease, but the exact genes and loci have not been identified. However, more than one gene is most likely involved to result in the different expressions like asthma, rhinitis, and atopic dermatitis. 

Environmental factors:

Some environmental factors that can help develop the atopic diseases are allergen exposure, maternal smoking, breast feeding, or lack of hygiene.

Treatments:

Since genes cannot be altered, the best treatment would be to treat the atopic dermatitis properly and as early as possible. The earlier the condition is treated, then the more effectively the symptoms can reduced and the chances in progression to be lessened. Non-aggressive effective cleansing, daily emollient treatment and topical corticosteroid treatments help control inflammatory flare-ups. Even though there is not a 100% guarantee that treating eczema will prevent it from progressing into the atopic march, it can help decrease the chances.

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