Atopic Triad

Eczema, allergic rhinitis (commonly known as hay fever) and asthma are three conditions that occur together so frequently they are referred to as the “Atopic Triad,” or the “Allergic Triad.” These conditions are very common in children and are influenced by genetics.

What is the Atopic Triad and What Causes It?

“Atopy” refers to the tendency to develop disorders related to allergies and the autoimmune system. Certain individuals may be predisposed to hyper-reactive immune responses, causing frequent allergic reactions upon exposure to irritants or allergens. The term “Atopic March” is used to describe the natural ordered progression of eczema to allergic rhinitis to asthma. Typically, children prone to these allergic diseases will first develop symptoms of eczema in infancy or early toddlerhood. Later on, they will present with symptoms of allergic rhinitis, or hay fever, and finally asthma in late childhood.

These conditions are widely thought to be linked to genetics, though the causality is not exactly straightforward. If just one parent presents symptoms of one or more of these illnesses, it could increase the chance of their child contracting one, two or all three of the conditions in the Atopic Triad. Furthermore, the child’s symptoms may not necessarily be the same as the parents. Allergic disorders are also influenced by environmental factors within the first three months of life, such as levels of contact with allergens, exposure to air pollutants such as cigarette smoke and chemical cleansers and dietary factors. There is no conclusive evidence supporting options for primary prevention of the Atopic Triad in children, but there are a number of methods for coping with the symptoms.

Symptoms and Treatment for Eczema:

Eczema, sometimes referred to as atopic dermatitis, is a chronic inflammatory skin condition characterized by the following symptoms:

  • Dry, patchy rash on the skin, accompanied by redness and itchiness at the rash site;
  • The rash is affected by temperature, stress and exposure to allergens;

Eczema can sometimes be confused with severely dry skin or irritation due to other common skin conditions, but will often be made worse by lotions and creams used to treat typical rashes. An allergy test can help to identify and avoid triggers if eczema tends to flare up due to contact with allergens. Otherwise, symptoms can be prevented from worsening by avoiding harsh chemicals, perfumes and dyes found in skin products. Opting for hypoallergenic and natural skin products when possible, and using mild cleansers prescribed by a dermatologist or pediatrician will help mitigate irritation. Additionally, preventing scratching or rubbing of the affected area is essential to avoid skin lesions and possible infection. Young children may require gloves or mittens to prevent them from scratching.

Symptoms and Treatment for Allergic Rhinitis:

Seasonal allergies tend to crop up in the spring and summer months, due to increased levels of pollen and other plant allergies in the air. However, allergic rhinitis can also be caused by pet dander or the spores of mould and fungi. Symptoms of this condition include:

  • Runny nose and sneezing;
  • Itchy, watery eyes;
  • Sinus pressure or congestion;
  • Headaches;

The most effective way to prevent symptoms of allergic rhinitis is to completely remove the allergen or allergens from the environment. Unfortunately, this may not be possible in some cases, such as with pollens. Nevertheless, it will help to lessen exposure to the allergen by reducing time spent in areas where the pollen count is high and keeping windows and doors closed in spring and summer. Also, taking care to leave shoes by the door, rinsing off after spending time outdoors and frequently laundering sheets and outdoor clothing can help avoid the spread of pollen indoors. Children may need to be reminded to frequently wash their hands after playing outside and to avoid touching their eyes, nose and face.

There are a number of methods for alleviating the symptoms of allergic rhinitis. Medications such as an antihistamine or a nasal decongestant can be recommended by a pediatrician in appropriate doses according to age, though some may cause drowsiness.

Symptoms and Treatment for Asthma:

Asthma is a chronic lung disease causing inflammation of the airways. Asthma can be caused by a hyper-responsiveness of bronchioles in the lungs due to stress or by an extreme allergic reaction. Symptoms of asthma may include:

  • Difficulty breathing or shortness of breath;
  • Wheezing;
  • Coughing, especially at night or in the morning;
  • Tightness in the chest;

Asthma doesn’t necessarily have to slow a child down, but in some cases, it can become severe enough to cause asphyxiation. It is important to pay attention to when asthmatic symptoms flare up in order to avoid the triggers. If these symptoms occur after physical activity, an inhaler may help alleviate symptoms and prevent asthma attacks. Other triggers may include air pollutants and environmental factors, such as pesticides, dust, perfumes, chemicals from cleaning products, and smoke. Keeping the house well ventilated and clean, and frequently laundering bedding and clothing can help alleviate asthmatic symptoms. Regular exercise and a healthy, balanced diet may also contribute to a reduction in the severity of symptoms.

Other Related Illnesses:

There is some evidence to show a link between the Atopic Triad and food allergies. Children with food allergies are more likely to contract atopic dermatitis, and young children with a cow’s milk allergy have recently been shown to have an increased likelihood of experiencing asthmatic symptoms in the future. There is no strong causal link between food allergies to allergic rhinitis, however, or enough conclusive data to suggest that food allergies could be a fourth manifestation in the Atopic March.

Another corresponding condition to the Atopic Triad is a defect in the skin barrier. As the skin serves as the first line of defense for toxins, pollutants and irritants, an impaired function of the epidermis is known to cause atopic manifestations such as eczema. This defection can be caused by genetic abnormalities, leading to a strong disposition toward the Atopic Triad.

In general, a dysregulation of the autoimmune system is likely to lead to a number of allergic manifestations in many different combinations. However, no combination of atopic conditions has followed as specific an epidemiological pattern as the Atopic Triad.