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Do you know the atopic triad?

by Owen Wiseman, H.BSc., on 6 November 2017, Allergies
atopic triad

The Merriam-Webster Dictionary defines comorbid as “existing simultaneously with and usually independently of another medical condition”. The atopic triad or atopy triad is a set of comorbid conditions – atopic dermatitis, asthma, and allergic rhinitis.

75% of children with atopic dermatitis will go on to develop allergic rhinitis while between 50-70% will develop asthma…

To start, we must understand what atopy is.

The word describes a genetic syndrome where the affected has a tendency to be hypersensitive to allergens, in other words, hyperallergic. When the immune system detects a foreign body or pathogen, it responds via white blood cells to identify, contain, and attack the invader.

When pathogens enter the body, they are inspected by a class of cells known as phagocytes. Everything that enters the body carries a specific molecular pattern, like a Social Insurance Number, and humans have evolved a pattern recognition system that can spot common red flags of infection. When the body notices the enemy flag, macrophages and neutrophils spring into action to fight off the invader. In those with atopic syndrome, the body sees harmless particles like food, pollen, or pet hair as dangerous invaders and so they mount an attack that results in allergy symptoms.

Eczema – the first condition of the atopic triad

The first of the triad, atopic dermatitis, is a condition more commonly known as eczema. This condition affects over 17% of individuals across the nation and is caused by the same process as an allergic reaction. The reaction is characterized by swollen, itchy, and red bumps on the skin that reflect inflammation, and these bumps can be filled with fluid that upon breaking, can ooze and crust. The reaction could be aggravated by something contacting the skin, such as your loved one scratching the patch of eczema on their elbow for the 15th time in a row. The condition could also be worsened in response to ingesting a certain food group. Unfortunately, due to the nature of atopy, approximately 75% of children with atopic dermatitis will go on to develop allergic rhinitis while between 50-70% will develop asthma.

Hay fever – the second condition of the atopic triad

Allergic rhinitis is another condition with a more easily recognized name, hay fever. Hay fever is often confused with the common cold at first because of their many overlapping symptoms – itchy, watery eyes; a stuffy, runny nose; and sneezing. Most of the causes of allergic rhinitis are related to seasonal pollens.

Asthma – the third condition of the atopic triad

The final member of the puzzle is asthma, a lifetime condition affecting over 2.4 million Canadians. Asthmatic reactions are easily recognizable due to the near-instantaneous airway inflammation and subsequent difficulty in breathing that may come across as wheezing or gasping.

So what connects the three conditions?

All of them are caused by an over-reaction of the immune system to an otherwise harmless allergen from the environment and they share some common mechanisms. The conditions all have a genetic aspect at play and because of the similarities, they can incite those affected to develop one of the comorbid conditions, or all three. Comorbid conditions are often associated with a more extensive and intricate treatment plan, but due to the similarities between them, the triad can be managed a little easier than unrelated comorbid conditions. Education early on the development of the ailment is important as those impacted often carry it into adulthood. However, some may notice that they become less sensitive to certain environmental triggers or their symptoms become more manageable.

Here are a few tips to manage the atopic triad:

  • See an allergist. Since all of these conditions are caused by an exaggerated response to an otherwise innocent allergen, the most important step in confronting the trio is to get tested. Identifying the cause of the inflammation ensures that it can be avoided to the best of one’s ability.
  • Keep a food log. One method of identifying whether food allergens are the cause is through an elimination diet. This involves keeping track of the foods that are normally ingested and then eliminating something for approximately two weeks. The ‘diet’ also involves tracking symptoms (duration, severity, description) to see whether there were any major changes after getting rid of that food. It is recommended that you discuss this option with your primary care provider to ensure it is done safely.
  • Symptomatic relief. Dealing with the symptoms of allergies is something that many are familiar with. Products like Allergy Relief come in liquid, tablet, and nasal spray This homeopathic preparation works energetically on the toxins that cause the immune system to go haywire. The benefit to these products is that they are safe for pregnant women and children 1 up, are sugar, lactose, and gluten-free. In addition, unlike some allergy relief medications, these are non-addictive, non-drowsy and carry no side effects.
  • Topical relief. Some products like the Echinacea Cream work to soothe skin irritation and calm the red inflammation common with conditions like eczema. Echinacea has also shown its ability to restore the skin’s fatty barrier that protects against unwanted microbes and contributes to what goes in and out of the skin.
  • Z is for zinc! This micromineral is a key player structurally throughout the body and also regulates gene expression, cell-signaling, and hormone release among other functions. It also participates as a catalyst in reactions, a sort of chaperone to make sure the reaction runs without issue. Studies have shown that a zinc deficient can make skin conditions like atopic dermatitis worse. Adding foods like oysters, beef, and kidney beans to your diet is a great way to get a healthy dose.

References:
https://dermatology.ca/public-patients/skin/eczema/
http://jamanetwork.com/journals/jamapediatrics/fullarticle/2478040
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2713155/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062798/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110625/
https://www.ncbi.nlm.nih.gov/pubmed/16426372
https://www.ncbi.nlm.nih.gov/pubmed/17692428
https://www.ncbi.nlm.nih.gov/pubmed/28610718
http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14179-eng.htm

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