Managing atopic dermatitis and asthma

Atopic dermatitis and asthma are both inflammatory conditions. This means that they are due to overreactions of the immune system.

In some people with atopic dermatitis, this overreaction occurs in response to an environmental trigger, or an allergen. This is known as “allergic atopic dermatitis.”

Although healthcare professionals do not fully understand the causes of the condition, genetic mutations that compromise the integrity of the skin barrier are common in people with atopic dermatitis. A leaky skin barrier allows pathogens and allergens to get into the skin more easily and makes it harder for the skin to retain moisture.

Together, this leads to the skin discoloration, itchiness, and dry skin that are characteristic of atopic dermatitis.

Similarly, overreactions to allergens in the airways are the basis for the breathing problems associated with asthma. Inflammation causes tightening and narrowing of the airways, which can lead to:

• wheezing
• coughing
• chest tightness
• shortness of breath

The exact causes of asthma are not well defined, so it is difficult to know how exactly atopic dermatitis, asthma, and inflammation are related.

However, the association of atopic dermatitis with other atopic conditions suggests that it may be that sensitization to an allergen (or allergens) early on within the ecosystem of the skin reprograms the immune system to overreact in other settings as well.

This is supported by the observation that children with atopic dermatitis without allergic features are no more likely to develop asthma than children without atopic dermatitis. On the other hand, children with allergic atopic dermatitis are seven times more likely to develop asthma by 3 years of age.

The progressive nature of the atopic march has led many to wonder whether or not there are preventive measures to take to interrupt this progression and potentially reduce the risk of asthma and other allergic conditions in children with atopic dermatitis.

The science is still out on this, and evidence supporting asthma prevention in atopic dermatitis is limited. This is partly due to the fact that asthma tends to develop later in the atopic march — typically during late childhood or early adolescence — requiring long periods of observations to identify an effect.

The American Academy of Pediatrics recommends exclusive breastfeeding of newborns for at least 3–4 months, which studies suggest is protective against wheezing in the first 2 years of life. There is also some evidence to suggest that breastfeeding for longer than 3–4 months may be protective against asthma in childhood, but more research is necessary to confirm this.

There is also some evidence to indicate that the proactive and ongoing use of a moisturizer can help prevent atopic dermatitis in infants. However, it is not yet clear how this affects the likelihood of developing asthma later in life.

The sections below look at some management options for atopic dermatitis and asthma.

Avoid triggers

One of the best ways to manage allergic conditions is to avoid the triggers that lead to symptoms.

Many of the most common triggers for atopic dermatitis and asthma overlap, including:

• pollen
• pet dander
• certain foods, such as peanuts
• stress and other extreme emotions
• household cleaners and disinfectants

Other common asthma triggers may include:

• smoke, such as from tobacco or fires
• dust mites
• air pollution
• mold
• respiratory infections, such as colds and the flu

Each case of asthma and atopic dermatitis is different. One person may have several triggers, while another may have only one or two.

It is important for a person to carefully track their symptoms to determine what causes them to flare up.

Make lifestyle changes

Symptoms of atopic dermatitis are often manageable or preventable with lifestyle interventions, such as taking lukewarm baths and using fragrance-free moisturizers.

Topical creams and ointments can also help control flare-ups.

Take medications

People typically treat asthma with a combination of quick-relief and controller medications to help prevent flare-ups and to treat them as needed. These medications are available in the form of inhalers, nebulizers, and pills.

Many atopic dermatitis and asthma treatments work by reducing or controlling the inflammation that drives disease. People can use these drugs continuously to prevent flare-ups or on an as-needed basis to control flare-ups when they occur.

For people with moderate or severe disease that does not respond well to treatment, the use of a biologic therapy may be necessary. These are injectable treatments available in the form of a shot or an infusion administered every few weeks. They target specific molecules in the body that are known to cause inflammation.

These treatments are not for everyone, and their use depends on the type and severity of the asthma or atopic dermatitis an individual has.

There are several biologics available for either atopic dermatitis or asthma, but only one — dupilumab — has approval for both conditions.

A healthcare professional can help a person decide which treatment (or treatments) is right for them based on their individual symptoms.

Not everyone with atopic dermatitis develops asthma, but having the former does increase the likelihood that a person will develop the latter. This is especially true if the person has symptoms that suggest that their atopic dermatitis may be related to allergies.

For many people, taking steps to avoid triggers can help reduce asthma and atopic dermatitis flare-ups. It is important for a person to understand the individual nature of their condition and to make adjustments that suit their needs and lifestyle. People can also use medications to help prevent and control symptoms.

If a person’s atopic dermatitis or asthma is not well controlled with their current treatment plan, they should talk with a healthcare professional to determine if other treatment or management options are available.