A Proactive Approach to Pediatric Atopy, Rhinitis, and Asthma

Chronic conditions in children are on the rise, including atopic dermatitis (AD).¹ These conditions often reduce quality of life for the patient and create emotional and financial strain for the family. Common therapies for prevalent atopic conditions such as asthma, allergies, and hay fever involve use of steroids, anti-inflammatories, and topical medications. The functional medicine approach targets underlying causes, preconception and prenatal care, and modifiable lifestyle factors, which can lead to better outcomes.

Allergic conditions have common underlying etiologies, which can predispose children to multiple comorbidities. For example, a cross-sectional US study of children with atopic dermatitis (AD) found 71% also had asthma or allergic rhinitis.² In addition, children with AD are likely to enter what is known as the atopic march, a commonly seen progression from AD to allergic rhinitis and asthma.^1,2

As children grow into adulthood, childhood AD has been linked to clinical depression, anxiety disorders, and suicidal ideation in adults.³ Research has also found a high prevalence of obesity, cardiovascular risk, hypertension, adult-onset diabetes, and hypercholesterolemia in adults with AD.⁴ Adolescents with AD were more likely to engage in a sedentary lifestyle,⁵ which can increase cardiovascular risk in later years. Researchers conclude that additional study into the mechanisms of disease associations could lead to personalized treatment approaches.⁶

Management of environmental factors, along with lifestyle approaches such as behavioral modifications and changes in diet, exercise, and social engagement, have proven beneficial. For example, probiotic supplementation has a reported benefit for children with AD,^7,8 with specific strains shown to reduce the severity of AD in children under the age of three and prevent its onset in infants.⁹ A small, experimental study indicated that oxidative stress in the skin could be induced by air pollutants, including tobacco smoke, volatile organic compounds, and particulate matter. Exposure of this type could lead to skin barrier malfunction.¹⁰ Skin barrier defects may play a major role in the development of additional allergic conditions.¹¹ These modifiable factors offer potential avenues to work with pediatric patients to decrease their health risks.

The rising tide of pediatric atopy can be stemmed by interventions that go beyond symptom management to instead address the underlying causes and triggers. In doing so, the progressive train of chronic diseases can be broken, promoting overall health.