Understanding the connections between atopic dermatitis and asthma and recognizing the triggers may help manage both conditions.
Atopic dermatitis, also known as eczema, is a skin condition that causes dry, flaky, and itchy skin. Asthma is a lung condition that causes breathing difficulties, and both conditions have links with inflammation and reactions to various allergens.
This article examines the connection between atopic dermatitis and asthma, including how best to manage the associated symptoms.
Atopic dermatitis is an inflammatory skin condition that affects about 10% of people in the United States. Many cases resolve on their own during early childhood or adolescence, but many people may experience persistent symptoms or flare-ups well into adulthood.
For some people, atopic dermatitis is the first step in a series of allergic conditions. This is known as the “atopic march.” In addition to atopic dermatitis, conditions involved in the atopic march
- food allergies
- allergic rhinitis (hay fever)
- asthma
Studies suggest that over 25% of people with atopic dermatitis develop asthma. This is a rate more than three times higher than in the general population. The risk of asthma is higher with increasing severity of atopic dermatitis.
The sections below look at some management options for atopic dermatitis and asthma.
Learn more about atopic dermatitis and asthma.
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 individual’s experience 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.
Symptoms of atopic dermatitis are manageable or preventable with lifestyle measures, such as taking lukewarm baths and using fragrance-free moisturizers.
Topical creams and ointments can also help manage flare-ups.
People typically treat asthma with a combination of quick relief and controller medications to help prevent flare-ups and 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 managing the inflammation that drives disease. People can use these drugs continuously to prevent flare-ups or on an as-needed basis to manage flare-ups when they occur.
For people with moderate or severe disease that does not respond well to treatment, the use of biologic therapy
These treatments are not for everyone, and their use depends on the type and severity of an individual’s asthma or atopic dermatitis.
Several biologics are available for either atopic dermatitis or asthma, but only one — dupilumab — has approval for both conditions.
A healthcare professional can help people decide which treatment is right for them based on their symptoms.
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 “allergic atopic dermatitis.”
Although healthcare professionals do not fully understand the causes of the condition, genetic mutations that affect how well the skin barrier works are common in people with atopic dermatitis. A protein called filaggrin is typically low in people with atopic dermatitis, leading to drier and itchier skin. A leaky skin barrier allows external allergens and irritants to enter the body more easily, making people more vulnerable to developing allergic reactions to them, which drives inflammation.
Together, this can cause skin discoloration, itchiness, and dry skin that is 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 for certain how atopic dermatitis, asthma, and inflammation are related.
However, the association of atopic dermatitis with other atopic conditions suggests it may be that skin sensitization to an allergen early programs the immune system to overreact in other parts of the body as well.
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 that can interrupt this progression and potentially reduce the chance of asthma and other allergic conditions in children with atopic dermatitis.
There are limits to evidence supporting asthma prevention in patients with atopic dermatitis. This is partly because asthma tends to develop later in the atopic march — typically during late childhood or early adolescence — requiring long periods of observation to identify an effect.
The American Academy of Pediatrics recommends exclusive nursing of newborns for at least 3–4 months, which studies suggest is protective against wheezing in the first 2 years of life. Some evidence also suggests that nursing for longer than 3–4 months may protect against childhood asthma, but more research is necessary to confirm this.
Not everyone with atopic dermatitis develops asthma, but having atopic dermatitis does increase the likelihood that a person will develop asthma. This is especially true if the person has symptoms that suggest that their atopic dermatitis is due 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 manage symptoms.
If a person’s atopic dermatitis or asthma is not well managed with their current treatment plan, it is advisable to talk with a healthcare professional to determine if other treatment or management options are available.