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While this podcast mainly caters to adults with skin conditions, I thought this topic is important for parents: the atopic triad. Since one part of the atopic triad is eczema, I wanted to bring awareness to it. You may feel inclined to see if your child will grow out of these conditions, but after chatting with today's guest, it sounds like that's probably not the right approach — especially if it's in the first year of life.
Today's guest, Dr. Chris Thompson, is a Board Certified Otolaryngologist, Head & Neck Surgeon with over 25 years of experience practicing medicine in Texas. He earned his undergraduate degree in Biomedical Engineering from Texas A & M University in College Station and went on to receive his Doctorate of Medicine at the University of Texas Southwestern Medical Center in Dallas. Dr. Thompson focuses solely on allergy, sinus and nasal treatment and is considered an expert in all three fields. He is one of a handful of doctors that played an integral role in the development of the cutting-edge sinus procedure, Balloon Sinuplasty. He is very excited for the future of allergy treatment through sublingual immunotherapy, as more patients choose and stay consistent with the treatment.
Join us as Dr. Thompson discusses all things relating to early onset allergies, eczema, and asthma!
Did you treat your child's eczema early or find allergies or asthma popped up after eczema first appeared? Let me know in the comments if you have questions!
Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android
In this episode:
- What is the Atopic Triad?
-
Can allergies be triggered through the skin barrier??
- Can you prevent the “Atopic March”?
- Why you really shouldn't let allergies, asthma, or eczema just “run the course”
- Are there side effects from certain allergy meds?
Quotes
“If your child has even has mild eczema, they have a 20 to 30% chance of developing asthma. If they have severe eczema, it's upwards of 70% of those kids are gonna go on to develop asthma and you CAN intervene.” [23:04]
“If you don't treat (asthma), those muscles get bigger and bigger and the airways get narrower and permanently get damaged. So it's important to treat asthma early and aggressively so that you can prevent that lung damage that may ensue if you don't treat it.” [14:51]
Links
Find Dr. Thompson online
Follow Aspire Allergy on Instagram
Healthy Skin Show ep. 248: Is Eczema Related To Histamine Intolerance?
291: Can You Stop Eczema, Allergies + Asthma In Kids? w/ Dr. Chris Thompson FULL TRANSCRIPT
Jennifer Fugo (00:15.993)
Dr. Thompson, thank you so much for coming back to the Healthy Skin Show.
Chris Thompson (00:21.710)
Yeah, well thanks for having me back on Jennifer. It's great to get the word out on these things.
Jennifer Fugo (00:26.393)
It is, and especially because it is Allergy Awareness Month. So it's important for us to, I think, share and bring awareness to what can be going on on different topics. And that's one reason why I wanted to have you back on the show and why we're releasing this episode this month because the atopic triad, which might sound a little bit like medical jargon as I'm saying this, I'm thinking what parent says the atopic triad?
Chris Thompson (00:52.085)
Mm-hmm.
Jennifer Fugo (00:56.353)
We're talking about something that happens to usually very young children. So what is the atopic triad and who does this mainly impact? And then we'll go from there.
Chris Thompson (01:11.090)
Okay, sure. So it does sound jargony and I think it's easier if we just say eczema because most parents at least know that kids get eczema and eczema is the start of the atopic triad. It's the first thing that kids get and it's believed that that then leads to these other conditions like food allergy and environmental allergies to pollens, molds, things like that… and then Asthma. So the triad is really instead of three things it's really four because you get eczema, then food, peanut allergy being the most common, environmental allergies, again pollens and molds and then and pets and then asthma typically comes on a few years later. So it's a progression of symptoms and they seem to all be linked to that first part of the illness which is eczema.
Jennifer Fugo (02:11.573)
And so is there an age bracket which this normally happens in kids?
Chris Thompson (02:21.410)
Yeah, it's really the first year of life. So after age one, the likelihood of developing eczema goes down. So it's very high. Even in the first few months of life, you'll see children with eczema. And I know my youngest daughter had it. I would probably around five or six months, we started to notice that her skin was dry and itchy and bothering her. And I think that's fairly typical.
Jennifer Fugo (02:48.453)
And does this impact adults too?
Chris Thompson (02:52.370)
It does. It usually doesn't start in adulthood, but if you have eczema as a child, it can definitely persist into adulthood and be quite severe too. It's really an irritating quality-of-life problem to have eczema. Eczema is kind of like allergies. People don't often appreciate how much of a quality of life impact they have.
Jennifer Fugo (03:20.293)
Well, so one thing that has been interesting to me is looking at some newer research in the, I guess, the eczema or atopic dermatitis field, where they're suggesting that possibly the allergies are being triggered through this skin barrier. And it might not even be what they eat. So what are your thoughts on that?
Chris Thompson (03:44.270)
So yes, it's really interesting as we learn more about this. And from kind of a basic understanding of eczema, there's a loss in the integrity of the skin barrier. So your skin should be a strong barrier against everything, right? The skin really doesn't allow things to penetrate it. That's its chief function, is to protect us. And kids with eczema have a problem manufacturing kind of the glue if you will between the skin cells. So if you imagine you've got millions or billions of tiny little skin cells they have to be connected to one another otherwise things can get between them, and so we manufacture proteins that glue those cells together. And it appears that kids with eczema are missing some of that or they don't make it correctly or they don't make enough of it but that allows things to leak through the skin cells. And the thinking is that antigens, let's say peanut for a good example, somehow teeny tiny bits of that may get through the skin barrier for whatever reason. I mean there are skin products that have peanuts, or maybe it's in the air, But somehow it gets through the skin and then starts to create an immune reaction because your immune system doesn't normally see peanuts coming through the skin.
Chris Thompson (05:14.050)
So, it just takes us down this pathway, this immune pathway that makes us very reactive to, of course, peanut in this instance but then lots of other allergies begin to develop as an offshoot of that. It's almost like it turns on your propensity to have allergies when these things are leaking through your skin.
Jennifer Fugo (05:35.753)
And if you develop one allergy as a child, do you find that there's this, like if you develop one allergy, now you're at greater risk to develop a second. If you develop two allergies, now you're at greater risk. Is there an increasing risk, the more allergies you develop as a child or even as a baby?
Chris Thompson (05:56.290)
Yes. Yeah, that's really a good point because in that first year of life kids are, obviously they've already developed the eczema usually by then, but that's about when at the later part of the first year is when they start to develop allergies to other things, pollens and foods, and if you do develop one you're likely to go on and develop others, which is a little bit, makes it a little bit difficult to test. Because if you test them when they're young, you'll catch those allergies that they have currently but they may go on and develop other allergies. Although fortunately we can intervene and if you do stop those allergies at a younger age you can stop the others from developing as well. So there is hope.
Jennifer Fugo (06:45.233)
I was going to ask you that. Is there a way to swoop in? Do we have that technology now where we can jump in and kind of maybe not? I don't know if you can entirely stop the process in and of itself, but are you able to at least mitigate some of the additional risk? It sounds like there is. So what would you do in that particular instance? So let's just say you as the parent. You're the parent.
Jennifer Fugo (07:13.933)
I think my kid might be allergic to something. They have eczema on, a lot of times I notice like babies get eczema on their cheeks. That seems to be like a very common presentation. So they're starting with the eczema rash. There might be starting to develop an allergy, then what?
Chris Thompson (07:30.750)
Yeah, so you absolutely can. And I share the story of my daughter because she fits into this paradigm. She started to develop the eczema. And fortunately, being in the business, I knew what that meant and what was to come. The treatment of eczema is still fairly primitive, I would say, especially in younger kids. Because they are losing that barrier a bit, you really just put an artificial barrier on.
We use lots of creams and ointments. She wears gloves at night to help prevent moisture from leaving her skin. We used to have her in garments that would cover her arms and legs as well so that, again, there was less likelihood of moisture leaving the skin, where it would get dry and crack and itch and then get infected sometimes. So from a basic standpoint, when you have a young child with eczema, these are the things that you're going to be doing, keeping the skin clean, putting garments on that prevent the loss of moisture and then adding ointments. We go through gallons of aquaphor. So that's kind of the most basic treatment. As the severity level goes up, there are medications that can be added to that. But the awareness is important because if your child has eczema, you can be treating those things, but you really want to get ready for the next steps. We got her tested here with Dr. Silvers who you've had on to see what she might be allergic to and she was allergic to peanuts and then four or five environmental allergens. Oak pollen for instance was one that she was sensitive to. Fortunately, her peanut allergy was mild so we treated it by giving her peanuts and she eventually got to the point where she now is where peanuts are no problem.
Jennifer Fugo (09:25.257)
Wow.
Chris Thompson (09:30.830)
So in very mild peanut allergies you can treat it that way. Dr. Silver's expertise is in those children who can't tolerate peanuts and there is a mechanism where you can give them tiny amounts of peanuts under supervised circumstances and get those children able to eat peanuts. So, we treated the food allergies just by giving her peanuts which was fortunate and then we started her on allergy drops, which contain the things she was sensitive to. So for instance, pollen was one of the components of her allergy drop. And by giving children those things that they're allergic to, their immune system starts to calm down and begin to ignore it, which can really stop the entire triad. If you can intervene early enough, you can reduce the risk of asthma, which is really the worst part of all of this. If your child's starting with eczema, but you don't know that in a couple of years, they're much, much more likely to develop asthma than a child without eczema. But so few parents learn this. It's just not widely known and obviously, if you knew that you'd be all over it early on if you thought your child might have asthma and it could be prevented.
Jennifer Fugo (10:50.233)
Yeah, absolutely. And that's one reason why I thought this was so helpful to share this information because, you know, there's probably plenty of people listening to this, whether they're going to be grandparents, or they're going to be parents, or whomever, or they're friends with someone who they can share this with to really help them know what to do. So if so, what I'm hearing from you is that if it looks like your child, your baby develops rashes very young within that first year. Do you think as an allergist, do you think it's worthwhile for the child at that point to see an allergist or would you recommend they wait until they have some other kind of like it looks like they might actually have an allergy to something?
Chris Thompson (11:40.950)
Well, I think if the pediatricians are pretty tuned into this and astute, obviously they're very adept at treating eczema, so I think that's a good starting point. I do see though a lot of children not going on to allergy evaluation when they do have eczema. So it's probably a good idea just to put a bug in the ear of your pediatrician and say, you know, this is eczema. I've heard that it can go on to other things and that there may be some allergies that we can even identify now. I think that's a good time to transition and get a referral to an allergist. But most of the time it starts with the pediatrician because moms will bring their kids in with the skin rashes to the pediatrician. So I think that's a really good place to start.
Jennifer Fugo (12:37.135)
Okay.
Chris Thompson (12:40.850)
And then mentioning the fact to see if we can stop this from going on to the other bad things.
Jennifer Fugo (12:44.553)
Yeah, because can you just in terms of asthma, like my sister when she was younger had an inhaler, which she eventually thankfully outgrew and no longer I don't think really has a need for an inhaler anymore as an adult. But what is the issue? Is it that the allergens cause a constriction where the lungs can't breathe appropriately? So for a parent who might not be too familiar with someone who needs an inhaler… What exactly is going on with asthma?
Chris Thompson (13:17.690)
So all of this is inflammation, right? It's all about inflammation and whether it's allergies, food or environmental, or whether it's asthma. So the child gets off to a very allergic, inflammatory start with eczema. And in the lungs when there is inflammation in the sense of getting asthma, the airways or the muscles around the airways start to constrict. So we have little muscles that surround the tubes that allow us to bring air in, and those are there to protect us if there is something let's say there's smoke or something in the air those clamp down to limit the exposure. Well, they get a little bit off track when they're when the patient is allergic and they start to fire those muscles start to constrict all the time and you get the classic wheezing, restricted breathing and the medicines that you referred to your sister was taking probably were designed just to relax those muscles so that the airways could relax and open up and bring air in. That would be a rescue inhaler, where you just use it when you're having symptoms. And then children with more persistent asthma would take a different type of medicine involving a steroid that calms the immune system in the lungs so it doesn't react so much. And it really can make a big difference, not just at the time, but long term. If you don't treat that, those muscles get bigger and bigger and the airways get narrower and permanently get damaged. So it's important to treat asthma early and aggressively so that you can prevent that lung damage that may ensue if you don't treat it.
Jennifer Fugo (15:04.773)
Okay, oh my goodness, that sounds kind of scary actually.
Chris Thompson (15:10.210)
Well, again, I think with awareness though, it's not difficult to treat. And again, I know firsthand- my daughter has asthma. We have to use that steroid inhaler a few months out of the year, and she's great. But yeah, and I'm obviously concerned that her airways would, we call it remodeling. They may change with time if you don't treat it. So we try and get on it as soon as she has those symptoms.
Jennifer Fugo (15:37.133)
And in terms of medication, I assume there's a spectrum of things, especially for allergies. We talked a little bit about how, especially with adults, sometimes adults are left on certain medications for too long. I did want to just also touch on an EpiPen. How do you make the determination whether a child actually needs an EpiPen or even an adult?
Chris Thompson (16:03.610)
So typically that's going to be used for food allergies, again, most commonly peanut allergies, but other food allergies, milk and wheat and other nuts, because those can result in what's called anaphylaxis, where you go into shock because of the super high levels of inflammation that occur when you get exposed to whatever you're allergic to. We don't see that level typically with environmental allergens.
Jennifer Fugo (16:06.656)
Okay.
Chris Thompson (16:33.630)
I mean you can get very ill and it can trigger asthma, but we typically don't recommend EpiPens for those situations. So it's mostly for food allergy or maybe venom allergy, bee stings, wasp allergies, those sorts of things can also cause really severe episodes of anaphylaxis.
Jennifer Fugo (16:53.173)
Okay, and so your allergist would help you determine whether that was appropriate for your case.
Chris Thompson (16:59.330)
That's right. That would involve some testing, and the testing tells you what you're allergic to and how severe that allergy is. And obviously, if it's on the severe spectrum, that's when we get a little more aggressive with treatment.
Jennifer Fugo (17:11.693)
Yeah, yeah, because obviously we don't want to go into anaphylaxis. That is not good. Not good. No. No, it is not. So I wanted to ask you about this FDA news release that I had stumbled across, I think, sometime last year. It was after you and I had spoken. And I thought it underscored the interesting point of why sometimes we have to have awareness that, you know, there can be risks to all medication. All medication, right? And this was really surprising to me. It's entitled, and we'll link this up in the show notes, FDA Requires Stronger Warning About Risk of Neuropsychiatric Events Associated with Asthma and Allergy Medications Singulair and the Generic Montelukast. Can you talk a little bit about what is going on here? I know you had told me before we started talking, this is like new news per se to someone like yourself as an allergist, but it definitely took me back because I wouldn't have guessed that there would have been necessarily… I mean, that's… “Neuropsychiatric event” sounds a little scary. So what is going on here with us?
Chris Thompson (18:29.370)
Yeah, well, I think that's precisely why they came out with this requirement for a stronger warning because Singulair or Montelukast is widely prescribed. It's been around for a long time. It's used by a wide variety of physicians. And I think that we could probably do a better job at educating patients that there is a rare risk of developing depression, even suicidal thoughts as a result of taking this medication. It's an allergy medication, right? You wouldn't even consider that to be a potential issue with it; and again I think because it's been used for so long and this is a rare side effect that we as physicians may get a little lackadaisical and not explain that and so in that rare instance a patient probably isn't going to think that oh this is my Singulair that I started taking last month and they won't know to stop it.
So I think it's just a little bit of a wake up call that says, hey, discuss this with your patients. If you start someone on Singular, just mention it. It's super rare. But if you start to have these sorts of thoughts, it's probably not a coincidence.
Jennifer Fugo (19:44.133)
And so is this just from your experience or what you've read, is it something where, like you mentioned, maybe you've been taking it for a month and you noticed you're starting to feel depressed, or is this something that could be an onset if you're on it for like two years?
Chris Thompson (19:58.450)
Yeah, I'm sure it's possible, but usually it's going to be something that's going to come on fairly quickly. I would think, you know, first few weeks or months is when you're going to see it. Obviously, if you're taking it, you might consider it because if it's mild, it may be something that you've just learned to live with and might be something that can go away if you just stop the medication.
Jennifer Fugo (20:05.118)
Okay.
Jennifer Fugo (20:22.613)
And obviously any prescription medication, and I always say this, I learned this from my dad, who was a doctor, before you stop any of your meds, talk to your doctor. So obviously go back to your allergist or whoever prescribed the medication before stopping it. But if someone is on Singular or Montelukast, are there other options for them? If say this is happening to them, they're getting this side effect. Are there other medications that they could possibly trial that are sort of similar but don't have this impact?
Chris Thompson (20:52.730)
Yes, yeah, definitely. And it isn't a medicine that's dangerous to stop right away. So if you were having these problems, it's safe to do that. But yeah, I would definitely let the doctor that prescribed it know that you're having this and that we need to look into alternatives to that one.
Jennifer Fugo (21:10.993)
Yeah, it was just so wild. And the one thing that was funny, I noticed the date. It was March 4, 2020, and it was right before the world stopped. It's almost like we just were like, oh, whatever was going on, we forgot because everything shut down. And I think that's probably one of the reasons why I didn't pick up on it and other people. It just wasn't something that I think went probably beyond physicians. And I know that my audience likes to be a little bit more in the know and at least have some idea of whether they could ask questions and whatnot. And so I think it's just a good reminder that all medications have side effects. They all do, even things over the counter.
Chris Thompson (21:49.710)
That's right. Yeah, and strange ones sometimes too, right? Like this. You just, it's not drowsiness. It's a very odd symptom to have from an allergy medication.
Jennifer Fugo (22:00.093)
Yeah. Well, before we wrap up, and especially because you're a parent of a child who has dealt with, actually, it sounds like the atopic triad, or perhaps avoided parts of it, what would you want a parent to know if they're coming to your practice and they're nervous about what's happening to their baby or their child? What would be something that you would want them to know having been in their shoes.
Chris Thompson (22:34.110)
Yeah, I think the main thing to understand is that there are things that you can do to treat this beyond just treating the eczema because that's what the first symptoms are. And I think that's what typically happens. I think they treat the eczema with the things that we've discussed and they think that's kind of all you need to do. But the fact that we're talking about the triad, the progression of the disease, it's really important to understand that because if your child has even has mild eczema, they have a 20 to 30% chance of developing asthma. If they have severe eczema, it's upwards of 70% of those kids are gonna go on to develop asthma and you CAN intervene. You can do something to stop that. And I think that's the main message that we need to get out there. It's just not out there. Even among some pediatricians that I speak with, I think it's really important to understand that there are things that we can do.
Jennifer Fugo (23:34.293)
Yeah, absolutely. And it's nice to be able to talk to both sides and share with both parents and with doctors and other practitioners as well, just to have awareness about this. Because I also too, like I don't have children, I don't work with children. And I wasn't honestly aware that there was that high of a risk, especially with severe eczema. I didn't realize that. So it underscores the need not only to have awareness, but to take action, not to let it go and necessarily see if the child will grow out of it. It sounds like that's probably not the right approach, especially if it's in the first year of life.
Chris Thompson (24:11.290)
That's right. I think that's exactly right, Jennifer.
Jennifer Fugo (24:15.653)
Well, thank you so much. I know that your practice, you want to tell everybody, you have an interesting setup at Aspire Allergy and Sinus. You have multiple offices and a lot of different physicians, I believe, that work in your practice, correct?
Chris Thompson (24:32.150)
We do, we do. We've really grown a lot over the years, mainly I think because we offer a wide variety of treatments. We've combined ear, nose, and throat doctors like myself with allergists and immunologists. So we've got kind of everything at the same place. So yeah, we've grown quite a bit. We're in 65 locations now and we're very good at stuff like eczema,
Jennifer Fugo (24:55.155)
Gosh.
Jennifer Fugo (25:01.813)
That's awesome. Well, thank you so much for joining us again today. We'll put all of the links so everyone can find you and the practice in the show notes. And especially if they're looking for some help, I know that you're located in one area of the country of the US, but I also have, it has been known that some of my listeners will travel. So I… I…
Chris Thompson (25:25.090)
Yeah, that's right. We're in, I think, five states now. So we're getting out there. Hopefully we're close enough.
Jennifer Fugo (25:31.813)
Perfect. Well, thank you so much and I really appreciate your time.
Chris Thompson (25:35.570)
Yeah, me too, thanks. Thanks for helping me get the word out.
