Well Wisconsin Radio

Managing Asthma, Allergies, and Eczema with Dr. Roopa Shah 

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Host: Hello and welcome to Well Wisconsin Radio, a podcast discussing health and wellbeing topics with experts from all around the state of Wisconsin. I’m your host, Julie Cruz, and today my guest is Dr. Roopa Shah. Dr. Shah is a board-certified family medicine physician with SSM Health Dean Medical Group, a medical director with Medica, and a board-certified health and wellness coach. 

She has been serving patients in Madison, Wisconsin, at SSM Health Systems since 2002.  She can be seen weekly on local media, including Channel 3 and iHeartRadio, discussing various wellness topics.  Dr. Shah, thank you for joining us today to talk about managing asthma, allergies, and eczema.  

Guest: Thank you so much for having me. 

Host: You’re welcome. Will you please start our conversation off by giving us a brief overview of each of these conditions, the signs and symptoms, and what might cause them to occur?  

Guest: Yes. So, basically, um, they’re all related, um, conditions. Asthma, uh, I think as we all know, is a lung condition in which, uh, people have shortness of breath, difficulty breathing, wheezing, um, you know, uh, it can be triggered by allergies. 

Uh, so that’s the next one. So, seasonal allergies. Food allergies. These are all sorts of conditions, um, that are triggered by different allergens. So, seasonal allergies, as you would imagine, people have itchy eyes, runny nose, sneezing, congestion, uh, things like that. And finally, we have eczema, which is a skin condition. 

And we tend to forget that skin is our largest organ, um, and so a lot of these conditions, um, you know, present in the skin, and eczema is characterized typically by red, itchy, flaky, uh, patchy, um, rashes, and that type of skin condition.  

Host: Great. Thank you so much for that, that nice little overview. I appreciate it. It will help us as we kind of lead into the rest of our questions today and our listeners might be wondering why we chose to discuss these three conditions together. How are asthma, allergies and eczema connected? And what do all three of these conditions have in common?  

Guest: So, the way that these are all linked, um, is by, basically, these are all caused by inflammation in the body, and that’s their common connection. 

So, when your body comes into contact with a foreign substance or an allergen, right, it’s going to produce a cascade of chemicals that then cause inflammation and swelling in the body. Now, this could lead to what we were talking about with allergies, sneezing, itchy eyes, runny nose. Um, it could also, um, lead to, um, your eczema flaring up. 

So, then in response, your eczema, you would feel that your skin is getting more red, flaky, itchy as well. And then finally, again, just, you know, when you’re exposed to some sort of allergen, your asthma can get worse. So, you might feel like you’re getting more short of breath and wheezy, but inflammation is, is kind of the key. 

Um, and it’s caused by an immune system dysfunction. Um, and typically these folks have a lot of immunoglobulin E, which is a type of antibody that plays a major role in this antibody response, or this allergic response, I should say.  

Host: Good. Great. Thank you. And so, I recently read something about the term atopic or allergic march. What can you tell us about this, and you know, what is it? How is it related to these conditions?   

Guest: So, the atopic march, or the allergic march, is a term that’s given to the natural progression of these allergic diseases in a person over time. So, what typically happens is an infant will have some symptoms that will progress from let’s say dry skin to then eczema to then maybe food allergies to then maybe seasonal allergies and then to asthma. So, it’s this sequential development of the different organs being involved where one symptom would be predominant when they’re younger, but it’s pretty much laid out how it will progress over time in that person.  So, that’s why it’s called the allergic or the atopic march because these conditions are all what we call atopic diseases. 

And there’s a triad, um, seasonal allergies, asthma and eczema as we’ve been talking about.   

Host: All right, so what is the cause of the allergic march? What factors might increase the risk of this occurring and are there any environmental or genetic factors that increase that risk?   

Guest: Yeah, definitely. So, the exact cause of the atopic march is really not fully understood, but it is an area of lots of research going on currently. But as you mentioned, it is thought to be influenced by a combination of genetic and both environmental factors. Um, some of the thoughts initially for, let’s say eczema, which we also call atopic dermatitis, is that there is a skin barrier disruption. This may then allow allergens and other pathogens to enter the body and then trigger that kind of immune system dysfunction or inflammatory response. 

This in turn could then cause food allergies, seasonal allergies, asthma to flare, but no one knows exactly what’s involved.  Um, we know that children that produce a lot of IgE, um, IgE antibodies in response to these environmental triggers are at higher risk of the atopic march, so that’s been looked at. Um, other things that can influence, if you have a strong family history. If there’s other members in your family with a lot of eczema, allergies, hay fever, asthma, your risk is increased.  

There’s also some thought that when you’re younger, and if you’re exposed to more environmental allergens, then you’re more likely to experience the atopic march, and then progressively develop some of these, um, conditions as well. 

Host: Interesting. Thank you.  Will you please explain the development stages of the march and at what age does it usually begin? Kind of what happens, and can your allergies increase over time?  

Guest: The atopic march, again, um, like we mentioned, is this natural progression of allergic diseases, and usually it will start in infancy. So, um, we might see an infant born at birth who’s got a lot of dry skin issues. Over the next few weeks or months of their life, what we’ll notice is they’re developing eczema. This atopic dermatitis, that red, flaky, patchy skin. Parents will come in and say, my, you know, child has this rash, it’s really dry, um, and it’s all over their body.  

After that, what we’ll, what we might see then is that in the first few months or years of their life, that same child could then go on to develop food allergies. When parents are introducing those new foods, we might start seeing that they develop these, um, rashes around their mouth. Their eczema might flare, um, or they develop, you know, even more severe signs of a food allergy.  

After that, after about the age of three, then we’ll see these same children develop nasal allergies – sneezing, congestion, runny, that kind of perpetual runny nose. And so, then they’re developing seasonal allergies as well. And then finally, um, or kind of concurrently in that time, um, they can start developing asthma symptoms too. 

So, if they have a really bad, uh, seasonal allergy, um, you know, season that year, the parents may say, okay, they’re also wheezing. I hear my child wheezing and they look like they’re a little short of breath. So, some of it can occur during that time period, but generally the symptoms will start early in infancy, and we can just see that child progressing through that atopic march. 

Host: Hmm. Interesting. And how common is the allergic march of those three different conditions? How likely is it that people with one of the conditions will develop one or both of the other conditions? 

So unfortunately, yes. So, when people have one atopic condition, they’re very much likely to develop another. Um, and again, because these are all linked by those genetic and environmental triggers. Um, there’s been some quotes that up to 60 percent of people with like eczema or atopic dermatitis will develop asthma or hay fever, and up to 30 percent of them may even develop food allergies. So, there is a strong link to the other conditions and having one greatly increases your chances of having another. 

It’s not a certain diagnosis. Um, and of course, some people can have severe allergies, food allergies and never develop, um, asthma or other types of conditions. But it makes it that much more likely. And again, it’s even more likely if you’ve got that family history of it as well.  

Host: Wow. So, once it begins, can you prevent it from progressing? Are there steps that you can take that will make a difference and stop that progression of the other conditions?   

Guest: So, that’s an area of a lot of research that they’re looking at to see what kinds of things, um, in terms of early intervention could we do to slow the progression or potentially even halt the progression. There has not been any distinct, um, you know treatment protocol for this as of yet, um, there’s been a lot of talk, of course, you know as we’ve been talking a lot about Inflammation. Well, the opposite of that would be anti-inflammation right or anti-inflammatory. So, anti-inflammatory diets have been looked at. There’s also a lot of research into sort of this idea of the gut microbiome. 

So, even looking at babies and, and the baby’s gut microbiome, how can that help protect them against this, um, atopic march? So, things that have been looked at is, is vaginal birth, um, you know, protective is breastfeeding protective, you know, how do all of these things support a baby’s, you know, gut? Um, we can’t, of course, alter the family history. 

Um, we can look at the environment. We know that, um, you know, if we could maybe try to eliminate those early, um, allergens potentially from the home, like eliminating dust mites, um, or other sort of potential smoke, other allergens that may be in the home. Could this then prevent, you know, the allergic march, um, or prevent the severity of it? So, that’s been a, a big, um, area of interest as well.  

Host: Great. Thank you. So, our next question is, um, how do asthma, allergies, and eczema interact? And I think you talked a little bit about this, but can you talk more about, can they all occur at the same time? And, if so, what’s causing that to happen?   

Guest: So, they can all occur at the same time, unfortunately. Um, so for instance, when somebody with asthma has an allergic reaction to something like the outside, uh, pollens or dust mites or, pet dander, it will trigger their asthma symptoms. Of course, they’ll get short of breath. They might get wheezy, feel like it’s hard to take a deep breath in. Um, and we call this allergy induced asthma or allergic asthma. 

So, the trigger is the allergen. which then in turn causes the inflammation, um, in the, in the lungs to trigger that, um, asthmatic reaction. This is when those, um, IgE, uh, immunoglobulins are released in response to the allergen, causing all of that airway inflammation. Now, in the same token, it can also then, um, cause your skin to become more inflamed. 

So that same antibody response then is causing that eczema to flare. So, people will say, yeah, when the allergies are really bad outside, I find that my eczema is flaring. I have more red, itchy patches of skin. It’s harder to manage. It’s more widespread. Um, and of course, then their allergies are worse with the stuffy nose, itchy eyes and skin rash. 

So, a lot of the environmental triggers will trigger that initial antibody inflammatory response. And then all three of these conditions can flare at the same time. Um, and sometimes we’ll just see one or the other of them worse.  Um, but again, then if we can control that inflammation, we’ll see a lot of those symptoms subside a bit too. 

Host: Okay. Interesting. So, you know, we’ve kind of talked about how this allergic march is starting like with infancy almost as, you know, children age, but as an adult, can I develop allergies or asthma later in life and what might cause that to happen? How do I know like, that’s what I’m experiencing, versus just I have a common cold, right?  

Guest: Yeah, so that’s always tough, right? Because as an adult, sometimes we’re not on the lookout for developing these, you know, symptoms. But I certainly do see that quite a bit in my practice. Um, and it’s important to note too that asthma in adults can look a little bit different than asthma in children. You know, we usually associate, um, asthma with wheezing, uh, shortness of breath, um, but in adults sometimes, um, what we’ll see that more as is, uh, a lot of coughing. 

Um, so certainly to answer your question, yes, adults can develop this late onset, uh, asthma. It might look a little bit different than childhood asthma, um, and we can, we call it cough variant asthma sometimes, um, but it is possible. It’s less likely, um, for adults to develop these conditions, uh, but it certainly happens. I’ve certainly also seen adults develop food allergies, um, as an adult. That also is a possibility, um, in addition to seasonal allergies. Yeah, um, like you mentioned, people, uh, patients will come in to see me, think that they have a cold that’s been going on for three to four months. 

And I say, oh, you have allergies, I think. And sure enough, once we treat them with the right treatment, they get better, and they’re surprised. Well, I didn’t think you could develop allergies later in life, but you certainly can.  

Host: Hmm. Interesting. Yeah, that, that is very interesting. I, um, I’ve heard too of people may be moving from one part of the country to another part of the country and then developing allergies after they move and again thinking they have a common cold and not knowing that that’s what it is. Have you ever seen that happen or heard patients have experienced that before?   

Guest: Yes, definitely. Um, you know, especially here in Wisconsin where we do have a lot more greenery, a lot more trees, grass, pollens. These are just chocked full of different allergens for the right person, right? So, when you’re moving from a different area of the country to here, all of a sudden people develop the itchy eyes and their eyes are red and they’re sneezing and coughing and runny nose. Um, so yeah, different parts of the United States do have different allergens, um, from, like I mentioned, different trees and, and pollens, ragweed, you know, different, um, you know, environmental triggers like that. So, it’s certainly possible that when you go from one area of the country to another, your symptoms could be better or worse, right? Um, so it really can depend.  

Host: Yeah, yeah, thank you.  Um, so we’ve talked a lot about the conditions. We’ve talked about kind of what you might experience and how this march sometimes occurs. What can you tell us about what treatments are available to manage asthma, allergies, and eczema? So how do I know, like, when should I contact my doctor to get help treating these conditions? And is it possible to manage all three conditions with a single treatment?   

Guest: Well, that’s a tricky one. Um, because we do have really targeted treatments for the different conditions. Again, if we go back to the concept of the inflammation, whatever we can do to halt that inflammatory response could certainly help all three conditions. It definitely will. When we’re talking about, um, seasonal allergies, um, the main treatment that we like to use are antihistamine medications.  So, things that we have seen at the drugstore, your Zyrtec, your Claritin, Allegra, those types of medications really are going to help your seasonal allergies the most. 

They’re also going to impact those people that have allergic asthma, like we talked about. So, if you’re treating your allergies with an antihistamine, your asthma might be better. And, in turn, your eczema might be better as well, because again, one thing is going to kind of trigger the other.  Specifically, for asthma, of course, we have, um, very, uh, targeted treatments for that, uh, ranging from bronchodilators to sort of the newer treatments of the inhaled, um, steroids. and long acting, um, uh, beta agonists, which, uh, again, this treatment has really been, um, proven to help with the inflammation that occurs in the lungs while also opening those airways and helping people breathe better.   

Um, for eczema, of course, we have, uh, different treatments in terms of like creams, um, emollients, uh, those types of things that are really targeted just for the eczema itself. But again, when we treat those allergies with the antihistamines, we’ll notice that people’s skin improves as well, and their asthma symptoms get better. So, sometimes we have to use a combination.  

Host: Great, thank you. And I kind of have a follow up question.  Before we get into talking a little bit more about maybe other things that we can do to help treat those, you know, you talked about how the march starts when you’re younger. Um, I guess one question I have is, you know, if you had the, the, the march begin for you when you were a child, you experienced the eczema, allergies, the asthma. Is that something, are those conditions going to all stay with you during adulthood? Will that all stay with you? Those three conditions?   

Guest: Generally, they will. Um, the severity might really wax and wane throughout your lifetime, right? Again, depending on your lifestyle, your diet, what you’re exposed to in your environment. Certainly, let’s say, for example, you have a history when you were younger of, um, seasonal allergies and eczema. And then you, uh, grow up in a home without pets, without, you know, smoke, you spend a lot of time indoors, let’s say. 

So, for a long time, then your symptoms could be very well controlled. Or you may even imagine that like you don’t have those symptoms and you’re sort of; you outgrew it.  Then let’s say into adulthood, you move somewhere, you know, where there’s a lot of environmental allergens. You start spending a lot of time outdoors. You get a cat, for instance, you know.  And then you start finding that you’re sneezing, you’re, um, congested, you’re feeling like you’re wheezing a little bit or you’re short of breath, um, and that your skin is really itchy. You know, so then it’s, um, a good idea to talk to your physician, um, and sometimes just talking through that and taking that history of like, yeah, you know, when I was younger, I recall having some of these symptoms. 

Um, so certainly, they will wax and wane throughout your life, depending on, you know, what you’re exposed to, your immediate environment, where you live, those sorts of things. Um, and we all know, you know, folks who will say, hey, I spent the weekend at a friend’s house who had a cat and all of a sudden, I couldn’t breathe, right? 

Um, so having even those, um, one-time limited exposures can really trigger those symptoms for a person. So, to answer your question, they never, those symptoms, uh, those conditions really never leave you.  They can really be very quiescent, very well managed, until or unless you’re exposed to that trigger or that allergen that then gets your immune system, um, kind of in that heightened state again, releasing all those inflammatory chemicals again. So, the more that you can do to control your environment and stay in a state of anti-inflammation, the better off you’ll be in terms of managing those conditions.   

Host: Okay, great. Thank you. That helps just kind of clarify, like, what happens, right, after you’re a child and with the conditions over time. Plus, it leads into our next question, which is, what lifestyle changes can someone make to help manage the asthma, allergies, and eczema? What are some things that we can do just in our everyday life to help with these conditions?  

Guest: Yeah, so I think, um, first and foremost is, is trying to pinpoint best you can what your specific triggers are, right? For certain people, their asthma, for instance, might be triggered by pet dander, or it might be triggered by outdoor allergens. 

So, if we can limit, um, and avoid the triggers for our conditions, that’s when we’ll, we’ll do the best. So, again, if you find that you are allergic to pet dander, then limiting your contact with dogs, or cats, um, maybe don’t have them sleeping in your bedroom with you, maybe having them in a separate area. 

Um, maybe limiting your time with friends or family who might have those pets in their home so that your symptoms don’t get triggered. Uh, changing your clothes, um, sheets, washing, um, everything in hot water, vacuuming your home regularly. These types of things will sort of limit your exposure to those allergens.  

Again, if you have asthma, making sure your home air quality is really, um, you know, clean. So, using air filters, uh, that are really efficient to keep those dust particles at bay, right? Vacuuming your home again, using, um, dust mite pillow covers, mattress covers, these things all limit your exposure to those, um, allergens. 

Um, other things people can do if you know that, you know, for me, for instance, my allergies are triggered by being outside. So, I will limit my time outside and when I come back indoors, I’ll make sure to take a shower, change my clothes, you know, again, then you can kind of get some of those allergens off your skin and out of your nasal mucosa and other areas where it can start triggering those symptoms for you. So, there’s certainly a lot that you can do to control your, um, environment and exposures.  

Host: Great. Yeah. Thank you. Thanks for those great tips. I appreciate it. And you kind of alluded to this earlier, but, um, are you aware of any current research around the protection and prevention of the allergic march and kind of what, what do you know, or what can you share with us about the, what does the future hold for the, um, prevalence of the allergic march? 

Guest: So, there is a lot of, uh, research underway, trying to understand more. The role of diet, hygiene, certain early childhood infections, um, allergens, air pollution, and even environmental factors, because again, we’ve talked about some of these, but, and we’ve seen how they can help trigger or increase the severity of the allergic march. 

So, that’s where a lot of the current research is. Um, there’s also, um, some, more research going on, of course, in the area of immunotherapy and how that can affect, uh, things like atopic disease and the atopic, uh, march. So, there’s a lot of research surrounding that. Um, there’s some research that’s been looking into prophylactic antihistamines. Is that effective? Taking them before the march, you know, kind of, uh, continues. Does that help alter the severity? Um, as we were talking about before, can it help alter the severity or halt the progression of the march? So, lots of different areas of research going on right now.   

Host: Wow. Yeah, that sounds like a lot of good avenues to be looked at to see how that can impact what’s happening with the march. Thank you.  

Guest: Sure. 

Host: And, um, Dr. Shaw, this is our last question for today. And so, I just want to ask, what would you recommend for our listeners if they are experiencing or a family member of theirs is currently experiencing any of these conditions? Do you have kind of any parting words of wisdom to share?  

Guest: So, I think if you’re experiencing any of these conditions, of course, it’s a great idea to talk first, you know, to your primary physician. Um, and you know, there’s a lot of first line treatments and advice that we can give you to help with these conditions. Um, if things get more severe or they’re more difficult to manage with some of those treatments, first line treatments like antihistamines or topical creams, asthma medications. 

Certainly, then seeing a board-certified allergist and immunologist is a great, um, next step. Uh, they really are up to date on the latest treatments, um, and research on these topics and can really offer some more treatments that might be beneficial to you. So don’t wait if you’re, if you’re suffering, don’t suffer in silence, you know, um, make sure that you come in and talk to your physician about it because there is a lot of great treatment, um, out there to help, help folks. 

Host: Yeah. That’s some really good words of wisdom is to, and advice is to not wait and to ask for help and seek that, seek that help and treatment, um, sooner than later. Right.  

Guest: Yeah.  

Host: Great.  

Guest: Definitely.  

Host: Thank you, Dr. Shah. I appreciate you, um, chatting with us today about managing asthma, allergies, and eczema.   

Guest: Thank you so much for having me.  

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