Allergies, Asthma & Eczema: Pediatric Treatment of the Atopic Triad

Autumn Frandsen, ND

This article explores the holistic treatment of the atopic triad—eczema, asthma, and allergies—in children. It highlights the role of immune pathways, gut and skin microbiomes, and practical naturopathic interventions to address triggers and reduce symptoms.

One of the first health concerns that brings new mothers into the office is eczema, also known as atopic dermatitis. They typically try applying over-the-counter products, including lotions, coconut oil, steroid cream, or some combination thereof. However, the scaly red skin often induces panic that brings them in the door when all other efforts are exhausted. This can be a blessing in disguise because it usually prompts the doctor to test for food allergies, environmental allergies, and infections that are common precipitating factors in eczema. The clear, tangible benefit to investigating these things further is that eliminating allergic triggers, clearing up infections, healing the gut, and desensitizing the body to the allergies produces a noticeable change in the outward appearance of the skin. A less obvious effect is that this provides the patient with added protection against more than multiple types of asthma and reduces the risk of allergic rhinitis and other allergy symptoms in the future. Skin inflammation can create an internal inflammatory cascade that can perpetuate further skin conditions and lead to several inflammation-based illnesses later in life.^1,2

Pathophysiology of Atopic Triad in Children

Asthma, eczema, and allergies have very similar triggers and immune reactions. However, there is a difference in pathophysiology between children and adults. Infections, environmental allergens, specific food allergies unique to each person, chemical exposure and allergy, and overall inflammation in the gut trigger each member of the atopic triad. The predominant pathway that links all three conditions is the activation of cytokines and the release of eosinophils, followed by the release of histamine. The difference lies in the type of interleukin the CD4 immune complement releases.³

Immune System Differences in Children

In children with eczema, the issue often arises because the immune response is heavily skewed toward T helper 2 (Th2) cells because there are fewer Th1 cells, not strictly because the body is inflamed. This helps explain why eczema tends to appear before asthma or allergies. When children get viral infections, and the immune system activates the Th1 pathway, flares often decrease, while the cascade tends toward the Th1 pathway. In adults, there are increased instances of interleukin 22 (IL-22)-producing CD4 and CD8 T cells within the skin and increased activation of human leukocyte antigen DR. Hence, the pathogenesis is much more complex.³ In asthma, T lymphocytes produce mostly IL-4, IL-5, and IL-13, while in allergies the pathway favors production of IL-4 and IL-5 only.^4,5,6,7,8

Treatment of the Atopic Triad

There are several common themes in treating children’s eczema, allergies, and asthma. Due to the varying symptoms and location of reactivity, there are specific treatments for each as well. The commonality lies in the need for treatment with supplements such as vitamin D, bromelain, curcumin, quercetin, essential fatty acids, and pre/probiotics. Gut healing, testing for infectious triggers, allergy testing, and desensitization/elimination are also indicated.⁶

Essential Fatty Acids

Working with essential fatty acids can be complicated. It is hard to predict which fatty acid will work best for each patient, so several options are listed below. The lower end of the range is appropriate for children under the age of 4, while children between the ages of 4 and 15 will benefit from higher doses. I prefer formulas with a higher EPA-to-DHA ratio, as EPA and DHA help reduce PGE2 levels.

• Flaxseed oil: 1-2 tsp, up to 2 times per day
• Sunflower oil: 2 grams, 1-2 times per day
• Fish oil: 15-30 mL cod liver oil daily or up to 3 grams EPA 1-2 times per day 

Reduction of Systemic and GI Inflammation

• Curcumin: 600 mg, 2-3 times per day.
  • Curcumin downregulates pro-inflammatory interleukins and inhibits the synthesis of a pro-inflammatory enzyme, 5-lipoxygenase (5-LO,) including 5-hydroxyeicosatetraenoic acid (5-HETE) and leukotriene B4 (LTB-4), which contribute bronchoconstriction, chemotaxis, and increased vascular permeability.¹³
  • Other anti-inflammatory plant constituents, such as quercetin, also inhibit 5-LO but act more broadly as antioxidants, whereas boswellic acids specifically target 5-LO.¹⁴

Healing of the GI Tract

• L-glutamine: 2.5 g 1-2 times per day
  • Glutamine is a critical nutrient for the small bowel mucosa, serving as a primary fuel source for cellular metabolism, regulating cell proliferation, and repairing and maintaining the gut barrier functions. Its consumption in small bowel mucosa exceeds the production rate during catabolic stress such as trauma, sepsis, and post-surgery. ¹⁴
• Slippery Elm (Ulmus rubra, aka Ulmus fulva): approximately 400-500 mg 3 times per day
  • In the upper stomach and esophagus, Slippery Elm’s mechanism of action appears to involve reflex stimulation of the nerve endings in the mucosal lining, leading to increased mucous secretion. This enhanced mucus production creates a protective coating, shielding the stomach and small intestine from excess acidity.¹⁵
• Marshmallow Root (Althea officinalis): 100 mg per day.
  • Acts as an antimicrobial and a demulcent, helping coat and soothe the GI lining and providing anti-inflammatory effects.¹⁶
• Larch arabinogalactan: 200-1500 mg per day
  • Supports the growth of beneficial intestinal microflora, including  Bifidobacterium and Lactobacillus acidophilus.¹⁷

Further Considerations

• Address any anxiety, as stress creates inflammation
• Use stool testing to identify and treat any pathogens or enzyme deficiencies
• Blood tests can be done for either mother or child for factors including allergies, Lyme disease, Candida, and Epstein-Barr virus

Addressing Triggers

In my experience with testing for IgE-mediated allergic responses to foods and environmental triggers, there are some cases where little to no reaction is detected. In these cases, eliminating foods found to be sensitive through IgG or IgA testing is beneficial and sometimes more beneficial than eliminating IgE-mediated food allergies. This is attributed to the fact that several immune pathways can also cause atopic dermatitis or asthma, such as the activation of memory T-cells found within the epithelium of the skin and mucous membranes.^7,8

Potential desensitization methods include sublingual immunotherapy, weekly oral immunotherapy, low-dose allergen therapy, mental field therapy/tapping, and acupuncture. My favorite method is weekly oral immunotherapy, as it can address both food and environmental allergic triggers as well as sulfites, nickel, and other chemicals without having to stress the immune system so frequently.⁹

Eczema Treatment

In addition to the above treatments recommended for every atopic triad patient, it is important to consider certain skin irritants, such as nickel, in treating eczema. Nickel-induced eczema typically occurs on the hands and feet but is limited to those locations. Ingestion of foods high in nickel or cooking with stainless steel can also trigger a flare in those with nickel sensitivity.¹⁰

The microbiome in our GI tract influences our mood, immune system function, and overall health. Imbalance in our microbiome, genetic predisposition, and allergic triggers are very important factors to consider when determining whether a patient is likely to develop eczema. Some less-publicized studies have shown that the skin’s microbiome is vital in protecting a child from developing both eczema and allergies. A healthy cutaneous microbiome inhibits colonization with pathogens such as Staphylococcus aureus, a crucial component of an intact, functional epidermal barrier. The microbiome of the GI tract has gained increasing attention; the microbiome of the skin is likely not far behind.¹¹

As the diversity of the cutaneous microbiome decreases, eczema tends to become more severe, and pathogenic bacteria, such as S. aureus, colonize the skin more easily. Early clinical studies suggest that when applied topically, commensal organisms such as Staphylococcus hominis or Roseomonas mucosa can help reduce eczema severity. This application supports commensals’ role in decreasing S. aureus colonization in patients with eczema.¹¹

Asthma Treatment

• Urtica dioica: 1 tsp herb in infusion 1-2 times per day
• Boswellia serrata: 600 mg 2 times per day (18)
• Quercetin: 1200 mg twice per day or for dietary sources, eat onions, kale, cherry tomatoes, apples, broccoli, black or green tea, and blueberries- Quercetin causes a decrease in pro-inflammatory cytokines, has a role in leukotriene creation, and suppresses interleukin IL-4 production. It can improve the Th1/Th2 balance and restrain antigen-specific IgE antibody formation. It is also effective in inhibiting enzymes such as lipoxygenase, eosinophil, and peroxidase and in suppressing inflammatory mediators.
• Herbal decoction: ¼ ounce of a combination of Tussilago farfara, Verbascum thapsus, Foeniculum vulgare, Lobelia inflata, and Glycyrrhiza glabra decocted in 1-2 pints of water for up to 10 minutes. This can be administered when cooled at 1 tbsp every 2-4 hours.
• Vitamin C: 1-3 g, up to 3 times per day to act as an antioxidant 
• Biotherapeutic drainage remedies, as indicated, can help reduce the total body burden, thereby decreasing reactivity.
• Magnesium glycinate: 200-400 mg per day

Allergy Treatment

• Homeopathic remedies such as Natrum muriaticum 200C: 3 pellets up to 5 times per day

Final Thoughts

The younger the child is when parents seek eczema treatment – especially through a holistic provider – the more likely it is that the presence of asthma or allergies will be subclinical or nonexistent. Methods used to treat the immune system dysfunction that precipitates eczema often provide the triple benefit of addressing the atopic triad – all at once.¹² A naturopathic approach to healing the gut and the skin, coupled with eliminating triggers and infections, gives a child a chance to get a handle on their health before they even remember there was an issue.

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References

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