• Some children are genetically predisposed to develop related allergic conditions known as the atopic triad — asthma, atopic dermatitis, and allergies like hay fever — which can be triggered by certain foods.
• Severe asthma attacks and severe allergic reactions can have similar life-threatening symptoms.
• Stay engaged with your child’s allergist to make sure that their asthma is well controlled with proper treatment and you’re prepared for potential emergencies.

If your child has food allergies, you know it can be tough to keep them safe and healthy. If they develop asthma as well, even more vigilance may be required. Members of MyFoodAllergyTeam often discuss the challenges of managing both allergies and asthma in their children. “My daughter is 11, and she has asthma with allergies — peanuts, wheat, and soy,” one parent wrote.

Researchers have studied links between food allergies and asthma in children extensively. These two conditions have clear connections, although medical scientists are trying to better understand how exactly food allergies may lead to asthma in some children.

Read on to learn more about the links between food allergies and asthma and recognize symptoms of asthma in a child with food allergies. The more you know, the better equipped you’ll be to talk to your child’s doctor about more effective treatment for these chronic conditions.

What Is Asthma?

Asthma is a long-term disease of the airways between the nose and lungs. During an attack, the airways become inflamed and constricted (narrowed), causing symptoms such as:

• Shortness of breath or trouble breathing
• Wheezing
• Coughing
• Chest pain or tightness

A severe asthma attack can be life-threatening. In the United States, about 4.5 million children have asthma, which affects 8 percent of the population overall. Male children are more likely to develop asthma than female children, according to the Asthma and Allergy Federation of America. The risk of Black children developing asthma is double that of non-Hispanic white children, per the federation.

Although asthma attacks in children have declined in the past 20 years, the Centers for Disease Control and Prevention (CDC) estimates that 50 percent of children with asthma have symptoms that aren’t well controlled.

Causes of Asthma

Asthma is probably caused by a complex combination of both environmental and genetic (inherited) risk factors. Various triggers can affect people with asthma differently and include:

• Exposure to chemicals, smoke, or dust mites
• Exercise, particularly in cold or dry air
• Emotional or psychological stress
• Some anti-inflammatory medications
• Food preservatives, such as sulfites
• Gastroesophageal reflux disease (GERD)
• Allergens like pollen

Read more about genetic risk factors for food allergies.

Asthma Treatment

For many people, asthma can be managed well with treatment options such as:

• Corticosteroid inhalers and inhalers that combine steroids with long-acting bronchodilators to keep airways open
• Oral medications
• Quick-acting (rescue) medications such as albuterol to relieve symptoms during an asthma attack

The Atopic Triad — Allergies, Asthma, and Atopic Dermatitis

Some people have a genetic predisposition to develop hypersensitivity to allergens that are harmless for most people. This genetic tendency is known as atopy. The atopic triad includes three types of allergic conditions that often develop together:

• Atopic dermatitis, the most common subtype of eczema
• Allergies, or hay fever, such as allergic rhinitis and allergic conjunctivitis
• Asthma

All three conditions of the atopic triad can be triggered by food, which indicates a food allergy.

In people with atopic disease, the immune system has a heightened immunoglobulin E (IgE) response to allergens. IgE antibodies are immune proteins that promote an allergic reaction, typically in the lungs, throat, nose, and skin. Each type of IgE antibody reacts to a specific allergenic protein. People with multiple allergies have different types of hypersensitive IgE.

Some form of atopy occurs in about 10 percent to 30 percent of the general population in developed countries. Sixty percent of people with atopic dermatitis will later develop asthma or allergic rhinitis, and 30 percent go on to develop food allergies. This progression of allergic conditions — from atopic dermatitis to food allergies and asthma — is known as the “atopic march.”

Pediatric research shows that the atopic march typically starts with eczema in early childhood, which raises the risk of developing food allergies. However, the sequence of atopic diseases can vary. Furthermore, atopic dermatitis doesn’t always lead to food allergies or asthma. These variations aren’t fully understood by researchers.

The Atopic March and a Damaged Skin Barrier

Atopic dermatitis causes itchy, dry, and inflamed skin. People with atopic dermatitis often report having a family history of the condition, and — unsurprisingly — many cases have a genetic link.

According to immunology research, these gene mutations are also associated with an increased risk of developing asthma and food allergies, but only in people who previously experienced atopic dermatitis — the first step of the atopic march. Researchers believe that people with atopic dermatitis are more likely to develop allergies and asthma because allergens in the environment enter through breaks in their inflamed skin.

One MyFoodAllergyTeam member wrote, “On top of the allergies, my kids have severe eczema.”

“My daughter suffers from certain foods triggering her eczema,” another said. “She does have food allergies, too.”

Asthma Attacks vs. Anaphylaxis

Many parents and caregivers of children with severe food allergies are familiar with symptoms of anaphylaxis (anaphylactic shock), a potentially life-threatening allergic reaction that rapidly restricts breathing. Severe asthma attacks have similar respiratory symptoms and can also endanger life. Although both food-induced anaphylaxis and asthma attacks can cause severe breathing difficulties, there are key differences to be aware of.

Usually, anaphylaxis symptoms come on suddenly, right after exposure to an allergen (substance that causes an allergic reaction). Anaphylaxis is a systemic reaction — it involves multiple parts of the body — causing hives (a raised, discolored rash) and sometimes digestive tract symptoms like abdominal pain and diarrhea. Anaphylaxis or anaphylactic shock can also cause swelling in the eyes, lips, tongue, mouth, or throat, making it difficult to breathe.

An asthma attack, unlike an anaphylactic reaction, usually involves just the lungs — it’s a local reaction, confined to the airways. Symptoms also tend to develop more slowly. It’s important to know that having both food allergies and asthma may put a child at greater risk of more severe symptoms during an anaphylactic or asthma attack. As one member of MyFoodAllergyTeam shared, “I find that asthma makes me much more prone to anaphylaxis.”

If your child has a risk of anaphylaxis due to food allergies, your doctor will advise you on how to be prepared with an epinephrine auto-injector in case of accidental allergen exposure. If your child is also asthmatic, you’ll be given instructions on how to treat an asthma attack and, if the asthma doesn’t respond to treatment, when it’s time to head to the emergency room.

Read tips for eating out safely with food allergies.

Food Triggers and Asthma Attacks

For children who already have asthma, some food allergies may trigger asthma, although this is a rare occurrence. Three common food allergens — cow’s milk, egg, and peanut — are sometimes linked to triggering asthma attacks in children.

The reverse may also be true — identifying and avoiding food triggers may help control asthma symptoms. “No wheat, no milk! Allergies and asthma are under control!” wrote a member of MyFoodAllergyTeam.

Stay Engaged With Your Doctor

It’s essential to inform your allergist if your child has any new or worsening symptoms of allergies or asthma. Staying engaged with your health care provider can help your child get the best possible care.

Fortunately, new treatment options for allergic diseases are in development. For instance, omalizumab (Xolair) is an injected biologic drug — a human-made version of an immune system protein — that targets IgE. By binding with and neutralizing IgE, biologic drugs could help prevent the processes that lead to allergic reactions and life-threatening anaphylaxis. Omalizumab is already approved by the U.S. Food and Drug Administration (FDA) to treat asthma in some children and adults.

Be sure to check in regularly with your doctor to ensure you’re following the best treatment plan to keep asthma symptoms under control.

Find Your Team

MyFoodAllergyTeam is the social network for people with food allergies and their loved ones. On MyFoodAllergyTeam, more than 39,000 members come together to ask questions, give advice, and share their stories with others who understand life with food allergies.

Does your child have both food allergies and asthma? Which developed first? How has that combination made it more difficult to keep your child safe and healthy? Share your experience in the comments below, or start a conversation by posting on your Activities page.