Wynne Armand, MD, from Massachusetts General Hospital.

Wynne Armand, MD

This year's wildfire season pushed air quality to hazardous extremes across large parts of the US, with several Midwest and East Coast metro areas registering among the worst readings on record.¹ Clinicians have largely focused on the resulting respiratory and cardiovascular fallout, but a parallel trend has drawn less attention: rising rates of allergic skin flares linked to the smoke itself.

One hospital dermatology practice documented a rise in 

-related visits during a single wildfire month, consistent with several years of comparison data showing visit volume rising and falling alongside pollution levels.

 Wynne Armand, MD, primary care physician at Massachusetts General Hospital, said that atopic dermatitis flares tend to appear within the same week of smoke exposure, while psoriasis flares can take several weeks to surface.

Whether wildfire pollutants simply reactivate existing allergic disease or help create it in the first place remains an open question, and Armand says clinicians are still leaning on judgment rather than a validated test to tell the difference. In the following Q&A, she walks through how she separates smoke-related irritation from a true allergic reaction and what she advises patients to do before, during, and after exposure.

For more on wildfire smoke's effects on skin and allergic disease, see the accompanying feature and video:

How Wildfire Smoke Triggers Allergic Disease Long After It

—the full written feature this interview accompanies

Wildfire Smoke's Hidden Toll on Patients with Allergies

Q&A: What Wildfire Smoke Does to Allergic Skin Disease, With Wynne Armand, MD

 Your article noted a sharp spike in eczema visits at Massachusetts General Hospital during wildfire season. What did that look like, and what pointed to wildfire smoke as the cause?

 Dr. Koosh, my colleague…was noticing that there was a dramatic spike in the number of patients presenting with flares of their atopic dermatitis or a form of their eczema, and it was really striking.

This led her to look at the records for her patients, comparing prior years, and really seeing a strong association with times when there were increased wildfires and air pollutants that seem to trigger or be associated with an uptick in the acute visits for these patients. This has been seen in many other studies and documented; it's not a unique finding.

You describe an oxidative stress pathway damaging the skin barrier. Does the same mechanism drive nasal, eye, and respiratory allergy symptoms during smoke events, or is it separate?

 What you described there is the initial irritant of just getting these particulate matter inside the airway and the eyes, and that causes an irritation. Anybody can experience that, not just people with atopic dermatitis. When we are referring to atopic dermatitis, [patients’] skin barrier is a little weakened, so it's easier for things to get through, and it triggers a stronger immune response.

Inflammation is a very broad, [a] general term that we see in a lot of diseases, and it can be triggered by different things. We see inflammation in both instances, but when you look a little bit closer, they differ in some of how that is happening and why.

Are patients with skin reactions also reporting worsening seasonal allergies, sinus symptoms, or watery eyes during smoke events?

 With wildfire smoke, there's a lot of direct irritation to the eyes, the nose, the airway, and if somebody already has underlying conditions—and that includes allergic type of conditions like allergic rhinitis or asthma that is often triggered by allergens—they can then also see worsening of their disease.

One researcher found respiratory symptoms peaking a year after wildfire exposure

. Do skin symptoms show a similar delayed reaction, or do they appear more immediately?

 In the literature, much of the atopic dermatitis that we're talking about tends to be fairly immediate in terms of the exacerbations…generally the same week. [With psoriasis], [the] flare seems to be documented more several weeks later, and that may be because that is more of a systemic inflammatory response as to more of a quick skin inflammatory response.

How do you distinguish a patient's smoke-related irritation from a true allergic reaction?

 Sometimes it's hard to understand if that's inflammation just from the acute exposure to a toxin versus an underlying condition that has an inflammatory, immune-related pathophysiology of why it's happening. A lot of it is the timing, a lot of it is the severity, a lot of it is the history. What we know about a patient-specific background [and] how they respond to different types of treatments will be all clues.

Ultimately, sometimes, though we don't often end up needing to. There are times when you actually need to look under a microscope to try to figure some of these answers out.

How confident are you in the current research connecting wildfire smoke to allergic disease?

 There is an enormous amount of literature to know that pollution triggers allergy symptoms. Wildfire pollution is a little bit newer in terms of the data and the science of how long we've been studying it, but there's a lot of overlap in terms of the toxins and pollutants that we see in normal urban pollution and wildfire pollution.

 What's the one thing you wish more clinicians understood about treating patients with allergies during wildfire season?

 Talking more to patients about how to prevent them from getting sick is really important. We spend a lot of time after the fact, when people are acutely ill, and while that is of course without question extremely important, there's so much disease that we can prevent if we educate patients ahead of time [about] what types of things they can do to keep themselves healthy and prevent them from getting sick.

 What advice would you give patients with existing allergies on protecting themselves during or after a wildfire smoke event?

 One is really trying to minimize exposure. Depending on what condition, what the person's background is in terms of their health, how vulnerable they are, [and] what they're able to tolerate, the level of rigidity in how you want to minimize that exposure is going to be different.

But in general, being aware of your surroundings. That means following the air quality. It means following the local public health officials on what they're advising in terms of the risk of being outdoors during these events.

[It] may mean not going outside, [or] when you're going outside, minimizing what you do. It may mean when you go outside…avoiding things like exercise if you have asthma, for example, or wearing barriers… [such as an] N95 respirator.

Also, wearing clothing to protect the skin if you have some of these skin conditions… [or] using a mineral sunscreen. A zinc or titanium-containing sunscreen barrier can maybe make a little bit more of a difference. Rinsing off the skin when you can from these irritants and pollutants and allergens when you're indoors.

That means closing the windows, making sure you're circulating the air from inside and not from outside. That you have good filters and you're changing the filters. Not creating more indoor air pollution; [avoiding] burning a fire [or] cooking with a gas stove. All these things [can] make sure that you're in an environment with healthy, clean air.

What specifically do you want to see researched regarding allergies and wildfires?

 Understanding exactly the contribution of wildfire to the development of the diseases will be a very critical piece of it.

Miller B. Wildfire smoke is driving terrible air quality in major cities, but relief is coming. CNN. Published July 17, 2026. Accessed September 14, 2026. 

https://www.cnn.com/2026/07/17/weather/smoke-forecast-northeast-midwest

Armand W. One surprising effect of wildfires: Itchy, irritated skin. Harvard Health Publishing. Published June 24, 2024. Accessed September 14, 2026. 

https://www.health.harvard.edu/blog/one-surprising-effect-of-wildfires-itchy-irritated-skin-202406243052

Articles

Hazardous wildfire smoke episodes are increasingly associated with dermatologic morbidity, particularly eczema and other atopic dermatitis flares that track temporally with pollution spikes. Particulate-driven oxidative stress and barrier disruption may amplify immune activation in predisposed patients, while ocular and airway symptoms often reflect nonspecific irritant effects superimposed on allergic rhinitis or asthma. Atopic dermatitis exacerbations typically occur within a week of exposure, whereas psoriasis may flare weeks later. Differentiating irritant inflammation from allergic disease remains largely clinical, underscoring the need for prevention-focused counseling and clearer mechanistic research.

In this Q&A, Armand explains why eczema visits spike during wildfire smoke events and how allergic patients can protect themselves.

What Wildfire Smoke Does to Allergic Skin Disease, With Wynne Armand, MD

are documenting a wildfire health effect that extends well past the smoky week that makes headlines.

Most wildfire smoke research centers on its cardiopulmonary effects, with fine particulate matter linked to asthma flare-ups, heart attacks, and strokes. California studies tied children's smoke exposure to more coughing, wheezing, bronchitis, colds, and asthma-related doctor or hospital visits. Wildfires also release carbon monoxide, and inhaling it limits oxygen delivery to the body's organs and tissues, causing headaches, nausea, and dizziness, and at high levels, death.

The Link Between Wildfire Smoke & Allergies

However, little research focuses on the link between wildfire smoke and allergies.

An observational study published in 2022 reported that patients at a local allergy clinic in northeastern North Carolina showed measurable declines in lung function a full year after exposure to wildfire smoke from 2 peat bog fires (2008 and 2011) in the Great Dismal Swamp. Investigators reviewed 5 years of clinical records for 842 patients with allergic rhinitis and/or asthma, using peak flow measurements and wind direction as a proxy for smoke exposure, and found that deficits were consistently worse one year after the fires than during them.

For every 1 percent increase in time the wind blew from the fire toward the community, peak flow dropped by an average of 2.21 liters per minute, with the steepest declines seen in women, Black patients, and under strong wind conditions. These findings held up even after adjusting for age, sex, race, and BMI, suggesting the smoke exposure itself, not just demographic factors, was driving the delayed drop in lung function. The authors proposed that wildfire smoke may act as an adjuvant, heightening patients' allergic sensitivity or triggering a delayed immune response that doesn't surface until months later.

"We didn't see anything initially during the actual wildfire or immediately thereafter," said investigator Jim Blando, PhD, chair of the Department of Epidemiology, Biostatistics, and Environmental Health at Old Dominion University, in an interview with 

Blando compares the pattern to how the body responds to poison ivy: the first exposure may not trigger a reaction, but repeated exposure builds sensitization. He also points to climate change more broadly, noting longer growing seasons and earlier pollen production are compounding the problem alongside wildfire smoke.

At Massachusetts General Hospital, Wynne Armand, MD, has watched a related pattern unfold in dermatology records.

Eczema flare visits spiked sharply during recent wildfire seasons, tracking closely with air pollution severity. Armand explains patients with eczema already have a weakened skin barrier, making it easier for smoke particles to trigger a stronger immune response.

Both experts caution the underlying science is still developing. Armand said understanding wildfire smoke's specific contribution to allergic disease, not just symptom flares, “will be a very critical piece” of future research.

In the meantime, both recommend a mix of monitoring air quality, minimizing outdoor exposure during smoke events, wearing a properly fitted N95 respirator, and for skin protection, using mineral-based sunscreen and rinsing exposed skin after being outdoors.

“I personally feel pretty confident that as we look into it further, we are going to find a lot of evidence supporting that wildfire smoke is very allergenic,” Blando said.

Blando J, Allen M, Galadima H, Tolson T, Akpinar-Elci M, Szklo-Coxe M. Observations of Delayed Changes in Respiratory Function among Allergy Clinic Patients Exposed to Wildfire Smoke. Int J Environ Res Public Health. 2022 Jan 22;19(3):1241. 

doi: 10.3390/ijerph19031241. PMID: 35162264; PMCID: PMC8835059.

Armand W. One surprising effect of wildfires: Itchy, irritated skin. Harvard Health Publishing. June 24, 2024. Accessed September 9, 2026. 

Videos

Research suggests wildfire smoke does more than irritate the airways in the moment; it may worsen allergic disease for months afterward.