It’s pretty clear that children with atopic dermatitis — especially moderate-to-severe disease — are at risk for what researchers call the atopic march, according to Jonathan Spergel, M.D., chief of the Allergy Program at Children’s Hospital of Philadelphia and a speaker for the National Eczema Association.
“Whether we call it a march of progression or association is a nuance, but it’s a fact that many children with atopic dermatitis early in life, as they get older will develop other atopic diseases, such as asthma, allergic rhinitis and food allergies,” Dr. Spergel says. “It’s not that everyone goes on to develop asthma or allergic rhinitis, but there’s definitely an increased risk. And the risk goes up by the severity of the atopic dermatitis.”
About half of patients with moderate-to-severe atopic dermatitis will develop asthma and about three-quarters will develop allergic rhinitis, according to Dr. Spergel.
The classic atopic march starts with atopic dermatitis and is followed by the potential for food allergy, then asthma, then allergic rhinitis. But the succession, if it happens at all, can vary, he says.
WHY THE MARCH HAPPENS
The evidence in human and animal studies suggests inflamed skin leads to increased sensitization, according to Dr. Spergel.
1. Davidson WF, Leung DYM, Beck LA, et al. Report from the National Institute of Allergy and Infectious Diseases workshop on "Atopic dermatitis and the atopic march: Mechanisms and interventions". J Allergy Clin Immunol. 2019;143(3):894-913.
2. Kraft MT, Prince BT. Atopic Dermatitis Is a Barrier Issue, Not an Allergy Issue. Immunol Allergy Clin North Am. 2019;39(4):507-519.