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Atopic dermatitis and the atopic march

Jonathan M Spergel1, Amy S Paller

  • 1Division of Allergy and Immunology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.

The Journal of Allergy and Clinical Immunology
|December 6, 2003
PubMed

Insights

Atopic dermatitis (AD) affects infants and children, negatively impacting quality of life and leading to other allergic conditions like asthma. Early intervention may help slow this progression, known as the atopic march.

Area of Science:

  • Pediatric Dermatology
  • Allergology
  • Immunology

Background:

  • Atopic dermatitis (AD) is a prevalent skin disorder in infants and children, with increasing incidence globally.
  • AD significantly impacts patient and family quality of life, causing sleep disturbances and financial burdens.
  • The condition often initiates the 'atopic march,' a progression to other allergic diseases.

Purpose of the Study:

  • To review the characteristics, impact, and progression of atopic dermatitis.
  • To explore the concept of the atopic march and its underlying mechanisms.
  • To discuss potential early intervention strategies for atopic dermatitis.

Main Methods:

  • Review of longitudinal studies on atopic dermatitis progression.
  • Analysis of epidemiological data on atopic dermatitis prevalence.
  • Examination of immunological theories regarding epicutaneous sensitization and T cell migration.

Main Results:

  • Approximately 50% of AD patients develop asthma, and 66% develop allergic rhinitis, especially with severe AD.
  • Epicutaneous sensitization is hypothesized to drive the atopic march via T cell migration to airways.
  • Preliminary studies suggest oral antihistamines may slow the atopic march.

Conclusions:

  • Atopic dermatitis is a critical early manifestation of allergic disease with significant long-term implications.
  • Understanding the atopic march is crucial for developing effective prevention and treatment strategies.
  • Early intervention, potentially with oral antihistamines, shows promise in mitigating the progression of atopic diseases.

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