Does a 'reverse' atopic march exist?

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G Barberio1, G B Pajno, D Vita

  • 1Department of Pediatrics, Allergy Unit, University of Messina, Italy.

Allergy
|November 27, 2008
PubMed

Insights

The atopic march, a common allergy progression, may not always start with atopic dermatitis. This study found children with asthma alone can develop atopic dermatitis later, challenging the traditional pathway.

Area of Science:

  • Allergy and Immunology
  • Pediatric Respiratory Medicine
  • Dermatology

Background:

  • The classical atopic march describes a progression from atopic dermatitis to asthma.
  • This established pathway has been increasingly questioned in recent research.

Purpose of the Study:

  • To investigate the onset of atopic dermatitis in children who initially presented with asthma alone.
  • To evaluate the characteristics of children developing atopic dermatitis after a baseline diagnosis of asthma.

Main Methods:

  • A prospective observational study followed 745 children (6-9 years) with asthma but no prior atopic dermatitis or food allergy.
  • Children were monitored for 9 years, with 692 completing the observation period.
  • Retrospective analysis compared demographic, familial, and sensitization profiles of children who developed atopic dermatitis versus those who did not.

Main Results:

  • 20% of children initially diagnosed with asthma alone developed atopic dermatitis over the 9-year follow-up.
  • No significant baseline differences in demographics or family history were found between groups.
  • Children who developed atopic dermatitis showed a higher proportion of single sensitization to mites and lower polysensitization compared to controls.

Conclusions:

  • The development of atopic dermatitis can occur in children with asthma as the initial allergic manifestation.
  • These findings challenge the rigid, classical paradigm of the atopic march.
  • Allergic disease progression may be more variable than previously understood.

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