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Establishing the sequential progression of multiple allergic diagnoses in a UK birth cohort using the General
1Schering-Plough Ltd, Welwyn Garden City, UK.
Insights
The most common allergic march in children is eczema, followed by asthma, then rhinitis. Some allergic diagnoses may surprisingly protect against developing further allergic conditions.
Area of Science:
- Pediatric Allergy and Immunology
- Epidemiology
- Public Health
Background:
- The sequential development of allergic diseases, known as the allergic march, is of significant international research interest.
- Understanding these progressions is crucial for early intervention and management strategies.
Purpose of the Study:
- To investigate the sequential progression of multiple allergic conditions in a UK national birth cohort throughout childhood.
- To estimate the risks associated with developing subsequent allergic diagnoses.
Main Methods:
- A birth cohort of 43,477 children born in 1990 was established using the UK General Practice Research Database.
- 24,112 children with complete follow-up to age 18 were analyzed for disease trajectories and risk estimation.
Main Results:
- Over half (52.1%) of children developed at least one allergic condition.
- Eczema was the most frequent initial diagnosis (60.7%).
- Specific sequences were identified, such as eczema followed by asthma (RR 1.59) and asthma followed by rhinitis (RR 0.54).
Conclusions:
- Multiple variants of the allergic march exist, with eczema-asthma-rhinitis being the most prevalent.
- Certain allergic disease sequences may offer a protective effect against the development of further allergic conditions.
Background:
There is considerable international interest in understanding the sequential progression of multiple allergic conditions (also sometimes known as 'the allergic march').
Objectives:
To study the sequential progression of multiple allergic conditions in a national birth cohort throughout childhood.
Methods:
We constructed a birth cohort of 43,477 children born in 1990 and registered in UK general practices within a year of birth, using the national General Practice Research Database. Of these, 24,112 with complete follow-up until the age of 18 years were studied in order to understand disease progression and to estimate the absolute and relative risks of developing second and third allergic diagnoses following an index allergic condition.
Results:
52.1% of children were diagnosed with at least one condition at some point in childhood. We were able to describe 15 different disease trajectories. Eczema was the most likely index condition with 60.7% [95% confidence interval (CI): 59.8-61.6] of allergy sufferers being diagnosed with this condition first. For those with a diagnosis of eczema, the relative risks of being diagnosed with asthma followed by rhinitis and rhinitis followed by asthma were 1.59 (95% CI: 1.32-1.91; P<0.0001) and 0.54 (95% CI: 0.43-0.68; P<0.0001), respectively. For those diagnosed with asthma first, the relative risks of being diagnosed with eczema followed by rhinitis and rhinitis followed by eczema were 1.27 (95% CI: 0.96-1.68; P=0.095) and 0.27 (95% CI: 0.20-0.36; P<0.0001), respectively. For those diagnosed with rhinitis first, the relative risks of being diagnosed with eczema followed by asthma and asthma followed by eczema were 0.64 (95% CI: 0.42-0.95; P=0.025) and 0.47 (95% CI: 0.32-0.67; P<0.0001), respectively.
Conclusions:
Among children diagnosed with multiple allergic diseases there is likely to be a number of variants of 'the allergic march'. Of these, the diagnosis of eczema followed by asthma, which is in turn followed by rhinitis, is the most common trajectory. Surprisingly, some diagnoses indicate a possible strong protective effect of manifesting further likely allergic diagnoses.
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