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The Multiple Trajectories of the Allergic March
L de Las Vecillas1,2, S Quirce1,2,3
1Department of Allergy, La Paz University Hospital, Madrid, Spain.
Insights
The allergic march, a common progression of allergy symptoms, is not linear. Understanding individual allergic disease trajectories is key to preventing multimorbidity.
Area of Science:
- Immunology
- Genetics
- Environmental Health
Background:
- The allergic march describes sequential allergic diseases, but its progression is highly variable.
- While nearly half of children have allergy symptoms, only 4-6% develop multiple allergic diseases.
- Allergic diseases share risk factors but often arise independently, defying a single linear path.
Purpose of the Study:
- To review the current understanding of the allergic march.
- To explore clinical observations, omics data, and risk factors influencing allergic disease progression.
- To discuss interventions for preventing allergic multimorbidity.
Main Methods:
- This narrative review synthesizes existing literature.
- It examines clinical data, omics findings, and etiological mechanisms.
- The review considers genetic and exposomic interactions in allergic disease development.
Main Results:
- Allergic march trajectories are heterogeneous, not following a single linear progression.
- TH2-mediated inflammation, barrier dysfunction, and genetics are key etiological factors.
- The exposome significantly interacts with these factors, influencing disease onset and progression.
Conclusions:
- Studying allergic diseases from an omics perspective is crucial for understanding diverse progression pathways.
- Identifying distinct trajectories can lead to targeted interventions for preventing allergic multimorbidity.
- Preventive strategies should consider individual genetic and environmental exposures.
Abstract:
The allergic march comprises the sequential appearance of a series of allergic comorbidities. However, variability in the onset and progression of allergic diseases generates a heterogeneous scenario that does not follow a linear and single trajectory. Almost half of the pediatric population presents at least 1 allergy symptom. However, only 4%-6% present multimorbidity, with several allergic diseases co-occurring. It has recently been shown that although they share etiological mechanisms and risk factors, allergic diseases arise independently. In most cases, progression is not consecutive, or at least not the same in all patients. TH2-mediated inflammation, epithelial barrier dysfunction, and genetic predisposition play a fundamental role in the etiology of allergic diseases, on which the interaction with the exposome acts decisively. Therefore, studying diseases from an omics point of view is essential when attempting to describe the various trajectories of allergic progression and to propose effective interventions to prevent multimorbidity. In this narrative review, we provide an overview of the current perception of the allergic march, including clinical observations, omics data, risk factors, and measures aimed at modifying its course or even preventing its onset.
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