Atopic March: Collegium Internationale Allergologicum Update 2020

Abstract

In recent decades, the worldwide prevalence of allergic disease has increased considerably. The atopic march is a model aimed at explaining the apparent progression of allergic diseases from atopic dermatitis (AD) to allergic asthma (AA) and to allergic rhinitis (AR). It hypothesizes that allergic disease begins, typically in children, with the development of AD, then AA, and finally progresses to AR. This theory has been widely studied in cross-sectional and long-term longitudinal studies and it has been found that as prevalence of AD declines, prevalence of AA increases. A similar relationship is reported between AA and AR. The legitimacy of the atopic march model is, however, currently debated. Epidemiological evidence and criticism of longitudinal studies point to an overstatement of the atopic march’s prevalence and incorrect mechanisms, opening a discussion for alternative models to better explain the pathophysiological and epidemiological processes that promote this progression of allergic diseases. Albeit, risk factors for the development and progression of allergic disease, particularly AD, are critical in identifying disease progression. Investigating the role of age, severity, family history, phenotype, and genetic traits may give a better indication into the progression of allergic diseases. In addition, studies following patients from infancy into adulthood and a general increase in longitudinal studies would help broaden the knowledge of allergic disease progression and the atopic march.

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“…Psoriatic patients displayed a baseline airway inflammation, 30,31 that may lead to the epidemiologically proven increased risk of asthma, and chronic obstructive pulmonary disease (COPD) 32 . AD theory of “atopic march” gives the pathogenetic rationale to the increased asthma risk found in atopic patients 33 . Then, HS and PsO patients, there is an high prevalence of smokers and in both disease smoking increase the severity and flares 34,35 .…”

Unsupervised modeling and genome-wide association identify novel features of allergic march trajectories

“…We ascertained the presence or absence of allergic conditions of interest (AD, IgE-FA, asthma, and AR) by using a combination of International Classification of Diseases (ICD) diagnosis codes, allergen information, and medication prescriptions, as described previously. 4,5,17 Conditions were identified by using the following ICD codes: AD (691.nn and L20.nn), IgE-FA (V15.0 [1][2][3][4][5], 995. [6][7], 995.7, Z91.01[0-3], Z91.018, and T78.1XXA), asthma (493.n and J45.nn), and AR (477.nn and J30.n).…”

“…On the basis of population-level disease incidence patterns, the march begins with atopic dermatitis (AD) and progresses to IgE-mediated food allergy (IgE-FA), asthma, and allergic rhinitis (AR). [1][2][3] Our prior longitudinal studies of this progression in birth cohorts using observational data derived from electronic medical records have allowed measurement of the individual and cumulative risk that early march members impart for development of the latter. 4,5 However, population-level studies often ignore the fact that multiple distinct disease developmental trajectories exist within the allergic march.…”

“…A, 2log10(P) values for the association tests (2 tailed) are shown on the y-axis; chromosomes are ordered on the x-axis. One genetic locus surpassed the genomewide significance threshold (2log10(P) > 7 3. [indicated by the orange dotted line]).…”

Modern Outlooks on «Atopic March» Secondary Prevention Capabilities in Children with Atopic Dermatitis

“…Несмотря на это, именно концепцию «атопического марша» чаще всего рассматривают в клинической практике, поскольку она является наиболее наглядным путем развития аллергических заболеваний в результате бесконтрольного течения тяжелого АтД у детей. Вместе с тем следует отметить, что оценка распространенности случаев, развивающихся по классическому пути «атопического марша», может быть завышена [8].…”