The atopic march and atopic multimorbidity: Many trajectories, many pathways

Amy S. Paller*, Jonathan M. Spergel, Paola Mina-Osorio, Alan D. Irvine

*Corresponding author for this work

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

The atopic march recognizes the increased occurrence of asthma, allergic rhinitis, or both after atopic dermatitis (AD) onset. Mechanisms for developing atopic comorbidities after AD onset are poorly understood but can involve the impaired cutaneous barrier, which facilitates cutaneous sensitization. The association can also be driven or amplified in susceptible subjects by a systemic TH2-dominant immune response to cutaneous inflammation. However, these associations might merely involve shared genetic loci and environmental triggers, including microbiome dysregulation, with the temporal sequence reflecting tissue-specific peak time of occurrence of each disease, suggesting more of a clustering of disorders than a march. Prospective longitudinal cohort studies provide an opportunity to explore the relationships between postdermatitis development of atopic disorders and potential predictive phenotypic, genotypic, and environmental factors. Recent investigations implicate disease severity and persistence, age of onset, parental atopic history, filaggrin (FLG) mutations, polysensitization, and the nonrural environment among risk factors for development of multiple atopic comorbidities in young children with AD. Early intervention studies to repair the epidermal barrier or alter exposure to the microbiome or allergens might elucidate the relative roles of barrier defects, genetic locus alterations, and environmental exposures in the risk and sequence of occurrence of TH2 activation disorders.

Original languageEnglish (US)
Pages (from-to)46-55
Number of pages10
JournalJournal of Allergy and Clinical Immunology
Volume143
Issue number1
DOIs
StatePublished - Jan 2019

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Keywords

  • Atopic dermatitis
  • allergic rhinitis
  • asthma
  • atopic march
  • endotypes
  • epidermal barrier
  • food allergy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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