Atopic march is a phenomenon that refers to the progression of allergic diseases from eczema to food allergies to asthma and allergic rhinitis. The atopic march typically begins in infancy or childhood, and it is characterized by a sequence of allergic disorders that can persist into adulthood.

Atopic dermatitis, also known as eczema, is often the first manifestation of the atopic march. It is a chronic, inflammatory skin disorder that affects around 20% of children worldwide. Eczema is characterized by red, itchy, and scaly patches on the skin. It usually develops in the first few months of life and can persist into adulthood.

As children with eczema grow older, they may develop other allergic disorders such as food allergies, allergic rhinitis (hay fever), and asthma. These conditions are related to each other because they are all driven by an overactive immune system that produces an exaggerated response to allergens.

Food allergies are often the second manifestation of the atopic march. Children with eczema are at an increased risk of developing food allergies, particularly to eggs, milk, and peanuts. Food allergies can cause a range of symptoms, from mild skin rashes to life-threatening anaphylaxis.

Allergic rhinitis is the third manifestation of the atopic march. It is a common condition that affects up to 30% of the population worldwide. Allergic rhinitis is characterized by nasal congestion, sneezing, itching, and a runny nose. It is usually triggered by environmental allergens such as pollen, dust mites, and animal dander.

Asthma is the fourth and final manifestation of the atopic march. It is a chronic respiratory condition that affects around 300 million people worldwide. Asthma is characterized by inflammation of the airways, which causes them to narrow and restrict airflow. This can lead to symptoms such as wheezing, coughing, and shortness of breath.

The atopic march is thought to be driven by a combination of genetic and environmental factors. Children who have a family history of allergic diseases are more likely to develop eczema and other allergic disorders. Environmental factors such as exposure to allergens and pollution can also trigger the development of allergic diseases.

Prevention and treatment of the atopic march depends on identifying and managing the underlying allergic disorders. This may involve avoiding allergens, using topical or oral medications, and in severe cases, immunotherapy. Early intervention can help to prevent the progression of the atopic march and improve quality of life for affected individuals.

In conclusion, the atopic march is a sequence of allergic disorders that typically begins with eczema and progresses to food allergies, allergic rhinitis, and asthma. It is driven by an overactive immune system that produces an exaggerated response to allergens. Identifying and managing underlying allergic disorders is crucial to preventing the progression of the atopic march and improving outcomes for affected individuals.

Written by: Ruchi Gupta MD MPH, Board Certified Pediatrician & Allergy Expert