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

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...

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Bibliographic Details
Published in:Journal of allergy and clinical immunology 2019-01, Vol.143 (1), p.46-55
Main Authors: Paller, Amy S., Spergel, Jonathan M., Mina-Osorio, Paola, Irvine, Alan D.
Format: Article
Language:English
Subjects:
Age
Allergens
Allergic rhinitis
Asthma
Atopic dermatitis
atopic march
Children
Children & youth
Comorbidity
Dermatitis
Ecological risk assessment
Eczema
endotypes
Environmental factors
epidermal barrier
Exposure
Filaggrin
Food allergies
food allergy
Immune response
Longitudinal studies
Lymphocytes T
Microbiomes
Multimorbidity
Rhinitis
Risk factors
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Summary: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.
ISSN:0091-6749
1097-6825
DOI:10.1016/j.jaci.2018.11.006