Atopic March Research Articles

The Impact of Prenatal Nutrition on the Development of Atopic Dermatitis in Infancy and Childhood.

Atopic dermatitis (AD) is an inflammatory skin condition characterized by skin barrier disruption and inflammation that has been associated with the development of food allergies, asthma, and allergic rhinitis, known as the atopic march. The prevalence of AD has been increasing globally, with a marked increase in developed countries. Although many studies have examined environmental factors contributing to the development of AD in infancy and childhood, less is understood about the influence of prenatal factors. Several studies have examined the role of maternal diet and nutrition on the development of AD in offspring; however, formal recommendations and robust trial data are lacking. Herein, we examine the existing literature surrounding maternal diet on the development of AD in infancy and childhood.

The Presence of Atopic March in Patients Diagnosed with Atopic Dermatitis

Objective: Atopic march is a model that explains the progression of allergic diseases from atopic dermatitis (AD) to allergic asthma and rhinitis. In our study, while evaluating the presence of allergen sensitivity and allergic diseases in patients who were diagnosed with AD and followed up until the age of at least 5 years, we wanted to investigate how much the definition of classical atopic gait responded to expectations. Material and Methods: We retrospectively reviewed the file records of patients diagnosed with atopic dermatitis, whose ages were 2 years and under at the time of application and followed up regularly until at least 5 years of age. We recorded the clinical and laboratory findings. We noted the allergic disease status and allergen sensitivity of the patients when they were 5 years old. Results: Forty-one patients with a diagnosis of AD who met the criteria were identified. During the application, we found food sensitivity in 28 (68.3%) patients. When 41 patients reached the age of 5, 13 (31.7%) were diagnosed with asthma and 12 (29.2%) were diagnosed with allergic rhinitis. Conclusion: We found the frequency of asthma and allergic rhinitis higher in patients with AD than in the normal population. However, we could not show a relationship between food sensitivity and the development of asthma and/or allergic rhinitis. Effective skin care in AD can be protective for developing of allergic diseases. In order for clinicians to understand the heterogeneity of atopic disease models in children and to eliminate this variability, infants with AD should be followed up in later life.

The risk of atopic comorbidities and atopic march progression among Black and White children with mild-to-moderate atopic dermatitis: A cross-sectional study

Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with the sequential propagation of atopic comorbidities, such as asthma and allergic rhinitis. This atopic march has been depicted as a homogenous progression of allergic diseases, but patient factors such as race may reveal heterogeneity in this process. The goal of our cross-sectional study was to evaluate differences in atopic illnesses and subsequent atopic march progression among a national cohort of Black and White children with physician-diagnosed mild-to-moderate AD.

Route of Sensitization to Peanut Influences Immune Cell Recruitment at Various Mucosal Sites in Mouse: An Integrative Analysis.

Symptom occurrence at the first ingestion suggests that food allergy may result from earlier sensitization via non-oral routes. We aimed to characterize the cellular populations recruited at various mucosal and immune sites after experimental sensitization though different routes. BALB/cJ mice were exposed to a major allergenic food (peanut) mixed with cholera toxin via the intra-gastric (i.g.), respiratory, cutaneous, or intra-peritoneal (i.p.) route. We assessed sensitization and elicitation of the allergic reaction and frequencies of T cells, innate lymphoid cells (ILC), and inflammatory and dendritic cells (DC) in broncho-alveolar lavages (BAL), lungs, skin, intestine, and various lymph nodes. All cellular data were analyzed through non-supervised and supervised uni/multivariate analysis. All exposure routes, except cutaneous, induced sensitization, but intestinal allergy was induced only in i.g.- and i.p.-exposed mice. Multivariate analysis of all cellular constituents did not discriminate i.g. from control mice. Conversely, respiratory-sensitized mice constituted a distinct cluster, characterized by high local inflammation and immune cells recruitment. Those mice also evidenced changes in ILC frequencies at distant site (intestine). Despite absence of sensitization, cutaneous-exposed mice evidenced comparable changes, albeit less intense. Our study highlights that the initial route of sensitization to a food allergen influences the nature of the immune responses at various mucosal sites. Interconnections of mucosal immune systems may participate in the complexity of clinical manifestations as well as in the atopic march.

Risk Factors for the Development of IgE-Mediated Food Allergy in Preschool Children with Asthma.

Food allergy is a component of the atopic march and may have effects on asthma. This study aimed to evaluate the risk factors for confirmed immunoglobulin E-mediated food allergies and their impact on the clinical picture in preschool children with asthma. Clinical history and allergic assessment results were obtained from medical records and analyzed retrospectively. Preschool children with asthma were included in the study and the characteristics of food allergy and asthma were evaluated. The patients were grouped as those with food allergy (Group I, n = 60) and those without (Group II, n = 98). In patients with food allergy and asthma, the number of episodes requiring systemic steroids in the last year (p = 0.002), atopic dermatitis (p = 0.001), parental atopic disease (p = 0.009) and aeroallergen sensitivity rates (p < 0.001) was higher than patients without food allergies. The use of medium or high doses of inhaled steroids to achieve asthma control was more frequent in patients with food allergies (p = 0.014). Parental history of atopic disease [p = 0.007, odds ratio (OR): 3.27, 95% confidence interval (CI) 1.37-7.77)], atopic dermatitis (p = 0.017, OR: 2.80, 95% CI: 1.19-6.57), starting complementary food after 6 months (p = 0.004, OR: 3.9, 95% CI: 1.5-10.0) and having aeroallergen sensitivity (p < 0.001, OR: 6.01, 95% CI: 2.21-16.29) were identified as significant risk factors for food allergy. Asthmatic preschool children with food allergies are more likely to have a parental atopic disease, atopic dermatitis, aeroallergen sensitivity and starting complementary food after 6 months. These patients experience more asthma attacks and need higher doses of steroids.

Culturing of Bacterial Isolates from Skin of Pediatric Atopic Dermatitis Subjects

Atopic dermatitis (AD), characterized by skin barrier dysfunction and inflammation, is associated with food allergy and asthma development. Underlying mechanisms for disease co-expression remain poorly understood. The skin microbiome’s role in modulating skin disorders, including AD, and systemic immunity is still under investigation. We hypothesize that metabolic output of skin-associated bacteria in AD contributes to barrier dysfunction and the atopic march.

Assessments of Histopathology In Skin of Patients With Allergic Asthma

The atopic march is the observed linear and time-dependent progress of allergic diseases as they develop during childhood, beginning with clinical manifestations of atopic dermatitis (AD) followed by allergic asthma (AA) then allergic rhinitis. However, it has been noted that some patients with AA have no clinical history of AD. We examined the skin of AA and AD patients to compare measures of histopathology at the cellular level.

Longitudinal Atopic Dermatitis Endotypes: An Atopic March Paradigm That Includes Black Children

Longitudinal Atopic Dermatitis Endotypes: An Atopic March Paradigm That Includes Black Children

Airway Hyperresponsiveness and Eosinophilic Airway Inflammation In Patients With Atopic Dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disorder, and described as the first clinical manifestation of the atopic march. AD typically presents in infancy, predating the development of allergic asthma (AA) and allergic rhinitis. Studies in adults with AD showed that 58–72% of patients had airway hyperresponsiveness (AHR) consistent with asthma, however there was no relationship between severity of AD and degree of airway hyperresponsiveness.

The CARD14 Variant Rs11652075 Interacts with Vitamin D3 to Confer Barrier Dysfunction and Atopic Dermatitis Risk

A disrupted skin barrier is a major risk factor for the development of atopic dermatitis (AD) and progression of the atopic march. We recently found that the CARD14 variant rs11652075 is associated with low epidermal expression of the barrier gene filaggrin (FLG) in children with AD, and that CARD14 regulates keratinocyte FLG expression in a rs11652075-dependent manner. Since CARD14 mediates signaling through multiple pathways, we hypothesized that differential signaling activity in keratinocytes harboring the variant allele confers risk to barrier dysfunction and AD.

The atopic march in southern China is picking up pace.

The atopic march in southern China is picking up pace.

Disease characteristics, comorbidities, treatment patterns and quality of life impact in children

Disease characteristics, comorbidities, treatment patterns and quality of life impact in children <12 years old with atopic dermatitis: Interim results from the PEDISTAD Real-World Registry

Allergens and atopic dermatitis

Childhood onset of atopic dermatitis (AD) is often associated with food allergy, asthma, and allergic rhinitis (AR), otherwise known as the atopic march. Skin barrier dysfunction has been found to be a key component of the atopic march.1 Nevertheless, most patients with AD do not have food allergies, asthma, or AR. This highlights the myriad of AD triggers as it is known that beyond the role of allergies, AD can be induced by many environmental factors including Staphylococcus aureus (S aureus), pollution, detergents, different irritants, scratching, and other noxious agents that inflict skin epithelial damage.

The effects of secondhand smoke on respiratory pathology, sensitization and development of allergic diseases in young children (literature review)

The prevalence of active smoking in Ukraine significantly exceeds the worldwide average, which is certainly a risk factor for children to be exposed to secondhand smoke. The article provides literature data and presents a modern view on the problem of secondhand tobacco smoke impact on the child population. In pediatric practice, the pathological impact of secondhand smoke on the child’s health is significant at the stage of its fetal development. Historical data convincingly prove the connection between the antenatal effect of secondhand smoke and the increased risk of perinatal losses and risks of pregnancy — miscarriage, stillbirth, and premature birth. As early as the 1960s and 1970s, scientific evidence was obtained for an association between the effects of tobacco smoke and the risk of sudden infant death syndrome. Children are most vulnerable to the negative effects of tobacco smoke at an early age because they have closer and longer contact with their parents, especially their mothers. Many studies have found an association between the effects of secondhand smoke and airway pathology (bronchitis, pneumonia), as well as an increase in the severity of respiratory syncytial viral infection (bronchiolitis). Numerous literature data indicate an association between the effect of passive smoking and the frequency and severity of oral cavity (dental caries) and middle ear (recurrent and chronic otitis, middle ear effusion) pathology. Many studies have shown the effects of secondhand smoke on the development and severity of bronchial asthma in children, but scientific data on the causal relationship of tobacco smoke with other allergic diseases (atopic dermatitis, allergic rhinitis, and food allergies), which are common in young children and preceded bronchial asthma in the "atopic march, are more limited and contradictory. The literature was searched using the PubMed database.

Atopic March: Dermatologic Perspectives.

The progression of allergic diseases with the development of atopic dermatitis and food allergy in infancy and subsequent asthma and allergic rhinitis in the later childhood is known as 'atopic march'. There have been many arguments in favour of and against this concept. This article reviews the latest epidemiology, immunological mechanisms and translational implications in clinical practice and research, which is relevant to the dermatologists. The role of skin as a site of initiation and the potential for interventions on skin that may prevent subsequent allergic diseases is also highlighted.

Syntropia of allergic diseases

The review article presents studies of foreign and domestic scientists devoted to the syntropy of allergic diseases - the formation of an “atopic march”. The authors analyzed the possibilities of predicting the development of allergic diseases and the need for further research to understand the processes of their progression.

Atopic Dermatitis With Coexisting Food Allergy in Early Life Is Associated With Childhood Asthma.

PurposeAtopic dermatitis (AD) and food allergy (FA) are associated with respiratory comorbidities, in the concept of ‘atopic march.’ However, children with AD and a coexisting FA have various disease courses, and the mechanism of atopic march remains unclear. In this study, we investigated whether the phenotype of AD with coexisting FA in early life affected asthma or allergic rhinitis (AR) in school children.MethodsA total of 1,579 children from the Panel Study on Korean Children (PSKC) cohort were followed-up in 2013. The participants diagnosed with AD in this cohort were classified by the age of AD onset and persistence as well as FA history. We compared the presence of comorbidities—asthma and rhinitis—among different AD phenotypes.ResultsAsthma and AR with current symptoms within 12 months at age 6–8 years were associated with early-onset persistent AD phenotype, regardless of coexisting FA. AD with FA conferred a higher risk of recent wheezing at 8 years of age than AD without FA (adjusted odds ratio, 8.09; 95% confidence interval, 2.54–25.76). Children with early-onset persistent AD with FA manifested a distinctive trajectory with a higher prevalence of wheezing and AR at age 5–8 years than those without AD.ConclusionsAD with FA in early life is strongly associated with asthma and AR in school children, and the early-onset persistent AD with FA had a strong additive effect on the risk of asthma at school age. Classifying AD phenotypes regarding FA in early life will help predict and prevent asthma and AR in school children.

Phenotypes of atopic dermatitis up to 36 months of age by latent class analysis and associated factors in Japan.

BackgroundAtopic dermatitis (AD) in early childhood is the first allergic manifestation in the atopic march. Recently, latent class analysis (LCA) has revealed the presence of AD subgroups in childhood.ObjectiveThis study aimed to elucidate different AD phenotypes up to 36 months of age and identify factors associated with a particular AD phenotype in early childhood.MethodsPediatric allergists or dermatologists examined children who visited local public health centers in Chiba or Yokohama city at 4, 18, and 36 months of age for regular health checkups between 2003 and 2005. LCA was used to identify AD subtypes on the basis of the course of skin symptoms and comorbidity of other allergic diseases. After LCA, the association between genetic and environmental factors and AD phenotypes was assessed.ResultsA total of 1,378 children who underwent the 3 checkups were included. Complete data were available for 515 children up to 36 months of age. Of 515 children, 183 were diagnosed with AD at least at one out of the 3 time points. The LCA model of these children with AD separated 4 AD phenotypes: early-persistent (EP), early-transient (ET), late-onset (LO), and variable (V). Antibiotic use by 4 months of age was significantly higher in EP group than in other 3 groups. Mother’s allergy was significantly higher in EP and LO groups than in other 2 groups. Passive smoking at 18 months of age was higher in LO group than in other groups. Furthermore, >80% of V group was born in spring–summer.ConclusionWe identified 4 AD phenotypes using LCA on the basis of the onset/course of AD and comorbidity of other allergic diseases and also identified several factors related to the particular phenotypes, which may be useful markers for the prediction of prognosis of AD in early childhood.

Preventive Antenatal Educational Program on Allergic Diseases (PAEPAD) versus standard antenatal care for prevention of atopic dermatitis: study protocol for a single-centre, investigator-blinded randomised controlled trial

IntroductionPatient education serves an essential purpose in the long-term management of allergic diseases as a secondary prevention approach. However, evidence on using education for primary prevention is limited. This study...

Факторы риска развития прогрессирующего течения атопического дерматита у детей и подростков

Study Objective: To determine the risk factors for the development of a progressive course of atopic dermatitis (AD) in children and adolescents. Study Design: Observational prospective cross-sectional study. Materials and Methods. The study enrolled 89 outpatients with AD aged 2 months — 17 years. The diagnosis was verified based on Hanifin and Rajkа criteria (1980); skin disorders were assessed via SCORAD followed by statistical analysis. Family history, breastfeeding duration and symptoms manifestation were assessed. Study Results. Based on our results, compared to children with erythemato-squamous plaques with lichenization AD (ESPL) and lichenoid AD (L), children with erythemato-squamous plaques of AD (ESP) predominated (ESP vs. ESPL vs. L: 44 (50%) vs. 28 (31%) vs. 17 (19%) respectively (p &lt; 0.05). Progressive AD was noticed in more than 50% (p &lt; 0.05). SCORAD index was maximal in lichenoid AD (p &lt; 0.05). Progressive AD is frequently accompanied with genetic predisposition on the mother’s side as well as early AD manifestation and shorter breastfeeding. Prolonged course of the disease influences the risks for lichenoid forms. Conclusion. Risks for progressive course of AD is higher in children with genetic predisposition on the mother’s side, duration of breastfeeding with regard to early AD manifestation. Basically, clinical symptoms of the atopic march were related to seasonal allergic rhinitis, less often with asthma. Кeywords: atopic dermatitis, severe cases, children, adolescents.