Determinants of the Atopic March in Children with Early-Onset Atopic Dermatitis

Children with early-onset atopic dermatitis (AD) are at an increased risk of developing asthma, allergic rhinitis, and food allergy, according to results of a study published in the Journal of the American Academy of Dermatology.1 The risk was particularly higher among male patients, those with severe disease or a family history of atopic conditions.

The objective of the study was to identify risk factors for the atopic march in infants with early-onset atopic dermatitis (AD) and to evaluate the temporal relationship between AD and ensuing atopic conditions. Data for the study was obtained from the MarketScan Research Database (2010–2018). A total of 27,228 infants diagnosed with AD before 1 year of age were compared to 55,174 matched controls without early-onset AD. The subsequent development of asthma, allergic rhinitis, and food allergy were the primary study outcomes.

Retrospective analysis of data showed that asthma occurred in 19.21% of infants with early-onset AD compared to 8.65% of controls. They also had a higher incidence of allergic rhinitis (28.27% vs 12.62%) and food allergy (16.00% vs 2.27%) compared to controls. Children with AD were more likely to have all the three conditions of the atopic triad (10.6%) compared to 0.71% among the controls.

Within the AD group, the chances of developing the atopic triad was greater among males with hazard ratio (HR) of 1.66, those with severe disease (HR 3.16), and those with a family history of atopy (HR > 3.40). Twenty percent of AD patients developed allergic rhinitis during follow-up.

These findings add to the evidence for the notion of atopic march. The increased risk of all the three atopic conditions in children with AD highlights the need for targeted risk assessment and screening in these patients.

Source:    Una E Choi, et al. Risk factors and temporal associations of progression of the atopic march in children with early-onset atopic dermatitis. J Am Acad Dermatol. 2025 Apr;92(4):732-740. doi: 10.1016/j.jaad.2024.10.107.