Infants with atopic dermatitis, high-risk factors more likely to experience atopic march
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Key takeaways:
- Infants diagnosed with atopic dermatitis are more likely to develop asthma, allergic rhinitis and food allergies.
- Second atopic diagnosis was found to occur within 1 to 2 years of initial diagnosis.
Severe disease, male sex, family history and prenatal factors were significantly associated with an increased risk for atopic march progression in infants with atopic dermatitis, according to a study.
“AD is often diagnosed prior to development of asthma, allergic rhinitis and food allergy, forming a classic atopic march,” Una E. Choi, MD, of the department of dermatology at the University of Maryland School of Medicine, and colleagues wrote. “While the atopic march has been presented as a sequential progression of allergic conditions, the temporal relationship between early-onset AD and subsequent development of the atopic march is not fully understood.”
The large, retrospective cohort study used the MarketScan Research Database from 2010 to 2018 and included 27,228 patients with AD (60.3% boys) diagnosed before age 1 year and 55,174 controls (51% boys) with no AD diagnosis before age 1 year.
Results showed that higher proportions of patients with AD compared with controls developed asthma (19.21% vs 8.65%), allergic rhinitis (28.27% vs 12.62%), food allergy (16% vs 2.27%) and all three conditions at once, which is known as the atopic triad (10.69% vs 0.71%; P < 0.001 for all).
Among infants diagnosed with AD, 20.1% developed allergic rhinitis as the second atopy diagnosis after a mean of 497.7 ± 7.9 days following their AD diagnosis. Similarly, 12.4% developed asthma after a mean of 408.4 ± 6.6 days and 11.9% developed a food allergy after a mean of 269.3 ± 6.4 days.
Factors that contributed to a higher likelihood of infants with AD developing the atopic triad included being male (HR = 1.66; 95% CI, 1.45-1.9), having severe disease (HR = 3.16; 95% CI, 2.77-3.6) and having a family history of atopy (HR > 3.4; P < .001).
Delivery via cesarean section as well the mother’s antibiotic usage during pregnancy were also significant factors in atopic march progression among infants with early-onset AD.
The authors called the study’s use of health care claims data a limitation.
“Early-onset AD is associated with higher rates of developing atopic march conditions compared to controls,” Choi and colleagues wrote. “Particular attention should be paid towards risk factors and atopic march screening in early-onset AD patients.”
Perspective
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The findings of this study strengthen our understanding of the association between AD and other atopic diseases. By identifying risk factors for the development of other atopic diseases, and by better characterizing the timeline along which they occur, it will help dermatologists with screening of infants who develop AD, particularly severe AD, and counseling of their parents. An important long-term next step to build off of this research will be to evaluate the extent to which the risk is modifiable and to work to identify the best approaches to reduce development of other atopic diseases.
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