Atopic march, also called allergic march, is the course of allergies as they appear from infancy and progress through childhood.
Studies have found that allergies tend to occur and progress in order, from the skin to the digestive system to the respiratory system. Specifically, they show up as atopic dermatitis (eczema) and food allergies in infancy. Then allergic asthma and allergic rhinitis (nasal allergies) in childhood.
This article explains the causes, risk factors, symptoms, diagnosis, and treatment of atopic march.
Allergic diseases are on the rise. Currently, allergies impact 20% of people worldwide.
Causes of Atopic March
Studies have suggested a link between eczema and later onset allergies. In addition, scientists believe that a dysfunction in the skin barrier can cause eczema and predispose children to develop food allergies and general immune hyper-reactivity.
Eczema affects 3% of adults and 30% of children. One study found that of kids with eczema, 50% of them developed a food allergy by age 1.
Eczema and other allergies are caused by a combination of environmental and genetic factors. However, scientists believe the increase in allergic asthma prevalence may also be linked to lifestyle factors and changes in environmental situations, such as dust mites and outdoor air pollution.
Research on atopic march suggests that infants with eczema are at increased risk of developing allergic asthma and nasal allergies. The younger a child is when they experience environmental allergies, the more likely they will also experience atopic march.
One study found that infants who had eczema by 2 years old had a significantly increased risk of allergic asthma and nasal allergies by age 6 or 7 years old.
Food allergies commonly coexist alongside eczema. In fact, having a food allergy is the most significant risk factor for atopic march.
The symptoms of atopic march are progressive, starting with the skin, moving to the digestive tract, and finally, the respiratory system. They include:
- Eczema: This allergic skin rash appears between birth and 1 year. Symptoms include fussiness, superimposed skin infections from scratching, and difficulty sleeping.
- Food allergies: These typically start to present when solids are introduced. It can be as young as 6 months. The most common food allergens include milk, eggs, wheat, peanuts, tree nuts, fish, soy, and shellfish.
- Allergic rhinitis: Nasal allergies typically appear between 4 to 6 years of age. Symptoms include sneezing, runny nose, congestion, itchy nose and eyes, cough, irritated throat, and itchy ears.
- Allergic asthma: This chronic lung condition can appear between 5 and 7 years of age. Symptoms of allergic asthma include wheezing, coughing, chest tightness, and breathlessness. Exposure to an allergen brings on symptoms of allergic asthma.
When to Call a Healthcare Provider
Your healthcare provider might diagnose an allergic march if they notice you or your child progressively develop allergies and allergic asthma. However, since the allergies occur separately, over time, you will likely receive multiple diagnoses over the years.
Diagnosing allergies involves taking a complete medical history and performing allergy tests. Doctors test for allergies in a couple of ways, including:
- Skin prick test: The skin test is the gold standard for allergy testing. This test involves placing allergens onto your skin to watch for a reaction.
- Blood test: These tests are less common because they are not as reliable as skin tests. However, they can be helpful for children or for those who take medications that interfere with skin testing. Blood tests measure antibodies to allergens present in your blood.
If you have symptoms of allergic asthma, your healthcare provider will likely also want to do allergy testing. That’s because when you have allergic asthma, it’s crucial to identify your triggers so you can avoid them. Asthma testing includes:
- Spirometry: A pulmonary function test used to diagnose lung disease.
- Peak airflow: A monitoring tool that measures how quickly your lungs expel air.
- FeNO test: FeNO stands for fractional exhaled nitric oxide. This test measures inflammation from a specific type of allergy cell, called an eosinophil, in your airway.
- Provocation tests: This test measures lung function after exposure to specific triggers to determine if there is evidence of asthma.
Treating atopic march involves treating each condition involved. Therefore, treatments often overlap and primarily include avoiding allergens and managing symptoms.
Treatments depend on the severity and may include:
- Eczema treatment: Avoiding triggers, washing in lukewarm water with fragrance-free soap, keeping skin moisturized, bleach baths, hydrocortisone cream, antihistamines, antibiotics, phototherapy
- Food allergy treatment: Food restrictions, antihistamines, epinephrine (injectable adrenaline used for severe allergic reactions)
- Allergic rhinitis treatment: Avoiding allergens, nasal sprays, antihistamines, decongestants
- Allergic asthma treatment: Avoiding triggers, quick-relief medications, controller medications, biologics (used to prevent airway swelling)
If you have atopic march, you may benefit from seeing a specialist. Healthcare providers who specialize in diagnosing and treating atopic march include:
Since genetic predisposition is involved in developing allergies and asthma, it is not always possible to prevent atopic march.
However, considering the connection between skin barrier dysfunction and the development of eczema and allergies, some studies have concluded that protecting the skin barrier early in life may help prevent eczema and food allergies.
Atopic march is the progression of allergies in infancy and childhood. It begins with eczema and then progresses to food allergies, nasal allergies, and allergic asthma. Researchers believe that a dysfunction in the skin barrier may be responsible for this process by causing hyper-reactivity in the immune system.
Healthcare providers diagnose the conditions of atopic march as they appear over time. Treatments involve avoiding triggers and managing the symptoms of each disorder.
A Word From Verywell
If you or your child have multiple allergies and asthma, you may wonder if you have atopic march. Any time you have allergy or asthma symptoms, it's essential to see your healthcare provider for a diagnosis. They will help you with a treatment plan, which may include medication for emergencies.
Additionally, since allergies and asthma can range from unpleasant to life-threatening, it's a good idea to get tested so that you know the triggers to avoid.