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Impact of food allergy on the atopic march from atopic dermatitis

Published online May 7, 2025

The atopic march (AM) suggests that having one allergic disorder, especially in infants and toddlers, raises the likelihood of developing another atopic disorder in childhood. However, the validity of the AM has recently been questioned. The relationship between food allergy (FA) in children with atopic dermatitis (AD) aged birth to 36 months and the prevalence of other atopic disorders at ages 5−11 years needs further study.

A recent article in The Journal of Allergy and Clinical Immunology: In Practice by Zeiger et al. identified 10,688 children with early onset AD (2 separate AD visits and 2 separate AD dispensed medications) from birth to 36 months using electronic health record data. Atopic disorders were determined based on ICD-9/10 coded visits. Moderate-severe asthma was defined as GINA-step care level of ≥3 for ≥4 years from ages 5−11 years. Unadjusted and adjusted risk ratios (aRR) for moderate-severe asthma, allergic rhinitis (AR) plus aeroallergen sensitization, and anaphylaxis in children at aged 5−11 years with FA (FA+) and without FA (FA−) by age 36 months were determined by using multivariable regression analysis.  

Multivariable regression analysis revealed significantly increased aRR with 42% higher risk of moderate-severe asthma (aRR 1.42, 99% CI 1.14-1.76), 34% higher risk for AR (aRR 1.34, 99% CI 1.19-1.51), and 69% higher risk for anaphylaxis (aRR 1.69, 99% CI 1.33-2.15) in FA+ vs. FA− children (all P<.001) at ages 5-11 years. The study provides compelling evidence that early-onset FA by age 36 months in children with early-onset AD increases the future risk of moderate-severe asthma, AR, and anaphylaxis. The findings underscore the potential of using administrative data for studying the AM and developing predictive models to identify high-risk children for targeted mitigation strategies.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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