Allergy/Atopic March and United Airway Disease: What We Know and What We Need to Know?

Abstract

Abstract “Allergy/atopic march” refers to a typical sequence in which the allergic or atopic features appear at a certain age, and may or may not persist thereafter. In general, atopic dermatitis or atopic eczema occurs first, which progresses to immunoglobulin-E-mediated food allergy, asthma, and then allergic rhinitis (AR). However, this sequence may not be conspicuous in many cases. AR is an independent risk factor for asthma; in fact, AR often precedes that of asthma. United airway disease (allergic rhino-bronchitis) means the coexistence of AR and asthma. This has been shown in clinical and experimental studies, which suggest a similar immune pathology between the upper and lower airways in allergic subjects. In children with asthma, coexistent AR leads to an increased risk of asthma exacerbation leading to hospitalization and/or emergency visits as well as increased health-care cost. Treatment of AR in asthmatic children results in a lowered risk of asthma-related hospitalizations and emergency visits, and improved quality of life. In this article, we have discussed the current evidence for the clinically relevant effects that allergic conditions (from food allergies to atopic march, united airways disease, and AR) can have on children with asthma along with the future of allergic diagnosis (precision allergy molecular diagnosis) and allergen immunotherapy.