The atopic march: what's the evidence?

Objective: To review and compile data from published studies that provide support for the existence of the atopic march. Data Sources: Relevant articles and references found via a PubMed search using the following keywords: atopic march, allergic march, atopic dermatitis, eczema, atopic eczema, atopy, rhinitis, wheeze, bronchiolitis, and asthma. Study Selection: All articles were reviewed and the most relevant were selected for inclusion in this review and for the compilation and graphical presentation of disease trends. Results: Data on the prevalence of each phenotype of the atopic march confirm the temporal pattern of progression from eczema to allergic rhinitis and asthma. However, the atopic march as it is currently defined, is lacking precision, which affects its usefulness. Early events in the atopic march, such as eczema, may be more useful with more careful refinement of the phenotype into atopic and nonatopic eczema. Conclusion: Evidence supports that the atopic march is a useful paradigm to describe the clinically observed progression of atopy in certain children. There may be more precise phenotypes of the early stages of the atopic march that may improve its utility in predicting the development of later atopic, comorbid chronic disease. Ann Allergy Asthma Immunol. 2009; 103:282-289.