Interventions for Atopic Dermatitis to Prevent Allergy March

Abstract

“ Allergic March “ refers to the progression of allergic conditions which often begins with atopic dermatitis (AD) in early infancy followed by food allergy, allergic rhinitis and asthma in later childhood. The epidemiological links of AD and other allergic diseases support the concept of “Allergic March”. Genetic defects and environmental factors contribute to skin barrier dysfunction in infants who are at higher risk of development of AD. Proposed biological mechanisms of allergy march involve early antigen penetration through the disrupted epidermal barrier in AD leading to subsequent immune changes and development of other allergic diseases. Intervention strategies targeting to the skin to prevent the allergic march are reviewed. Primary prevention with early use of emollients starting in the neonatal period has been shown to reduce the incidence of AD in high risk infants by half. Further studies are needed to explore the long term outcomes of this approach on food and respiratory allergies. Evidences for secondary prevention through control of skin inflammation in AD infants are limited. Proactive use of topical anti-inflammatory agent for maintenance is the current recommended approach in management of chronic AD. However, whether aggressive proactive treatment in infants with early signs of AD may prevent subsequent allergic outcomes is still uncertain.