What other atopic conditions can children with chronic atopic dermatitis and severe dust mite allergy develop?

Children with Atopic Dermatitis and Dust Mite Allergy Are at High Risk for Developing Other Atopic Conditions

Children with chronic atopic dermatitis and severe dust mite allergy are at significant risk of developing asthma and allergic rhinitis as part of the atopic march. 1

The Atopic March and Associated Conditions

• Children with atopic dermatitis (AD) in early childhood are often accompanied by the development of other allergic diseases such as asthma and allergic rhinitis in what is known as the "atopic march" 1, 2
• Over half of patients with asthma have allergic rhinitis, and 10% to 40% of patients with allergic rhinitis have asthma 1
• In children with early childhood eczema, 57.6% develop allergic rhinitis and 34.1% become asthmatic, with the likelihood related to the severity of the dermatitis 1
• The risk of asthma is particularly high when there is a family history of eczema 3

Specific Risk Factors for Developing Additional Atopic Conditions

• Early onset of eczema is associated with an increased risk of sensitization to inhalant allergens 3
• Severe eczema at initial presentation is associated with increased tendency to produce food-specific IgE 3
• Early allergic reactions to food are associated with later reactions to food, allergic rhinitis, urticaria, and sensitization to both food and inhalant allergens 3
• Dust mite allergy can trigger atopic dermatitis, and children with this combination are particularly susceptible to developing respiratory allergies 1, 4

Timing and Progression of Atopic Conditions

• Food allergies typically manifest first in infancy, causing primarily gastrointestinal symptoms and atopic dermatitis 1
• Perennial allergic rhinitis (e.g., dust mite and animal dander) may be present at a very early age 1
• Seasonal allergic rhinitis typically develops when the child is 2 to 7 years of age, as two seasons of exposure are generally required for sensitization 1
• The childhood risk of asthma is related to the severity and duration of the patient's rhinitis 1

Immunological Mechanisms

• Atopic conditions share common pathogenesis, being mediated by IgE, and frequently present together in the same individual 5
• In acute AD, significant activation of T helper 2 (Th2) cells occurs with increased expression of interleukins IL-4, IL-5, IL-13, and IL-31 1, 6
• Skin barrier dysfunction from filaggrin mutations predisposes patients to AD and facilitates allergen penetration, particularly house dust mites 2, 4
• The dust mite allergen Der p 1 has proteolytic activity that further compromises skin barrier function, creating a cycle that promotes sensitization 4

Clinical Implications and Management

• Assessment for associated conditions should be part of routine care for children with AD and dust mite allergy 1
• Evaluation for asthma should include inquiry about difficulty breathing, cough, wheezing, exercise capacity, and chest examination 1
• Treatment of allergic rhinitis in patients with concurrent asthma should include consideration of intranasal corticosteroids, which can reduce bronchial hyperreactivity 1
• Allergen-specific immunotherapy for allergic rhinitis in children with AD may prevent the development of asthma and sensitivity to new allergens 1

Monitoring and Prevention

• Children with AD should be regularly assessed for symptoms of allergic rhinitis and asthma, particularly as they age 1, 3
• Early identification and management of AD may help prevent the progression to other atopic conditions 2
• Environmental control measures for relevant allergens, particularly dust mites, should be implemented 1, 4
• Maintaining skin barrier function through proper moisturization and inflammation control is essential for preventing progression of the atopic march 7