Atopic march (allergic march) - the progression from atopic dermatitis to asthma - mediated by filaggrin defect?

PubMed databases from 1950 to the present were searched for relevant articles pertaining to epidemiologic and genetic evidence of the progression of the atopic march.

The data suggest that a sequence of atopic manifestations occurs, typically atopic dermatitis in infancy followed by allergic rhinitis and/or asthma in later stages. Reduced filaggrin expression is implicated as a major predisposing factor for atopy. Filaggrin mutations increase the risk for persistent dry skin and eczema independent of sensitization (JACI, 2012).

Longitudinal studies of individuals carrying loss-of-function filaggrin gene mutations are needed to define the risks associated with epidermal barrier dysfunction and identify targets for barrier repair and prevention of atopic dermatitis and other atopic disease.

Image source: Skin layers. Wikipedia, public domain.

The link between eczema/food allergy/allergic rhinitis/asthma ("allergic march") is under-appreciated. I discuss it, when relevant, with all patients and during lectures with students, residents and staff.

Allergic (atopic) march (click here to enlarge the image).

Skin-derived TSLP may trigger the progression from atopic dermatitis to asthma, thus explainig the infamous "atopic march" (Nature Immunology, 2012).


From atopic dermatitis to asthma: the atopic march. Spergel JM. Ann Allergy Asthma Immunol. 2010 Aug;105(2):99-106; quiz 107-9, 117.
Early food sensitization and presence of FLG mutation in infants with eczema increase the risk for later asthma. JACI, 2011.
Loss-of-function mutations in filaggrin gene are associated with atopic dermatitis, and now with peanut allergy too. JACI, 2011.
Gene defect can triple risk of peanut allergy - filaggrin has already been shown to be a factor in eczema and asthma. BBC, 2011.
Filaggrin gene mutations are associated with atopic asthma

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