What is the Atopic March?

The Atopic March is the term given to the progression of allergic or atopic conditions from infancy into childhood. 
 
The ‘march’ usually starts with atopic dermatitis/eczema (AD in babies and sometimes progresses to food allergy, asthma, and allergic rhinitis (hay fever), 
 
Don’t panic! 
 
Just because there is an atopic march, it doesn’t mean that every infant or child who has AD will go on to develop any of the atopic conditions listed !  Only 60% of children with severe AD go on to experience other conditions within the Atopic March and for those with mild AD, the figure is only 20%. 

Figure taken from Tsuge et al., (2021) (1) highlighting the atopic march and some of the different factors thought to be involved.

The reasons behind the Atopic March as like those thought to be behind AD generally. A fragile skin barrier that lets possible food or environmental allergens in, triggering the activation of an immune response.  Once the initial reaction has been experienced, the body identifies the food or environmental particle as an ‘enemy’ and reactions will manifest either as continuing AD or via other reactions such as hay fever, food allergy or even asthma. (2)
 
 
Nutritional strategies for infants and children who may have a familial susceptibility to atopy: 

1. If you are able, breastfeed your child for at least the first six months as multiple studies have shown that this decreases the likelihood of both AD and Atopic March.
2. If you are unable to breastfeed and you have atopy in the family, discuss which formulas may be the most beneficial with your doctor, paediatrician, or health visitor
3. Consider giving your infant a specially adapted probiotic for the first two years of life.  Studies have shown that infant probiotics with Lactobacillus rhamnoses given for the first 24-months, reduced onset of AD by 50%. (3)
4. Don’t eliminate any foods without the specific guidance of a specialist.  
5. If you do suspect an allergy or intolerance, keep a food and symptom diary. Note the foods eaten and the symptoms that occur e.g. lunchtime cheddar sandwich, 8pm AD flare. This can be useful when relaying your concerns to a health or nutrition professional. You don’t have to drive yourself mad writing everything, another way to do it is to recall what had been eaten in the 24 hours previous when symptoms occur. 
6. Dust mites, animal fur, pollen and mould are common allergens. Do your best to keep the home and specifically the bedroom as dust/animal/mould free as possible. 

 
 
References
 
1.         Tsuge M, Ikeda M, Matsumoto N, Yorifuji T, Tsukahara H. Current insights into atopic march. Children. 2021;8(11):1–17. 
2.        Yang L, Fu J, Zhou Y. Research Progress in Atopic March. Front Immunol. 2020;11(August):1–11. 
3.        Davidson WF, Leung DYM, Beck LA, Cecilia M, Boguniewicz M, Busse WW, et al. J Allergy Clin Immunol. 2020;143(3):894–913.