Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May;149(5):1702-1710.e4.
doi: 10.1016/j.jaci.2021.09.036. Epub 2021 Oct 18.

Longitudinal atopic dermatitis endotypes: An atopic march paradigm that includes Black children

Jocelyn M Biagini  1 , John W Kroner  2 , Asel Baatyrbek Kyzy  2 , Alexandra Gonzales  2 , Hua He  3 , Mariana Stevens  2 , Brittany Grashel  2 , Daniel Spagna  2 , Samuel Paul  2 , Rahul Patel  2 , Angelo Bucci  2 , Michael G Sherenian  1 , Liza Bronner Murrison  1 , Lisa J Martin  4 , Gurjit K Khurana Hershey  5
Affiliations

Longitudinal atopic dermatitis endotypes: An atopic march paradigm that includes Black children

Jocelyn M Biagini et al. J Allergy Clin Immunol. 2022 May.

Abstract

Background: The atopic march has been studied mostly in White populations, biasing our current paradigms.

Objective: We sought to define the atopic march in Black and White children and explore mechanisms for racial differences.

Methods: Utilizing the Mechanisms of Progression of Atopic Dermatitis to Asthma in Children (MPAACH) cohort (n = 601), we assessed longitudinal sensitization, food allergy (FA), allergic rhinitis, risk of asthma development (through the Pediatric Asthma Risk Score), Scoring for Atopic Dermatitis (SCORAD), transepidermal water loss, skin filaggrin (FLG) expression, exposures, and genetic heritability to define AD progression endotypes in Black and White children.

Results: White MPAACH children were more likely to be sensitized to aero and food allergens (P = .0001) and over 3 times more likely to develop FA and/or allergic rhinitis (AR) without asthma risk (P < .0001). In contrast, Black children were over 6 times more likely to proceed to high asthma risk without FA, sensitization, or AR (P < .0001). White children had higher lesional and nonlesional transepidermal water loss (both P < .001) as well as decreased nonlesional keratinocyte FLG expression (P = .02). Black children had increased genetic heritability for asthma risk and higher rates of exposures to secondhand smoke and traffic-related air pollution.

Conclusions: Black and White children with AD have distinct allergic trajectories defined by different longitudinal endotypes. Black children exhibit higher asthma risk despite a more intact skin barrier and less sensitization, FA, and AR. White children have less asthma risk, despite a more dysfunctional skin barrier, and more FA, AR, and sensitization. The observed racial differences are likely due in part to increased genetic heritability for asthma risk and harmful environmental exposures in Black children. Collectively, our findings provide a new paradigm for an atopic march that is inclusive of Black children.

Keywords: Atopic march; atopic dermatitis; biomarker; environmental exposure; genetic ancestry; race; skin barrier.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Progressor Phenotypes of Black and White MPAACH Children. A. Progressor phenotype across V1 and V2 by race (n=456). B. Children with at least one co-morbidity across V1 and V2 (n=325). *children that did not have a co-morbidity at V1 and did not yet complete V2 were not included in the non-progressor phenotype (n=145).
Figure 2.
Figure 2.
Sensitization patterns Food Allergy and Allergic Rhinitis in Black and White MPAACH children at visit 1.
Figure 3.
Figure 3.
A) maximum respiratory symptom frequency score and B) Pediatric Asthma Risk Scores (PARS) in Black and White MPAACH children at visit 1.
Figure 4.
Figure 4.
Skin FLG expression and TEWL in non-lesional and lesional skin in Black and White MPAACH children at visit 1.
Figure 5.
Figure 5.
Parental AD, asthma and environmental allergies/hay fever in Black and White MPAACH children.
See this image and copyright information in PMC

Comment in

References

    1. Davidson WF, Leung DYM, Beck LA, Berin CM, Boguniewicz M, Busse WW, et al. Report from the National Institute of Allergy and Infectious Diseases workshop on “Atopic dermatitis and the atopic march: Mechanisms and interventions”. J Allergy Clin Immunol 2019; 143:894–913. - PMC - PubMed
    1. Biagini Myers JM, Sherenian MG, Baatyrbek Kyzy A, Alarcon R, An A, Flege Z, et al. Events in Normal Skin Promote Early-Life Atopic Dermatitis-The MPAACH Cohort. J Allergy Clin Immunol Pract 2020; 8:2285–93 e6. - PMC - PubMed
    1. Sitarik A, Havstad S, Kim H, Zoratti EM, Ownby D, Johnson CC, et al. Racial disparities in allergic outcomes persist to age 10 years in black and white children. Ann Allergy Asthma Immunol 2020; 124:342–9. - PMC - PubMed
    1. Illi S, von Mutius E, Lau S, Nickel R, Gruber C, Niggemann B, et al. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. J Allergy Clin Immunol 2004; 113:925–31. - PubMed
    1. Ziyab AH, Hankinson J, Ewart S, Schauberger E, Kopec-Harding K, Zhang H, et al. Epistasis between FLG and IL4R Genes on the Risk of Allergic Sensitization: Results from Two Population-Based Birth Cohort Studies. Sci Rep 2018; 8:3221. - PMC - PubMed

Publication types