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. 2025 Apr;92(4):732-740.
doi: 10.1016/j.jaad.2024.10.107. Epub 2024 Nov 28.

Risk factors and temporal associations of progression of the atopic march in children with early-onset atopic dermatitis

Una E Choi  1 , Junwen Deng  1 , Varsha Parthasarathy  1 , Viviane Liao  1 , Anjali D'Amiano  1 , Matthew Taylor  1 , Zachary A Bordeaux  1 , Anusha Kambala  1 , Hannah L Cornman  1 , Joseph K Canner  2 , Aaron M Drucker  3 , Shawn G Kwatra  4
Affiliations

Risk factors and temporal associations of progression of the atopic march in children with early-onset atopic dermatitis

Una E Choi et al. J Am Acad Dermatol. 2025 Apr.

Abstract

Background: Risk factors and the temporal relationship between atopic dermatitis (AD) and atopic march remain understudied.

Objective: Determine risk factors for atopic march in early-onset AD patients and the temporality between AD and atopic march.

Methods: We used the MarketScan Research Database for our retrospective cohort analysis from 2010 to 2018, comparing infants diagnosed with AD before age 1 with controls without early-onset AD. Primary outcomes were hazard ratios (HRs) for the development of asthma, allergic rhinitis, and food allergy.

Results: Compared to 55,174 controls, higher proportions of the 27,228 AD patients developed asthma (19.21% vs 8.65%, P < .001), allergic rhinitis (28.27% vs 12.62%, P < .001), food allergy (16.00% vs 2.27%, P < .001), and all atopic triad conditions (10.69% vs 0.71%, P < .001). Among AD patients, higher proportions developed the atopic triad if they were male (HR 1.66, 95% confidence interval [1.45-1.90]), had severe disease (HR 3.16, [2.77-3.60]), or had family atopy history (HR > 3.40, P < .001 for all comparisons). Among AD patients, 20.1% developed allergic rhinitis.

Limitations: Our study was based on health care claims data.

Conclusion: Early-onset AD is associated with higher rates of developing atopic march conditions compared to controls. Particular attention should be paid toward risk factors and atopic march screening in early-onset AD patients.

Keywords: allergic; atopic dermatitis; atopic march; eczema; pediatric.

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Conflict of interest statement

Conflicts of interest Dr Drucker has received compensation from the British Journal of Dermatology (reviewer and Section Editor), American Academy of Dermatology (guidelines writer), and National Eczema Association (grant reviewer). Dr Kwatra is an advisory board member/consultant for Abbvie, Amgen, Arcutis Biotherapeutics, Aslan Pharmaceuticals, Cara Therapeutics, Castle Biosciences, Celldex Therapeutics, Galderma, Genzada Pharmaceuticals, Incyte Corporation, Johnson & Johnson, Leo Pharma, Novartis Pharmaceuticals Corporation, Pfizer, Regeneron Pharmaceuticals, Kiniksa Pharmaceuticals, and Sanofi and has served as an investigator for Galderma, Kiniksa Pharmaceuticals, Incyte, Pfizer, and Sanofi outside of the submitted work. Drs Choi, Deng, Parthasarathy, Liao, D'Amiano, Taylor, Bordeaux, Kambala, Cornman, and Canner have no conflicts of interest to declare.