Atopic march: modern view on the problem and measures for prevention



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Abstract

Atopic dermatitis  is one of the most common inflammatory skin diseases, affecting 10–21% of the population and accounting for up to 50–60% of allergic disorders. The classical concept of the atopic march suggests a sequential progression from atopic dermatitis in infancy to bronchial asthma in early childhood and allergic rhinitis  in school-age children. However, recent data demonstrate that only 3.1% of patients follow this strict sequence, while the majority exhibit a heterogeneous combination of atopic diseases, including food allergy  and eosinophilic esophagitis.
The key mechanisms underlying the atopic march include epidermal barrier dysfunction (filaggrin mutations), transcutaneous allergen sensitization, systemic T2 inflammation, and genetic predisposition. Other contributing factors include microbiome disturbances, lifestyle factors, and environmental triggers.
Preventive strategies involve the use of emollients from birth, early introduction of allergenic foods (e.g., peanuts) to induce tolerance, microbiome modulation, and targeted therapies (e.g., dupilumab) aimed at suppressing IL-4/13-mediated inflammation. However, no universal approach exists, highlighting the need for personalized strategies tailored to individual immunological and genetic profiles.
Thus, the modern understanding of the atopic march has evolved from a linear model to a concept of multimorbidity, requiring a comprehensive approach to diagnosis, prevention, and treatment. Further research should focus on developing predictive biomarkers and individualized therapeutic algorithms.

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About the authors

Alla O. Litovkina

National Research Center — Institute of Immunology Federal Medical-Biological Agency of Russia; Peoples’ Friendship University of Russia

Email: dr.litovkina@gmail.com
ORCID iD: 0000-0002-5021-9276
SPIN-code: 2337-7930

MD, Research Associate

Россия, Moscow; Moscow

Evgeniy V. Smolnikov

National Research Center — Institute of Immunology Federal Medical-Biological Agency of Russia; Peoples’ Friendship University of Russia

Email: qweril2010@yandex.ru
ORCID iD: 0000-0003-1302-4178
SPIN-code: 4874-8100

MD, Research Associate

Россия, Moscow; Moscow

Olga G. Elisyutina

National Research Center — Institute of Immunology Federal Medical-Biological Agency of Russia; Peoples’ Friendship University of Russia

Email: el-olga@yandex.ru
ORCID iD: 0000-0002-4609-2591
SPIN-code: 9567-1894

MD, Dr. Sci. (Medicine)

Россия, Moscow; Moscow

Maria V Khodzhava

National Research Center — Institute of Immunology Federal Medical-Biological Agency of Russia

Email: mchernobaeva@mail.ru
ORCID iD: 0009-0005-5140-1554
SPIN-code: 3046-8033
Moscow, Russia

Elena S. Fedenko

National Research Center — Institute of Immunology Federal Medical-Biological Agency of Russia

Author for correspondence.
Email: efedks@gmail.com
ORCID iD: 0000-0003-3358-5087
SPIN-code: 5012-7242

MD, Dr. Sci. (Medicine), Professor

Россия, Moscow

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