Atopic dermatitis alongside other atopic diseases: The first stage of atopic multi-morbidity syndrome? A literature review

The pathophysiological pathways of atopic dermatitis (AD) are different according to the phenotype, age of onset, severity of the disease, genetic background and triggering factors. A difficult-to-treat group of patients characterized by a early-onset and persistent disease, associated with asthma and/or food allergy, have been identified. The main hypothesis of the atopic march, term describing the course from AD to asthma, is a primitive defect in the epithelial barrier, self-sustained by a secondary sensitization. Severity of AD is the main risk factor linked with food allergy. Early-onset of the disease, male gender, parental history of asthma, and early-onset multiple sensitization are risk factors for asthma. The role of environmental factors should not be minimized to prevent the atopic march. Early emollient therapy is an interesting approach for high-risk infants to prevent AD but its ability to prevent the atopic march is not known. In clinical practice it is also important to keep in mind the specific risk factors linked to filaggrin mutations. (C) 2018 Published by Elsevier Masson SAS.