Prevention of atopic march progression and associated comorbidities in dermatitis: Carsten Flohr

Touch Medical Media coverage of data presented at EADV 2023:

Atopic march is a concept where the natural progression of atopic dermatitis culminates in allergies including food allergies, conjunctivitis and respiratory allergies, atopic march presents differently amongst patients and the order of progression can vary substantially.

touchDERMATOLOGY were delighted to speak with Prof. Carsten Flohr (Guy’s & St Thomas’ NHS Foundation Trust, London, UK) around the progression of atopic march, the associated comorbidities, impact of early detection and prevention strategies on patient outcomes.

The presentation ‘Early intervention to prevent atopic march?‘ (Presentation ID D2T02.2A) was presented at EADV 2023, Berlin, 11-14 October 2023 #EADVCongress.

Questions

1. Could you describe the progression of atopic march? (0:11)
2. What comorbidities are associated with atopic march? (1:19)
3. What impact is early detection of atopic dermatitis thought to have in the prevention of atopic march? (1:56)
4. What therapies are thought to prevent the development of atopic comorbidities? (3:21)

Disclosures: Carsten Flohr has nothing to disclose in relation to this video interview.

Support: Interview and filming supported by Touch Medical Media Ltd. Interview conducted by Victoria Jones and Katey Gabrysch.

Filmed in coverage of the EADV Annual Meeting.

This content was developed by Touch Medical Media and is not affiliated with the  European Academy of Dermatology & Venereology  (EADV) or the congress. 

Click here for more content on atopic dermatitis & for further EADV 2023 highlights visit here.

Transcript

Could you describe the progression of atopic march?

The atopic march is quite an old concept the idea that patients who first develop atopic dermatitis as babies usually during the first year of life, then invariably go on to develop food allergies first, and then later on respiratory allergies, hay fever, and asthma. That concept was based on hospital cohorts.

So people with quite severe disease and the studies were cross sectional by and large, the studies didn’t follow with people over time, and didn’t properly look at the trajectories that people take through the different diseases. We now know from large studies that have done long term follow-up and used machine learning approaches that you can take many different permutations through these atopic diseases. A lot of babies only develop atopic dermatitis, i,f they’re lucky, they grow out of it. Some will then develop food allergy, but no respiratory allergies, but you can even have a situation where people develop a fever and asthma when they’re at school and then only later on develop atopic dermatitis, so it’s much more complex than what people thought to begin with.

What comorbidities are associated with atopic march?

The co-morbidities are the allergic diseases. Interestingly, in context of food allergy, we’re now increasingly seeing children who develop guts disease induced by foods. So, chronic inflammation, they have a lot of abdominal pain, they very often fail to thrive and that’s an additional condition to the common garden food allergies, where people have hives – so itchy wheels coming up maybe around the mouth, somewhere else on the body, or vomiting, or respiratory problems like wheezing or itchy eyes and a runny nose.

What impact is early detection of atopic dermatitis thought to have in the prevention of atopic march?

So the key issue here is that we are increasingly understanding the importance of the skin barrier in the development of food allergies and potentially respiratory allergies. That is actually the inflamed skin called antigen presenting cells, dendritic cells that have dendrites, finger type extensions that reach up to the top of the skin barrier able to recognize environmental antigen, so that is foods, tree and grass pollen, as a danger signal through the skin, and people had become allergic to tree and grass pollen and food like peanut protein through the skin. So making that point that this the skin is important, portal entry for the other allergic comorbidities that might come later in life, and that means that in terms of prevention approaches, we need to focus on looking after the skin barrier better.

That is some controlling the skin inflammation if it is there in the first place, but also making sure that parents wash their hands thoroughly before they do baby massage or apply moisturizer on the baby because the contamination of the parent’s hands with food protein and massaging the protein into the skin opening up the hair follicles and the protein potentially getting stuck in the hair follicles and then talking to the skin immune system at that level. That that that’s the the real thing that we need to avoid and do that to prevent people from developing the other allergic diseases.

What therapies are thought to prevent the development of atopic comorbidities?

Controlling the skin inflammation as well as possible, in a positive sense, aggressively treating the inflammation in the skin, is important, and hand hygiene is important. You need to ensure that there isn’t too much peanut protein going on to the skin barrier and being rubbed into the baby’s skin. The more we can switch off the inflammatory process and strengthen the skin barrier in early life, the more likely it is that a child will not develop one of these comorbidities, especially if they’re fed the foods that children are usually become allergic to like peanuts and calcium or an egg in early life rather than exclusively breastfeeding. We now understand that if you see a food protein by mouth early, you become tolerant to the food, but if you see the protein through the skin barrier, it sends a danger signal and you are more likely to become allergic.