Study of the Atopic March: Development of Atopic Comorbidities
Open accessAbstract
Background: Atopic dermatitis (AD) is often the first step in the atopic march leading to the development of asthma or allergic rhinitis. The goal of this study was to determine whether early intervention with pimecrolimus limits the atopic march in infants with AD and to evaluate its efficacy and safety. Methods: This was a 3‐year double‐blind study in which patients were randomized to pimecrolimus or vehicle and then open‐label pimecrolimus for a planned further 3 years. Rescue topical corticosteroid was permitted if 3 days of study medication led to no improvement; investigators made decisions on rescue medication until week 14 and caregivers thereafter. Efficacy assessments included disease‐free days, Eczema Area and Severity Index, and body surface area affected. Results: Infants ages 3 to 18 months with recent‐onset AD (≤3 months) were observed for a mean of 2.8 years (N = 1,091). No significant differences between pimecrolimus‐ and placebo‐treated groups were found in the percentage of patients with AD who developed asthma (10.7%) or other allergic conditions (allergic rhinitis, 22.4%; food allergy, 15.9%; allergic conjunctivitis, 14.1%; one or more atopic comorbidities, 37.0%) by study end. Allergic rhinitis, food allergy, and having one or more atopic comorbidities (but not asthma or allergic conjunctivitis alone) developed significantly more often in infants with greater AD severity at baseline. Pimecrolimus was significantly more effective than vehicle for AD treatment at week 14. Adverse event incidences were similar. Conclusions: This longitudinal observation of infants with AD provides evidence of the atopic march. Pimecrolimus was safe and effective in infants with mild to moderate AD.
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Increasing severity of atopic dermatitis correlates with an increased risk of developing allergic rhinitis, with prevalence of allergic rhinitis among people with atopic dermatitis ranging from 15% to 61%.
“increasing severity of AD has been shown to correlate with an increased risk of developing AR, with prevalence of AR among people with AD ranging from 15% to 61%.1898-1900”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [1900]
The Results (Atopic Comorbidities; page not available) report that allergic rhinitis developed more often in children with greater baseline atopic dermatitis severity. They report 18.5% during the double-blind period, but do not give the claimed 15%–61% prevalence range among people with atopic dermatitis. (LLM, conf=0.87)
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- Authors
- Schneider, L., Hanifin, J., Boguniewicz, M., Eichenfield, L. F., Spergel, J. M., Dakovic, R., & Paller, A. S.
- Affiliations
- Boston Children's Hospital (US)
- Oregon Health & Science University (US)
- National Jewish Health (US)
- Rady Children's Hospital-San Diego (US)
- Children's Hospital of Philadelphia (US)
- Meda (Germany) (DE)
- Northwestern University (US)
- Corresponding author
- Paller, Amy S.
- ORCID
- Venue
- Pediatric Dermatology
- Publisher
- Wiley
- Published
- 2016-06-07
- Volume
- 33
- Issue
- 4
- Pages
- 388-398
- ISSN
- 0736-8046 (ISSN-L)
- 1525-1470
- PMC
- PMC5649252
- OpenAlex
- W2412285133
- Cited by
- 148
- References
- 23
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 21 · 2023: 25 · 2022: 17 · 2021: 12 · 2020: 13 · 2019: 17 · 2018: 13 · 2017: 10 · 2016: 3
- FWCI
- 17.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pediatric Dermatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Meda Pharma
- Topics
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Dermatology › Contact Dermatitis and Allergies
- Keywords
- atopic march, atopic dermatitis, pimecrolimus, infants, asthma development, allergic rhinitis, food allergy, allergic conjunctivitis, atopic comorbidities, topical calcineurin inhibitors, disease severity, Eczema Area and Severity Index
- MeSH terms
- Asthma, Dermatitis, Atopic, Dermatologic Agents, Double-Blind Method, Humans, Infant, Longitudinal Studies, Severity of Illness Index, Comorbidity, Tacrolimus, Treatment Outcome, Rhinitis, Allergic
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