The Atopic March: How Eczema, Food Allergies, Asthma, & Allergies Are Connected

The atopic march refers to the progression of allergic diseases, starting with atopic dermatitis (eczema) in infancy and potentially leading to food allergies, allergic rhinitis, and asthma (1). While each condition affects different parts of the body - skin, gut, airways - they are connected through immune system hypersensitivity.

Children with one atopic condition often develop others:

• About 35% of kids with atopic dermatitis develop IgE-mediated food allergy (2).

• Approximately 70% of kids with severe atopic dermatitis develop asthma, compared to 20–30% of kids with mild atopic dermatitis and approximately 8% of the general population (2).

• About 40% of patients with atopic dermatitis develop allergic rhinitis, compared to about 18% of the general population developing allergic rhinitis (3).

One important link in this progression is the disruption of the skin barrier, which can set off a chain reaction in the immune system, driving inflammation and sensitization that can contribute to the development of multiple allergic conditions (2).

Atopic dermatitis is a chronic inflammatory skin condition and the most common form of eczema. Beyond causing discomfort and itching, it weakens the skin’s protective barrier, potentially allowing allergens, irritants, and microbes to enter. This breach triggers immune cells to release inflammatory proteins (2).

To learn more about inflammation, read this article:  Understanding & Supporting A Healthy Inflammatory Response.

The immune system reacts to allergens encountered through the skin by developing what we call “sensitization” (2). Sensitization is a state where the immune system becomes primed to overreact to those allergens in other areas of the body, too - as is seen in the frequent development of food allergies, asthma, and rhinitis in kids with eczema.

If you're the parent of a young child with eczema, this information might feel overwhelming. It’s important to remember that your child is not a statistic and their health is not as black and white as a page in a textbook. While these statistics highlight patterns, they don’t mean that your child is destined to develop food allergies, allergic rhinitis, or asthma.

There is no guaranteed way to prevent the atopic march (6), and it’s equally important to remember that it may not occur at all. That said, proactive care can help reduce the severity of symptoms and may even slow or prevent the progression of allergic conditions (6). By managing eczema (atopic dermatitis) through supporting the integrity of the skin barrier (6), and promoting immune balance (6), parents may, in theory, be able to lower the risk of their child developing additional conditions like food allergies, asthma, or allergic rhinitis.

1. Support the Skin Barrier

• Daily Moisturizing: Use clean, hypoallergenic lotions and creams to lock in moisture and protect the skin. The research here is lacking, but some early evidence suggests that using a daily, gentle moisturizer from birth may prevent atopic dermatitis from developing (6), halting the march before it begins.

• Gentle Cleansing: When it comes to cleansing, choose a gentle, hypoallergenic body wash without foaming agents to avoid stripping the skin and damaging the barrier.

• Manage Eczema Flare-ups: Promptly treat flare-ups with strategies such as oatmeal baths and natural products like Henry’s Homestead Healing Salve, and see a dermatologist if home care isn’t working. For more tips, see the full article on eczema care: Eczema Treatment 101

2. Introduce Potential Allergens Early

• Introducing potential allergens, such as peanuts, early: Between 4 and 6 months old is now the age recommended to introduce potential allergens to children with atopic dermatitis to reduce their risk of developing food allergies (6). This approach aims to prevent peanut allergy from developing through transdermal sensitization, where allergens penetrate through damaged skin before they are consumed (6).

3. Identify and Manage Food Allergies

• Elimination Diets: If food allergies are suspected, an elimination diet can help identify and remove trigger foods. Learn more about elimination diets here: How To Conduct An Elimination Diet To Assess Food Sensitivities

4. Adopt an Anti-Inflammatory Lifestyle

• Diet and Digestion: What we eat, and how well we digest it, affects inflammation by influencing gut health, nutrient status, and immune function (7).

• Sleep and Stress: Quality sleep and stress management are essential at all ages for maintaining a balanced immune system, and reports show that 47-80% of children with atopic dermatitis also experience disrupted sleep (8). To learn more about how to address sleep issues in children, read this article: 9 Reasons Your Kids Aren’t Sleeping (And How To Help)

• Exercise and Nature: Activity levels and outdoor play help reduce inflammation, promote relaxation, and support overall well-being (9).

• Social Interactions: Positive social connections lower stress and inflammation, while loneliness and isolation can make both worse. For infants, social interaction looks like lots of face time and skin-to-skin time with caregivers.

5. Support a Healthy Microbiome and Address Leaky Gut

• A healthy microbiome plays a key role in immune regulation, while a disrupted microbiome can increase the risk of allergic conditions (10).

• Breastfeeding and skin-to-skin care: When possible, breastfeeding and plenty of skin-to-skin contact can provide beneficial microbes and immune support.

• Probiotics and Prebiotics: Once your child is ready for solids, add probiotic-rich foods (like sauerkraut and kefir) and prebiotic foods (like bananas and leeks) to support gut health.

• Outdoor Play: Exposure to natural environments introduces diverse microbes that train the immune system (11).

• Minimize Unnecessary Antibiotic Use: Use antibiotics only when necessary, as they can disrupt beneficial bacteria in both the gut and skin. If antibiotics are necessary, following them up with probiotic supplementation may help maintain gut health. To learn more, read this article: Restoring Gut Health After Antibiotics: A Guide For Families 

To learn more about how to care for your child’s skin, read these articles: Eczema Treatment 101 and Baby Skin Care 101.

The atopic march refers to the progression of allergic conditions, often starting with eczema and potentially leading to food allergies, asthma, or allergic rhinitis. While the atopic march is not certain to occur, there’s also no guaranteed way to prevent its progression. Genetics play a key role in determining a child’s susceptibility to allergic conditions, but environmental factors - such as skincare, diet, and stress management - help shape whether and how these conditions develop. Managing eczema early by strengthening the skin barrier, promoting immune balance, and supporting a healthy microbiome are helpful strategies. Parents can focus on daily moisturizing with clean skincare, gentle cleansing, adopting an anti-inflammatory lifestyle, supporting good gut health, and outdoor play.