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

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.