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The Allergic March: Understanding How Allergies Progress in Children
For many parents, discovering their child has one allergic condition often raises concerns about whether others might follow. This progression of allergic diseases throughout childhood is what allergists call the "allergic march" – a pattern we frequently observe in our clinical practice at LACK Clinic.
What is the allergic march?
The allergic march describes the typical progression of allergic conditions that may develop in children with an allergic predisposition. Rather than appearing randomly, allergic diseases often follow a predictable pattern, beginning in infancy and potentially continuing through childhood and beyond.
This pattern typically unfolds in stages:
1. Eczema (atopic dermatitis) often appears first, usually within the first few months of life
2. Food allergies commonly develop next, generally within the first three years
3. Allergic rhinitis (hay fever) and conjunctivitis often emerge during preschool or early school years
4. Asthma may develop in later childhood or adolescence
Not every child will experience all stages of the allergic march, and some may skip certain conditions entirely. However, research has shown that children who develop eczema early in life are at increased risk of developing other allergic conditions as they grow.
The science behind the progression
Understanding why allergies progress in this sequence lies in the relationship between our skin barrier and immune system. Recent research, including Professor Lack's groundbreaking work, has illuminated this connection.
When infants have eczema, their skin barrier is compromised. This allows allergens to penetrate the skin more easily, potentially leading to sensitisation – the process where the immune system becomes reactive to certain substances. This skin exposure may explain why food allergies often follow eczema, even before these foods are introduced into the diet.
As the child grows, exposure to environmental allergens through the respiratory system can trigger hay fever and asthma in those already predisposed to allergic responses.
Statistics and risk factors
The allergic march affects a significant portion of children with allergic tendencies. Research indicates that:
- 30-50% of children with eczema will develop food allergies
- Up to 75% of children with severe eczema may progress to develop asthma
- Having a family history of allergies significantly increases the likelihood of experiencing the allergic march
While genetics play an important role, environmental factors also contribute to how allergies develop. These include:
- Environmental allergen exposure
- Diet during early life
- Living environment (urban vs rural)
- Exposure to tobacco smoke
- Pollution levels
How the allergic march affects daily life
For children experiencing multiple allergic conditions, the impact on quality of life can be significant:
- Physical discomfort: Itchy skin from eczema, digestive issues from food allergies, congestion and irritation from hay fever, and breathing difficulties with asthma
- Sleep disruption: Itching, coughing, and breathing difficulties often worsen at night
- Academic challenges: Poor sleep, medication side effects, and allergy symptoms can affect concentration and school performance
- Social limitations: Food allergies may restrict participation in social activities, while visible eczema might affect confidence
- Family stress: Parents often report increased anxiety and stress when managing multiple allergic conditions
Parents frequently describe the challenge of addressing different symptoms simultaneously – perhaps managing eczema flares while also being vigilant about food allergies and monitoring for respiratory symptoms.
Can we interrupt the allergic march?
One of the most promising areas of recent research focuses on whether early intervention can alter or stop the allergic march. Evidence suggests several strategies may help:
Early eczema management
Proactive treatment of eczema to maintain skin barrier function may reduce the risk of subsequent food allergies. This includes:
- Consistent use of emollients to strengthen the skin barrier
- Prompt treatment of flares with appropriate anti-inflammatory medications
- Identifying and avoiding specific triggers
Early introduction of allergenic foods
Professor Lack's landmark LEAP (Learning Early About Peanut allergy) study demonstrated that early introduction of peanuts in high-risk infants significantly reduced their risk of developing peanut allergy. Similar principles may apply to other food allergens.
This research has transformed our understanding of food allergy prevention, showing that early, regular exposure to allergenic foods through the digestive system may help teach the immune system to tolerate these foods rather than react to them.
Addressing allergic rhinitis
Properly managing hay fever may reduce the risk of developing asthma or experiencing severe asthma symptoms. Options include:
- Allergen avoidance strategies
- Appropriate medications to control symptoms
- Consideration of immunotherapy in suitable cases
When to seek specialist care
If your child shows signs of allergic conditions, particularly if there's a family history of allergies, seeking specialist advice early can be beneficial. Consider consulting an allergy specialist if your child:
- Develops eczema in the first few months of life, especially if it's moderate to severe
- Shows signs of food allergies or reactions
- Consistent use of emollients to strengthen the skin barrier
- Prompt treatment of flares with appropriate anti-inflammatory medications
- Identifying and avoiding specific triggers
- Has persistent or recurring respiratory symptoms
- Has allergies that significantly impact their quality of life
Early intervention not only helps manage current symptoms but may potentially modify the progression of allergic disease.
The future of allergic march management
Research in this field continues to evolve rapidly. Promising areas include:
- **Biologics**: New targeted treatments that address specific pathways in allergic inflammation
- **Microbiome research**: Understanding how gut bacteria influence allergic tendencies
- **Prevention strategies**: Further refinement of approaches to prevent allergies from developing
- **Personalised medicine**: Tailoring treatments based on a child's specific allergic profile and genetic factors
Living confidently with allergies
While the allergic march represents a pattern many children with allergies follow, it's important to remember that:
- Each child's allergic journey is unique
- Many allergic conditions become more manageable with age
- Some children outgrow certain allergies entirely
- Modern treatments are increasingly effective at controlling symptoms
- With proper management, children with allergies can lead full, active lives
- Allergen avoidance strategies
- Appropriate medications to control symptoms
- Consideration of immunotherapy in suitable cases
At LACK Clinic, we focus not just on treating each condition as it appears, but on understanding the underlying connections between allergic diseases. This comprehensive approach aims to provide the most effective care for children at every stage of their allergic journey.
By understanding the allergic march, parents can be proactive about their child's care, potentially influencing how allergies progress and ensuring better quality of life regardless of which allergic conditions develop.
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