Racial-Related Patterns of Atopic March in Pediatric Patients With Atopic Dermatitis

Dermatologist Emily Gurnee, MD, reviews her experiences treating atopic dermatitis in children and educating their caretakers. Credit: Getty Images
Differences in atopic disorders and their progression in White and Black pediatric populations with atopic dermatitis are assessed.

The duration of atopic dermatitis (AD) predisposes pediatric patients to develop additional atopic illnesses and that risk was generally higher among White children, a cross-sectional study published as a letter to the editor in the Journal of the American Academy of Dermatology found.

AD has been associated with subsequent diagnoses such as asthma and allergic rhinitis. Although this atopic march has been established, it remains unclear whether there are racial disparities in disease development.

To assess for any potential ethnicity interactions, investigators from the University of Pennsylvania School of Medicine sourced data from the Pediatric Eczema Elective Registry (PEER). This study assessed for AD duration and instances of asthma, allergic rhinitis, medication, food, and animal allergies on the basis of ethnicity.

The PEER study included data from 8,014 patients, among whom 46.7% were boys, 52% were Black, and 37.7% were White.

The AD duration was 2 years or less among 1,588 patients, between 2 to 7 years among 4,337 patients, and 7 to 18 years in 2,037 patients. Patients with longer AD duration were more likely to be girls and to have a family history of eczema, asthma, and seasonal allergies (all P <.001). Patients with shorter duration of disease were older at AD onset (P <.001).

Among all patients, longer AD duration was associated with increased risk for asthma (relative risk [RR], 1.18; 95% CI, 1.13-1.23; P <.001), allergic rhinitis (RR, 1.11; 95% CI, 1.08-1.15; P <.001), medication allergies (RR, 1.14; 95% CI, 1.01-1.27; P <.05), food allergies (RR, 1.54; 95% CI, 1.42-1.67; P <.001), and animal allergies (RR, 1.50; 95% CI, 1.38-1.63; P <.001).

Stratified by ethnicity, the risk for asthma (RR, 1.23 vs 1.14), allergic rhinitis (RR, 1.14 vs 1.07), and animal allergies (RR, 1.54 vs 1.50) was higher among the White children compared with the Black children, respectively. Risk was similar for food allergies (RR, 1.55 vs 1.55).

Neither the White (RR, 1.14; 95% CI, 0.99-1.3) or Black (RR, 1.18; 95% CI, 0.96-1.44) patients with longer duration of disease were at significantly higher risk for allergies to medications.

These findings may have been limited by not including data on socioeconomic factors which can influence atopic disease development. In addition, it remains unclear whether long-term risks differ on the basis of ethnicity.

These data indicated to the researchers that atopic march was common among pediatric patients with AD. Their study indicated that duration of AD increased risk for developing various atopic illnesses and White children may be at elevated risk compared with Black children.


Del Pozo DV, Zhu Y, Mitra N, Hoffstad OJ, Margolis DJ. The risk of atopic comorbidities and atopic march progression among Black and White children with mild to moderate atopic dermatitis: a cross-sectional study. J Am Acad Dermatol. 2022;S0190-9622(22)00334-6. doi:10.1016/j.jaad.2022.02.023