Revisiting Atopic March in the Era of Type 2 Inflammation

Drs. Gupta and Newhall discuss how the traditional idea of the atopic march—eczema progressing to food allergy, asthma, and allergic rhinitis—may be too simplistic and does not always match what they see in the clinic, given what is now known about shared type 2 inflammation, cytokine pathways, and barrier dysfunction across organs. They note that these allergic conditions often arise in parallel rather than in sequence. They suggest using the atopic march as a way to talk about risk, while focusing on early skin protection, timely food allergen introduction, and emerging biologic treatments like dupilumab to potentially reshape a child’s long-term allergic trajectory.