Evolution of Eczema, Wheeze, and Rhinitis From Infancy to Early Adulthood: Four Birth Cohort Studies

Prior studies have suggested a pattern of eczema with progression to asthma and rhinitis termed the atopic march. This study aimed to investigate the heterogeneity in individual patterns of eczema, wheeze, and rhinitis from birth to early adulthood.

Four birth cohort studies of United Kingdom origin were included. All studies recruited pregnant women who gave birth to children between 1989 and 1999.

Symptom information was collected via questionnaires administered at various visits from infancy to adulthood. Specific information extracted included eczema, wheeze, and rhinitis at each follow-up visit. Filaggrin (FLG) was genotyped for 3 variations of loss of function. Children with 1 or more of the 3 variations were considered to have FLG loss-of-function mutation. Information collected was analyzed to describe single occurrence of disease compared with co-occurrence of disease. Descriptive cross-sectional analyses and longitudinal analyses were performed.

One-third of all participants demonstrated a single disease compared with 7% to 14% experiencing 2 co-occurring diseases. The co-occurrence of eczema, wheezing and rhinitis was rare, ranging from 2% to 4% by final time point and increasing gradually from birth to age 4 to 5 years. Infantile eczema was associated with subsequent multimorbidity (eczema, wheeze, rhinitis), the majority (75.4%) of children with eczema in the first year of life did not progress to multimorbidity in adolescence or adulthood. Eczema and wheeze in the first 3 years of life was significantly associated with an increased risk of all conditions, particularly an 18-fold increased risk of multimorbidity. Longitudinally, children with eczema were more likely to stay in that state or progress to multimorbidity, whereas those with wheeze were more likely to transition to no disease state. FLG mutations and SNP rs721389 did not increase the risk of wheeze or eczema separately but did significantly increase the risk of persistent multimorbidity.

This analysis confirms that although eczema, wheeze, and rhinitis coexist, there may not be a specific or typical pattern in which these conditions progress or persist. Children with eczema in early life appear to have the highest rate of transition to multimorbidity, though the majority still did not progress to wheeze or rhinitis.

The atopic march starts from eczema in infancy and progresses to include asthma and rhinitis through childhood and adolescence. This study demonstrates the known association between early atopic characteristics and future atopic comorbidity, though the way it progresses may not be a linear march, as previously suggested. Importantly, eczema appears to be a major risk factor for future atopic conditions. Diligent management of eczema in early childhood and monitoring for progression to additional atopic conditions is key in this patient population.