The allergic march, also called the atopic march, is the sequential development of allergic conditions in children that typically follows this pattern:
• Eczema (atopic dermatitis) in infancy, often the first sign of atopic predisposition
• Allergic rhinitis developing in toddlerhood or early childhood, causing persistent sneezing, runny nose, and nasal congestion
• Asthma developing later, often triggered by the same allergens driving rhinitis
These are not separate problems. They reflect the same underlying immune dysregulation expressing itself in different organs at different stages of development. A child being treated for asthma alone, without identifying and managing the allergic rhinitis that is driving upper airway inflammation and postnasal drip into the lower airway, will have persistently poorly controlled asthma. I evaluate every child with suspected asthma for the full range of atopic conditions as part of my assessment at Vatsalya Superspeciality Children Hospital, Varanasi.
Written by Dr Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA, FNPP, DPSM, FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, Uttar Pradesh 221002.
