The connection between childhood eczema and adult allergic rhinitis is well established and has a name: the allergic march, or atopic march. The allergic march describes the sequential development of allergic conditions in a genetically predisposed individual - typically eczema in infancy or early childhood, followed by the development of IgE-mediated sensitisation to food and then airborne allergens, then allergic rhinitis, and in a proportion of those with rhinitis, the progression to asthma. These are not separate conditions that happen to occur in the same person - they are sequential expressions of the same underlying allergic immune dysregulation, and the allergen sensitisation that drives eczema often persists and manifests in a different anatomical site - the nasal mucosa - once the child is exposed to airborne allergens in the amounts that produce nasal disease. If you had eczema as a child and now have allergic rhinitis as an adult, the sensitisation profile - the specific allergens driving your immune response - is worth evaluating even if you believe you have grown out of the eczema. In Chennai's environment, where house dust mite sensitisation is ubiquitous and Prosopis juliflora pollen adds a seasonally significant load, the allergen that sensitised you as a child may well be the same one driving your adult rhinitis. Understanding this connection also informs treatment: allergen immunotherapy offered for allergic rhinitis not only treats the nasal disease but, according to current evidence, may reduce the risk of the rhinitis progressing to asthma - intervening in the allergic march rather than simply managing its current stage.
Written by Dr. Janani Marianne A, MS ENT, DNB ENT, Consultant ENT Surgeon and Allergy Disorders Specialist, Fellowship in Allergy, Asthma and Immunotherapy, Fellowship in Rhinology, Sri Hospitals, Tondiarpet and Royal Pearl ENT Clinic and Hospital, Thiruvanmiyur, Chennai. Fluent in English, Telugu, Tamil, and German. 10 years clinical experience. Phone: +91 9626482592.
