JAMA PEDIATRICS PATIENT PAGE
Atopic Diseases in Children
Atopic diseases are a group of diseases linked by a shared underlying problem with the immune
system. The main feature is the development of a particular immunoglobulin (IgE) directed
against allergens that are usually harmless. Childhood atopic disease includes atopic dermatitis,
allergic rhinitis, asthma, and food allergy. This month’s JAMA Pediatrics includes 2 articles about
atopic disease.
Atopic dermatitis, also called eczema, is a chronic, relapsing inflam-
matory disease of the skin that leads to itching and risks for skin in-
fection. It is the most common skin disease in children: about 10%
to 20% of children in the United States and Western Europe have
atopic dermatitis. Skin treatment typically includes moisturizers and
anti-inflammatory treatments such as steroid creams.
Allergic rhinitis is caused by allergic inflammation in the nose and
throatafterbeingexposedtoanallergen.Symptomsincluderunnynose
(rhinorrhea),stuffynose(nasalcongestion),itching,andsneezing.Itchy
or watery eyes can also be symptoms. For some patients, the symp-
tomsareseasonal;forothers,thesymptomsareyearround.Treatment
often consists of trying to reduce exposure to the allergen and using
medicinessuchasnasalsteroids,oralantihistamines,ordecongestants.
Asthmaisadisorderthatincludesairwayobstructionthatisrevers-
ible, lungs that are much more sensitive to allergens and irritants, and
chronicairwayinflammation.Symptomsincludewheezinganddifficulty
breathing. Treatment often includes medicines that are inhaled as well
as taken by mouth to open the airways and reduce inflammation.
Food allergies are common in children. The most common are
nut and egg allergies. Some food allergies commonly resolve in later or early avoidance of possible things that can cause an allergic reaction
childhood, and others do not. Treatment involves being prepared increase risks of atopic disease. We know that early exposure to pea-
in case of accidental exposure and avoiding that food. nuts, for example, can reduce the risk of developing a peanut allergy.
Because the illnesses involved in atopic disease are linked by Other studies have found that more exposure to viral infections, such
common causes, the “atopic march” refers to the common prob- as through daycare or school, was protective for atopic disease.
lem that children who have one of these illnesses are at significant If your child has been diagnosed with one atopic disease, talk
risk for developing another at some point during childhood. For ex- with your pediatrician about ways to prevent the atopic march.
ample, about 75% of children with atopic dermatitis will develop al-
lergic rhinitis and more than 50% will develop asthma. There are 2
important factors in which children are at risk for atopic disease: FOR MORE INFORMATION
• Genetics: Genetics play a large role in developing atopic diseases; http://www.fmed.ulaval.ca/pediatrie/fileadmin/docs/serveur
_pediatrie/Acces_reserve/Medecins/Articles_scientifiques/recueil
these underlying genetic risks then react to a trigger in the envi-
/AtopicDiseases.pdf
ronment to cause the atopic illness. A family history of atopic dis-
http://kidshealth.org/parent/infections/skin/eczema_atopic
eases is a risk factor for children to develop these conditions.
_dermatitis.html
• Environment: Even though genetics are important in risks for dis-
ease, exposure to environmental agents, or “triggers,” is important
in atopic disease. To find this and other JAMA Pediatrics Patient Pages, go to the
Patient Page link on the JAMA Pediatrics website at
The“hygienehypothesis”isthatamorehygienicenvironmentand
jamapediatrics.com.
fewer childhood infections may be an important reason why there are
increases in atopic disease. According to this theory, too much hygiene
Author: Megan A. Moreno, MD, MSEd, MPH The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The
information and recommendations appearing on this page are appropriate in most
instances, but they are not a substitute for medical diagnosis. For specific information
concerning your child’s medical condition, JAMA Pediatrics suggests that you consult
your child’s physician. This page may be photocopied noncommercially by physicians
and other health care professionals to share with patients. To purchase bulk reprints,
call 312/464-0776.
96 JAMA Pediatrics January 2016 Volume 170, Number 1 (Reprinted) jamapediatrics.com
Copyright 2016 American Medical Association. All rights reserved.
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