Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
J Allergy Clin Immunol. 2024 Jun;153(6):1604-1610.e2. doi: 10.1016/j.jaci.2024.02.015. Epub 2024 Mar 2.
The atopic march refers to the coexpression and progression of atopic diseases in childhood, often beginning with atopic dermatitis (AD), although children may not progress through each atopic disease.
We hypothesized that future atopic disease expression is modified by AD phenotype and that these differences result from underlying dysregulation of cytokine signaling.
Children (n = 285) were enrolled into the Childhood Origins of Asthma (COAST) birth cohort and followed prospectively. Rates of AD, food allergy, allergic rhinitis, and asthma were assessed longitudinally from birth to 18 years of age. Associations between AD phenotype and food allergy, allergic rhinitis, asthma, allergic sensitization, exhaled nitric oxide, and lung function were determined. Peripheral blood mononuclear cell responses (IL-5, IL-10, IL-13, IFN-γ) to dust mite, phytohemagglutinin, Staphylococcus aureus Cowan I, and tetanus toxoid were compared among AD phenotypes.
AD at year 1 was associated with an increased risk of food allergy (P = .004). Both persistent and late-onset AD were associated with an increased risk of asthma (P < .001), rhinitis (P < .001), elevated total IgE (P < .001), percentage of aeroallergens with detectable IgE (P < .001), and elevated exhaled nitric oxide (P = .002). Longitudinal analyses did not reveal consistent differences in peripheral blood mononuclear cell responses among dermatitis phenotypes.
AD phenotype is associated with differential expression of other atopic diseases. Our findings suggest that peripheral blood cytokine dysregulation is not a mechanism underlying this process, and immune dysregulation may be mediated at mucosal surfaces or in secondary lymphoid organs.
特应性进行曲是指儿童时期特应性疾病的共同表达和进展，通常始于特应性皮炎（AD），尽管儿童不一定会经历每种特应性疾病。
我们假设未来特应性疾病的表达受 AD 表型的影响，这些差异是由于细胞因子信号转导的潜在失调所致。
儿童（n=285）被纳入儿童哮喘起源（COAST）出生队列，并进行前瞻性随访。从出生到 18 岁，通过纵向评估 AD、食物过敏、过敏性鼻炎和哮喘的发生率。确定 AD 表型与食物过敏、过敏性鼻炎、哮喘、过敏致敏、呼出气一氧化氮和肺功能之间的关联。比较 AD 表型之间对尘螨、植物血凝素、金黄色葡萄球菌 Cowan I 和破伤风类毒素的外周血单个核细胞反应（IL-5、IL-10、IL-13、IFN-γ）。
第 1 年的 AD 与食物过敏风险增加相关（P=0.004）。持续性和迟发性 AD 均与哮喘（P<0.001）、鼻炎（P<0.001）、总 IgE 升高（P<0.001）、可检测 IgE 的过敏原百分比升高（P<0.001）和呼出气一氧化氮升高（P=0.002）相关。纵向分析并未显示不同 AD 表型之间外周血单个核细胞反应存在一致差异。
AD 表型与其他特应性疾病的不同表达有关。我们的研究结果表明，外周血细胞因子失调不是该过程的机制，免疫失调可能发生在黏膜表面或次级淋巴器官中。
