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One allergy: one exposure and one pathway

Pediatric Research (2024)Cite this article

The study by Ho et al. in this issue of Pediatric Research indicates that asthma increases both severity and occurrence of rhinitis due to exposure to air pollutants.1 It adds to the increasing evidence that ‘one’ allergy is caused by ‘one’ exposure through ‘one’ pathway.2

Allergic diseases, including asthma, allergic rhinitis (AR), food allergy (FA), and eczema or atopic dermatitis (AD), have been increasing worldwide during past decades, posing great challenges to human understanding, prevention and clinical treatment. At first, people believed that these allergic diseases were independent and belonged to different organ diseases, such as eczema being a skin disease, rhinitis and asthma being respiratory diseases, and food allergy being intestinal disease. Subsequently, for over one century, people discovered the interrelationship between these allergic diseases:

  • On the one hand, there is a temporal order relationship between allergic diseases. The concept of the atopic march was developed to describe the progression of allergic disorders from eczema and FA in infants to AR and asthma in children.3 Epidemiological studies found that an average of 50% of children with AD in the first 2 years developed asthma in the following years,4 which was confirmed in a recent systematic review and meta-analysis that children with persistent or severe AD in early childhood have a higher risk of developing asthma in later childhood.5 Similarly, many studies reported that infants with FA will have a higher risk of developing asthma in later childhood and even adulthood.6 An increasing amount of evidence indicates that AR often precedes the onset of asthma and is thus a risk factor for the development of asthma.7

  • On the other hand, there exists a temporal coexistence or comorbidity relationship between allergic diseases. The epidemiological and clinical data have consistently shown that rhinitis and asthma occurring in the upper and lower respiratory airways are closely linked, leading to the concept of ‘united airway disease’ or ‘one airway one disease’.8 Birth cohorts in eight European countries (Denmark, France, Germany, Italy, Netherlands, Norway, Spain, and Sweden) have shown that eczema, rhinitis, and asthma coexist in the same children both at age 4 and 8 years.9 The comorbidity of eczema and FA with rhinitis and asthma was later widely observed. A systematic review concluded that the proportion of children with eczema developing asthma is significantly higher than that of children without eczema, and the incidence rates of asthma are three to four times higher than that in the general population.10 The coexistence between FA and asthma is revealed by the fact that FA may be a risk factor for life-threatening asthma, and vice versa, asthma may be also a risk factor for life-threatening FA.11

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References

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Funding

Funding

This work was supported by the National Natural Science Foundation of China (No. 21777193 and 42277430) and Scientific and Technological Innovation Leading Talents of Henan Province (224200510007).

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  1. School of Public Health, Zhengzhou University, Zhengzhou, 450001, China

    Qihong Deng & Le Liu

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  1. Qihong Deng
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Correspondence to Qihong Deng.

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Deng, Q., Liu, L. One allergy: one exposure and one pathway. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03060-3

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