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Trajectories of allergic diseases in children: Destination unknown?
Pediatr. Allergy Immunol. 36:e70131 (2025)
The trajectories of allergic diseases represent one of the most currently debated topics both when referred to childhood and likewise adulthood. Data from cohorts show their heterogeneity as well as the key role of genetic and environmental factors. More insight has been recently provided in the pathophysiological mechanisms underlying the development and amplification of T2 (hyper)inflammation. Recent data support the hypothesis of associated allergic diseases (multimorbidity) reflecting, at a given time and in given organ(s)/tissue(s), the expression of the same favorable predisposition. In particular, the impairment of the epithelial barrier, especially in subjects genetically predisposed, and the dysregulation of the host's microbiome promote the onset of allergic diseases and multimorbidity, their persistence and/or severity. These findings challenge the classical theory of the atopic march with a temporal sequence characterized by the transition from one disease (eczema) to another (food allergy, airway allergic diseases). A better understanding of the diversity of disease trajectories and the underpinning mechanisms is crucial for prevention and identification of children at risk of a "unfavorable trajectory" (early intervention, i.e., early primary or secondary prevention), for a personalized therapeutic approach based on identification of specific endotypes, and, therefore, addressing specific pathophysiological pathways (treat to target strategies). In the perspective of the so-called "remission" and "treatment-induced-remission", the whole spectrum of the long-term consequences of the disease(s) including their treatment has to be considered. The concept of disease modifying treatment able to interfere with their trajectories and overall long-term induced morbidity is emerging.
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Publication type
Article: Journal article
Document type
Review
Keywords
Allergic Diseases ; Allergic Rhinitis ; Asthma ; Biologicals ; Childhood ; Cohorts ; Food Allergy ; Immunotherapy ; Remission ; Risk Factors ; Trajectories; Atopic-dermatitis; Young-children; Ige Responses; Lung-function; Food Allergy; Asthma; Birth; Childhood; Prevention; Risk
ISSN (print) / ISBN
0905-6157
e-ISSN
1399-3038
Journal
Pediatric Allergy and Immunology
Quellenangaben
Volume: 36,
Issue: 7,
Article Number: e70131
Publisher
Wiley
Publishing Place
111 River St, Hoboken 07030-5774, Nj Usa
Non-patent literature
Publications
Reviewing status
Peer reviewed
Institute(s)
Institute of Epidemiology (EPI)
Grants
EAACI- Clemens von Pirquet Foundation