Will Children with Atopic Dermatitis Develop Other Allergic Diseases as They Get Older?
The progression of allergic diseases is known as the “allergic march” in medicine, with different types of allergic symptoms appearing at different ages. Infants typically first present with atopic dermatitis, mainly because the primary allergens they encounter at this stage come from food, resulting in skin manifestations.
As they grow older, airborne allergens like dust mites and pollens start to play a significant role. Allergic rhinitis and asthma symptoms tend to emerge gradually between 2.5 and 4 years of age, with allergic rhinitis usually preceding asthma symptoms.
Multiple studies have indicated that children who suffered from atopic dermatitis in early childhood have a significantly higher likelihood of developing allergic rhinitis and asthma later on. Therefore, early control of atopic dermatitis is crucial in preventing the subsequent development of other allergic diseases.
Can Immunotherapy Help Alleviate Atopic Dermatitis?
Immunotherapy is currently considered the only treatment capable of fundamentally altering the allergic constitution. Its mechanism involves gradually increasing the dose of the allergen administered to the patient via injections, inducing the immune system to develop tolerance to that specific allergen, thereby reducing allergic reactions.
Immunotherapy has proven more effective in controlling asthma symptoms than allergic rhinitis. Children also tend to respond better to this therapy than adults, possibly because their developing immune systems are more receptive to generating new tolerances induced by immunotherapy.
However, traditional subcutaneous immunotherapy injections may exacerbate skin symptoms in patients with concurrent atopic dermatitis, making it less suitable for this group. A more viable option is sublingual immunotherapy, which avoids the risks of injections by administering allergens under the tongue to induce mucosal tolerance, presenting a new opportunity for managing atopic dermatitis. Nevertheless, sublingual immunotherapy is still awaiting approval in Taiwan.
Can IgG Antibody Tests for “Chronic Allergy” Diagnose Food Allergies?
Certain tests claim to detect “chronic allergies” by measuring the levels of IgG antibodies against various allergens in the patient’s blood. These tests often show positive reactions to numerous allergen sources, leaving parents uncertain whether they need to eliminate all those seemingly “allergenic” foods from their child’s diet.
In reality, IgG is merely a normal immune response produced against foreign proteins, and does not represent a true allergic reaction. The key driver of allergic symptoms is the “immediate hypersensitivity reaction” mediated by IgE antibodies. Therefore, measuring IgG antibodies alone cannot accurately diagnose food allergies.
To confirm a food allergy, the most reliable approach is an oral food challenge, which involves observing whether the patient develops allergic symptoms after consuming the suspected food item. Only when evident allergic reactions occur after ingestion can a food allergy be definitively diagnosed.
How Safe Are Topical Medications for Atopic Dermatitis?
In recent years, several non-steroidal immunosuppressant topical medications (such as pimecrolimus and tacrolimus) have been widely used to treat atopic dermatitis, raising some safety concerns. Reports have suggested that systemic immunosuppressants may increase cancer risk as they suppress the immune system’s ability to fight tumors.
However, for non-steroidal drugs applied only to the skin in limited amounts, the expected systemic side effects should be relatively mild compared to systemic use, as the dosage is much lower. A large-scale, long-term follow-up study found no increased cancer incidence among atopic dermatitis patients using these topical medications long-term.
To further alleviate parents’ concerns about side effects, it is sometimes recommended to alternate between topical corticosteroids and non-steroidal immunosuppressants, such as applying corticosteroid ointments during the day and non-steroidal medications at night. This approach aims to achieve more effective and safer treatment outcomes.
Will Atopic Dermatitis Symptoms Naturally Improve with Age?
While allergic rhinitis and asthma may indeed improve as children grow older, the same cannot be said for atopic dermatitis. If left untreated and uncontrolled, the repeated scratching and skin damage caused by atopic dermatitis can exacerbate the condition, leading to a vicious cycle.
Therefore, the goal of atopic dermatitis treatment should be to completely restore normal skin condition and eliminate scratching behavior, which is considered true control of the disease. One cannot expect the symptoms to naturally subside with age. On the contrary, active and persistent treatment is necessary to thoroughly control the condition and prevent further deterioration.
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