Pediatricians often watch for signs that one illness might signal another. One example of linked health issues is the allergic march, a pattern that affects many babies and children worldwide.

The allergic march -- also called the atopic march -- is a chain of health problems that typically happen one after the other. All may have common roots in the immune system.

The first sign is usually atopic dermatitis, a form of eczema that often appears before a child's first birthday. Atopic dermatitis causes dry, itchy, scaly patches on a baby's skin that may signal increased risks for food allergies, hay fever, allergic pink eye and asthma.

For some children, another condition called eosinophilic esophagitis can appear later in the allergic march. Eosinophilic esophagitis is an allergic inflammation of the esophagus, the tube that carries food from the mouth to the stomach. It can make swallowing difficult and cause symptoms like vomiting or abdominal pain.

Ongoing studies show that the allergic march can unfold in many different ways. For example, it might begin with food allergies instead of atopic dermatitis. Additionally, more than one condition might emerge at the same time, instead of one following the others. Some younger children will have atopic dermatitis and allergies but never progress to asthma, which shows that the allergic march will not happen for everyone. However, studies confirm that 1 of every 3 babies and toddlers who have atopic dermatitis will develop allergies or asthma later on.

Research suggests that the allergic march begins in the immune system, which defends a child's body against infections that can make them sick. Kids with allergic-march conditions may have sensitive immune systems that fight harder than they should when they're exposed to certain triggers (allergens). These triggers don't usually sicken other kids, but in others, the abnormal immune response caused by the triggers leads to the development of these later allergic conditions, some of which are life long and can be life-threatening.

Allergens that can cause flare-ups in young children include foods they can eat, as well as irritants they can breathe in or that can interact with their skin. Foods made with eggs, peanuts, cow's milk, fish, soybeans, tree nuts, wheat or sesame can cause reactions in some children. Additionally, environmental factors such as tobacco smoke, pollution, pollen, dust, pet dander, laundry soaps, fragrances and more can irritate children’s skin or breathing passages.

Though there's strong scientific proof that allergies and asthma run in families, genes may not be the only cause. Studies have linked childhood obesity, especially before age 2, with elevated asthma risks. In addition, a less diverse diet in pregnant mothers is linked to food allergy and asthma risk.

Kids with heavy exposure to polluted air, tobacco smoke, animal dander and other irritants may develop allergies at higher rates than others. Black, Hispanic and Indigenous children are more vulnerable to asthma than white children, which might reflect high levels of allergens where some families live or difficulties in getting effective care. If you're worried about your child's risks, talk with your pediatrician about protective strategies.

There is no single treatment that stops the allergic march in its tracks, but there are ways to slow its progress. Sharing your family health history with your child's doctor is a helpful first step. Risks for eczema, allergies and asthma tend to run in families, so it's wise to discuss possible risks with your pediatrician.

Prevention can begin even before babies are born. Eating a balanced, nutrient-rich diet and avoiding antibiotics or antacids while you're expecting can strengthen your infant's immune system. Research shows that vaginal deliveries—whenever safe and possible—may contribute to healthy immunity too.

Once your baby arrives, preventive steps include ensuring a healthy skin barrier to prevent easy access for triggers to enter the body and providing effective allergy care to reduce the risk of asthma developing. Exposing your child to some foods early such as peanuts or eggs can also help teach their body to tolerate them. Allergen immunotherapy as a shot or oral tablet can be given to work with an immune system to prevent flare ups of hay fever, asthma or even eczema. Allergen avoidance measures, allergy medicines and breathing treatments may be part of your child's care plan too.

Talk with your child's doctor if you see signs of illness that could be linked to the allergic march. Diagnostic tests can help confirm any suspicions so you and your pediatrician can create an effective wellness plan for your child. Diagnosing and treating allergic-march conditions can help kids lead active, healthy lives.

____

Daniel DiGiacomo, MD, MPH, FAAP, is a pediatric allergist/immunologist at K. Hovnanian Children's Hospital at Jersey Shore University Medical Center. He completed his pediatrics residency at Children's National Medical Center and fellowship training at Massachusetts General Hospital in Boston. Dr. DiGiacomo, a member of the American Academy of Pediatrics (AAP) Sections on Allergy and Immunology and Epidemiology, Public Health and Evidence, has a clinical interest in infant food allergy. He enjoys spending time at the beach with his family during his time off and is an avid New York sports fan.

©2026 Tribune Content Agency, LLC.