ABSTRACT

Introduction

Eczema, allergic rhinitis, and asthma are traditionally considered atopic (or allergic) diseases. They are complex, multifactorial, and are caused by a variety of different mechanisms, which result in multiple heterogeneous clinical phenotypes. Atopic march is usually interpreted as the sequential development of symptoms from eczema in infancy, to asthma, and then allergic rhinitis. Areas covered: The authors reviewed the evidence on the multimorbidity of eczema, asthma, and rhinitis, and the implication of results of data-driven analyses on the concept framework of atopic march. A literature search was conducted in the PubMed and Web of Science for peer-reviewed articles published until July 2020. Application of Bayesian machine learning framework to rich phenotypic data from birth cohorts demonstrated that the postulated linear progression of symptoms (atopic march) does not capture the heterogeneity of allergic phenotypes. Expert opinion: Eczema, wheeze, and rhinitis co-exist more often than would be expected by chance, but their relationship can be best understood in a multimorbidity framework, rather than through atopic march sequence. The observation of their co-occurrence does not imply any specific relationship between them, and certainly not a progressive or causal one. It is unlikely that a sngle mechanism such as allergic sensitization underpins different multimorbidity manifestations.

中文翻译：

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特应性表型及其在特应性行军中的意义。

摘要

介绍

湿疹、过敏性鼻炎和哮喘传统上被认为是特应性（或过敏性）疾病。它们是复杂的、多因素的，并且由多种不同的机制引起，从而导致多种异质的临床表型。特应性行军通常被解释为症状从婴儿期的湿疹到哮喘，然后是过敏性鼻炎的连续发展。覆盖区域：作者回顾了关于湿疹、哮喘和鼻炎的多种发病率的证据，以及数据驱动分析结果对特应性行军概念框架的影响。在 PubMed 和 Web of Science 中对发表至 2020 年 7 月的同行评审文章进行了文献搜索。贝叶斯机器学习框架在出生队列中丰富的表型数据中的应用表明，假设的症状线性进展（特应性行军）并未捕获过敏表型的异质性。专家意见：湿疹、喘息和鼻炎共存的频率比偶然预期的要高，但可以在多发病框架中最好地理解它们的关系，而不是通过特应性行军序列。对它们同时发生的观察并不意味着它们之间有任何特定的关系，当然也不是渐进的或因果关系。过敏性致敏等单一机制不太可能支持不同的多发病表现。