ABSTRACT

Atopic dermatitis (AD) is often accompanied by atopic airway disease, i.e. allergic rhinitis and/or bronchial asthma. In children the first symptoms of AD usually precede the airway symptoms. This phenomenon is often called the atopic march. Epidemiological studies suggest a relationship between the severity of AD, and the degree of atopic sensitization, and bronchial asthma. Patients with established AD often show bronchial hyperresponsiveness, respiratory symptoms, and eosinophilic airway inflammation. Recent findings of impaired barrier function of the skin induced by mutations of the filaggrin and other epidermal genes which lead to an increased risk for bronchial asthma further emphasize the key role of the epidermal barrier in both AD and atopic airway disease. Murine models of AD and asthma further suggest that the skin is the primary organ in the sensitization to aeroallergens leading to asthma-like reactions in the airways. Taken together these findings suggest an association of AD and bronchial asthma. Although it is tempting to speculate that effective treatment of AD at an early age might intervene with airway symptoms, only a few studies have addressed this issue. In the present chapter we discuss current knowledge on the relationship of AD and asthma and intervention studies in AD with atopic airway disease.