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Asthma is a significant cause of morbidity and mortality in the pediatric population. Atopic dermatitis (AD) is often the first step in the atopic march leading to the development of asthma, allergic rhinitis, and food allergies in the future. This study aimed to evaluate the severity differences between asthmatic children with and without atopic march in addition to characteristics of asthmatic patients with GER and ear-nose-and-throat (ENT) pathologies. A total of 616 pediatric asthmatic patients were enrolled. The study subjects were divided into two groups. Group A included asthmatic children with a history of AD. Group B had asthmatic children without a history of AD. Multiple factors were studied, including sex, race/ethnicity, family history of atopy, asthma severity, allergic rhinitis, food allergies, smoke exposure, ear-nose-and-throat (ENT) pathologies, gastroesophageal reflux (GER), frequency of systemic steroid use, and hospital admission rates. Our results revealed that patients with atopic march are at risk of developing a higher severity of asthma, resulting in increased morbidity. In contrast, asthmatic patients without atopic march had a milder asthma severity, less need for steroids, and fewer hospital admissions. A higher prevalence of ENT pathologies and/or GER existed among asthmatic children without atopic march. Our findings suggest that patients with atopic march should be expected to exhibit a more severe phenotype of asthma with increased asthma morbidity. Asthmatic patients without atopic march had a milder asthma phenotype, less need for steroids, and fewer hospital admissions. A higher prevalence of ENT pathologies and/or GER existed among asthmatic children without atopic march.

Variation of asthma characteristics with atopic march, gastroesophageal reflux, and ENT pathologies