EoE as the fifth member of the Atopic March: Insights from 2026 Study

We’ve known for a long time that certain allergic diseases are linked, with the concept of the atopic march first popularised around 20 years ago. But up until now, eosinophilic oesophagitis (EoE) has never been included. 

Previous research has shown a link between a type of eczema called atopic dermatitis (AD) and EoE. As AD is often the first allergic disease to appear in the atopic march, this link could indicate that EoE is also part of the march. 

A new study, published in the Journal of Allergy and Clinical Immunology, has found that early-life AD is a risk factor for developing EoE later in life, adding to our understanding of this connection, and advises that EoE should be included in the atopic march. 

What is the atopic march? 

Also called the allergic march, the atopic march describes how allergic diseases typically progress as we grow older. For many people, AD is the start of this march, commonly developed in early infancy, and is often followed by the development of food allergies, allergic rhinitis (hay fever), and asthma. 

While every patient is different, many of our members have found that it helps them feel more prepared to manage their health in the future.

Learn more about allergies and EoE

EoE joins the atopic march 

Despite its similarities with other allergic diseases and the fact that many EoE patients also experience allergies, EoE has been left out of the march in the past. 

However, this latest study found that children who developed AD within their first two years of life were 10 times more likely to develop EoE by the age of 8, suggesting that EoE has been a member of the march all along. 

But working out where in the march it fits is a bit trickier. 

Because 67% of the children who had at least one allergic comorbidity in the study developed a food allergy (FA) and/or allergic rhinitis (AR) before they were diagnosed with EoE, the authors suggested that EoE occurs as the fifth and final step in the march. However, a previous study found that EoE is most commonly diagnosed around the time when AR is developing, rather than following it.

NOTE: It's likely that results varied across studies due to differences in participant groups and levels of access to care. Research must continue to develop a clear understanding of the progression of EoE and its associated allergic diseases.

What are the benefits of updating the atopic march? 

The atopic march is a helpful tool, but it isn’t perfect. The current model ignores that many patients don't mirror it perfectly, making it harder for them to manage their health as they grow up. Updating it would help ensure it more accurately reflects the real world. 

Recognising EoE specifically in the atopic march would also have two key benefits: 

• For clinicians, it would enable a more proactive and possibly preventive approach to EoE screening and encourage a shift towards more holistic management strategies. 

• For patients and their loved ones, it would help them better understand what progression may look like for them, removing some of the uncertainty that comes with chronic conditions, and empowering them to look for symptoms early. 

The importance of food sensitisation and allergies 

90% of the children with EoE in this study also developed at least one allergic comorbidity by age 8. Children with food sensitisation or FA were also significantly more likely to develop EoE than those without, with milk sensitisation or allergy having the strongest association with EoE. 

In the future, these findings could help doctors proactively identify children at higher risk of developing EoE or an allergic comorbidity, making it easier to catch these conditions early. The sooner patients are diagnosed, the quicker they can be treated and the easier it is to prevent more severe symptoms like strictures. 

Beyond serving as a potential risk factor for proactive screening, these findings also suggest that the oesophageal epithelium may be the site where allergens bypass our bodies’ proactive barriers and trigger an immune response rather than the skin. If researchers can find out why, we may be able to better understand how these conditions work and what causes them. 

What’s next? 

Including EoE in the Atopic March will be an important step towards increasing clinical awareness, setting the stage for proactive screening in patients who develop AD and FA early in life. This will help facilitate earlier diagnosis, appropriate treatment, and avoid progressive inflammation and narrowing of the oesophagus. Further research exploring when EoE and allergic conditions develop will help us better understand where along the Atopic March it fits. 

Conclusion 

The study identified EoE as the fifth member of the Atopic March. It also highlighted that: 

• While most children with AD won’t develop EoE, the risk is 10 times higher than in children without AD. 

• Children with food sensitisation or allergy (especially to milk) are more likely to develop EoE.

Watch Dr Mark Rothenberg explain the study and why it matters in the video below, or read the full study.

References:

Chang WC, Martin LJ, Satish L, et al. Longitudinal enrichment of eosinophilic esophagitis in children with AD: The MPAACH cohort. Journal of Allergy and Clinical Immunology. 2026;157(4):999-1001. https://doi.org/10.1016/j.jaci.2026.01.012

Related news:

Exploring the Link Between Atopic Dermatitis and Eosinophilic Esophagitis

The Oesophagus: Not Just a Food Pipe But An Immune Organ