FROM ATOPIC ECZEMA TO ASTHMA AND ALLERGY

The prevalence of atopic eczema has been regularly increasing for several decades: over the last 20 years, it has doubled in industrialized countries to reach 12 to 20%. The relationships between atopic eczema, asthma and bronchial hyperreactivity have remained vague for a long time and often excessively subjective. Over the last 5 years,tbe publication of documented studies therefore encouraged us to re-evaluate the relationships between atopic dermatitis, asthma and IgE-dependent allergy. Eczematous patients appear to have a high risk of developing asthma and/or bronchial hyperreactivity: they must therefore be informed of these risks and should receive preventive measurements, especially based on a good health education. Subjects suffering from severe eczema are usually exposed to a high allergenic load of respiratory allergens, but also to the usual food allergens, all too frequently underestimated. In practice, allergological investigation, useless when eczema is only moderate, is essential in the presence of severe dermatosis. However, in the presence of food sensitization(s), exclusion is only indicated after a precise allergological inventory and never on the basis of fallacious isolated positive in vitro tests; The natural history of atopic eczema remains uncertain in individual patients, hence the value of regular clinical surveillance focused on early detection of respiratory risks. Attempts to reduce the subsequent atopic risk warrant further investigation: primary prevention of atopic eczema and secondary prevention of the other manifestations of atopy (rhinitis and asthma) in children already suffering from atopic dermatitis.