If you’re a parent staring down the barrel of a diagnosis like eczema, food allergies, or asthma in your child, you’re probably overwhelmed.

And for good reason. These aren’t just isolated conditions. They’re often the opening acts of a longer story called the atopic march.

Let’s break that down so you can do something about it.

What Is the Atopic March?

Think of it as a progression.

The atopic march is a pattern—a typical sequence—where allergic conditions evolve over time. Most commonly, it starts in infancy with eczema or food allergies. Then, as kids grow, symptoms can shift. Suddenly, the eczema clears up, but now they’re sneezing nonstop in spring, or coughing all night after recess.

This isn’t random.

The atopic march means your child’s immune system is hypersensitive. If left unchecked, eczema and food allergies often lead to allergic rhinitis, asthma, or both.

But if you catch this early and act, you can stop the march in its tracks.

How to Spot the First Clues

If your baby develops red, itchy patches of skin that don’t go away with basic moisturizers—or they have frequent reactions to milk, eggs, or peanuts—that’s your first warning sign.

Or maybe your toddler always has a runny nose, but no one else at daycare is sick. Or your 5-year-old coughs for three weeks straight every time they get a cold.

These are red flags.

Here’s what to do next:

1. Get IgE levels tested. It tells you how revved up your child’s immune system is.
2. Track triggers. Use a notebook or app to record foods, pets, environments.
3. See an allergist. Not a general pediatrician. A real allergy specialist.

What Triggers the Atopic March?

It’s a combo of genetics and environment.

If the parent has allergies or asthma, your child’s chances shoot up. Now layer on pets (especially cats), mold, dust mites, and dietary triggers like dairy or eggs, and you’ve got a cocktail for hypersensitivity.

Here’s what helps:

• Dogs (weirdly) are protective, but only in the first year of life.
• Cats? Total opposite. High allergen load.
• Diversity in the gut microbiome helps, especially early on. That’s where probiotics help.

Pro tip: rotate your child’s diet. Overexposure to the same few foods may increase risk. Diversity trains the immune system to chill out.

Eczema: The Skin That Opens the Door

Think of eczema (atopic dermatitis) as the “leaky skin” problem. 

When the skin barrier is compromised, allergens sneak in through the skin, not the gut. The immune system panics. It reacts. And from that point on, it’s on high alert and not focused on building up a tolerance.

The more inflamed the skin, the more doors are open. This is why babies with moderate to severe eczema have a much higher risk of developing food allergies and asthma later.

If you want to stop it, treat the skin aggressively and early.

I recommend applying thick emollients (not lotions) twice daily. Think Vaseline or CeraVe ointment. You can also use steroid creams when flare-ups start. And avoid fragrances and laundry detergents with dyes.

The earlier you slam the door shut, the less likely allergens are to get in.

Eczema and Food Allergies: The Messy Duo You Can’t Ignore

If your baby has eczema, chances are high that they’ll develop food allergies too. 

Why? Because the same overactive immune cells are running the show in both. Next thing you know, eggs cause a rash, milk makes the skin flare, and peanuts start a war under the surface, even if there’s no classic “allergic reaction.”

But here’s the key: don’t panic and eliminate every food. That can make things worse.

Here’s how to introduce food safely when your baby has eczema:

1. Start with proper IgE testing, not those mail-order sensitivity panels. Ask your allergist to test the big five: milk, egg, peanut, soy, and wheat.
2. Only avoid the foods that are BOTH positive on testing AND cause visible symptoms. A positive test alone doesn’t mean danger.
3. Reintroduce tolerated foods often. Avoiding safe foods unnecessarily increases the risk of becoming allergic to them later.
4. Introduce common allergens early, ideally before 12 months (under expert supervision if needed). Early exposure builds tolerance.

And now there’s serious help: Xolair.

FDA-approved for children as young as one, it blocks the allergy-driving IgE molecule. It can reduce eczema, lower the risk of food reactions, and even make existing food allergies less severe.

How to Tell If the March Is Continuing

You should look for these signs:

• They wheeze after running.
• They sneeze every day, especially outside.
• They get “stuck” in colds—coughing for 2-3 weeks every time.
• Their eczema flares more often or spreads.
• Their nose runs just from going outside.

Please don’t wait to treat them. You can start allergy shots (immunotherapy) as young as age 4 in special cases, and earlier you treat, the better the result.

The Treatments That Work

You need targeted, evidence-based treatments that get to the root of the problem.

Immunotherapy is one of the most powerful tools we have. By exposing the immune system to tiny amounts of an allergen over time, it helps build long-term tolerance and makes you less reactive to allergens, something no antihistamine can do. 

There’s also biologics, like Xolair and Dupixent, which have completely changed how we manage eczema, asthma, and food allergies. These medications don’t just put a Band-Aid on inflammation, they reset the immune system at the source.

Probiotics also play a role. You want a diverse blend, more like a rainforest than a monoculture. A varied gut microbiome helps regulate immune overreactions, especially in early childhood.

The Hopeful Future

Treatments like Xolair, oral immunotherapy, and biologics now allow us to change how the immune system reacts.

But timing matters. The earlier you act, the better your chances of stopping the atopic march in its tracks. Waiting often means chasing symptoms instead of preventing them.

And here’s the silver lining: treat the underlying allergy, and you often improve everything: eczema, asthma, food allergies, hay fever. 

One root cause, multiple wins.

If your child is showing signs, don’t wait. Act early and get ahead of the march. It will be far easier to help them now compared to when they move out on their own in the future.

The best way to grow out of these conditions is to take action before they grow worse.