FROM ATOPIC ECZEMA TO ASTHMA AND ALLERGY

The prevalence of atopic eczema has been regularly increasing for seve ral 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 t ime and often excessively subjective. Over the last 5 years,tbe public ation of documented studies therefore encouraged us to re-evaluate the relationships between atopic dermatitis, asthma and IgE-dependent all ergy. Eczematous patients appear to have a high risk of developing ast hma 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 eczem a are usually exposed to a high allergenic load of respiratory allerge ns, but also to the usual food allergens, all too frequently underesti mated. In practice, allergological investigation, useless when eczema is only moderate, is essential in the presence of severe dermatosis. H owever, in the presence of food sensitization(s), exclusion is only in dicated after a precise allergological inventory and never on the basi s of fallacious isolated positive in vitro tests; The natural history of atopic eczema remains uncertain in individual patients, hence the v alue of regular clinical surveillance focused on early detection of re spiratory risks. Attempts to reduce the subsequent atopic risk warrant further investigation: primary prevention of atopic eczema and second ary prevention of the other manifestations of atopy (rhinitis and asth ma) in children already suffering from atopic dermatitis.