RECENT research has shed new light on allergic rhinitis (AR), a condition whose global burden is rising steadily among children. Once viewed as a predictable step within the so-called atopic march, new data from the Japan Environment and Children’s Study (JECS) indicate that the progression from early allergic diseases to AR is far from uniform. This large-scale cohort analysis reveals distinct allergic rhinitis phenotypes that may develop through separate biological pathways, offering fresh insights for prevention and management.
Distinct Pathways in Allergic Rhinitis Development
The JECS cohort followed more than 88,000 newborns across Japan, assessing allergic conditions from birth to age four. Children diagnosed with AR were classified into three groups: AD-AR (preceded by atopic dermatitis), Other-AR (preceded by food allergy or asthma), and AR-only (no prior allergy). While allergic rhinitis often co-occurred with other allergic diseases, findings showed that a significant portion of cases developed independently, challenging the traditional atopic march model.
Across all phenotypes, male sex and elevated IgE levels emerged as common risk factors. However, the AR-only group displayed an intriguing pattern, higher infection frequency appeared protective, whereas in AD-AR and Other-AR, frequent infections correlated with greater risk. This suggests that immune regulation and early microbial exposure may influence disease trajectories differently across subtypes.
Implications for Clinical Practice and Prevention
The identification of these allergic rhinitis phenotypes has meaningful clinical implications. The AD-AR group, linked strongly to parental allergic history and aeroallergen sensitisation, appears genetically driven and consistent with Th2-type immune responses. Conversely, AR-only may be more environmentally influenced, pointing to the potential benefit of early-life infection exposure or microbiome diversity in prevention strategies.
While this study is limited to early childhood, it highlights the heterogeneity of allergic rhinitis and the need for phenotype-specific management. Continued follow-up of the JECS cohort is expected to clarify long-term patterns, helping clinicians to better tailor interventions for children at varying stages of allergic disease progression.
Reference
Harama D et al. Not all rhinitis follows the atopic march: early-life risk factors and implications of infectious disease across three phenotypes in JECS cohort. Allergy. 2025;DOI:10.1111/all.70103.
