Early intervention and prevention of allergic diseases.

Helen A Brough, Bruce Joshua Lanser, Sayantani B Sindher, Joyce M C Teng, Donald Y M Leung, Carina Venter, Susan M Chan, Alexandra F Santos, Henry T Bahnson, Emma Guttman-Yassky, Ruchi S Gupta, Gideon Lack, Christina E Ciaccio, Vanitha Sampath, Kari C Nadeau, Cathryn R Nagler

Journal: Allergy 2022;77(2):416-441

PMID: 34255344

Abstract

Food allergy (FA) is now one of the most common chronic diseases of childhood often lasting throughout life and leading to significant worldwide healthcare burden. The precise mechanisms responsible for the development of this inflammatory condition are largely unknown; however, a multifactorial aetiology involving both environmental and genetic contributions is well accepted. A precise understanding of the pathogenesis of FA is an essential first step to developing comprehensive prevention strategies that could mitigate this epidemic. As it is frequently preceded by atopic dermatitis and can be prevented by early antigen introduction, the development of FA is likely facilitated by the improper initial presentation of antigen to the developing immune system. Primary oral exposure of antigens allowing for presentation via a well-developed mucosal immune system, rather than through a disrupted skin epidermal barrier, is essential to prevent FA. In this review, we present the data supporting the necessity of (1) an intact epidermal barrier to prevent epicutaneous antigen presentation, (2) the presence of specific commensal bacteria to maintain an intact mucosal immune system and (3) maternal/infant diet diversity, including vitamins and minerals, and appropriately timed allergenic food introduction to prevent FA.

© 2021 EAACI and John Wiley and Sons A/S.

Address: Department Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK.; Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK.; Division of Pediatric Allergy-Immunology, Department of Pediatrics, National Jewish Health, Denver, CO, USA.; Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA.; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.; Division of Allergy, Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA.; Department of Dermatology, Lucile Packard Children's Hospital at the Stanford University School of Medicine, Palo Alto, CA, USA.; Section of Allergy & Immunology, School of Medicine, University of Colorado Denver, Children's Hospital Colorado, Aurora, CO, USA.; Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.; Benaroya Research Institute and Immune Tolerance Network, Seattle, WA, USA.; Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA.; Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.; Department of Pediatrics and Medicine, University of Chicago, Chicago, IL, USA.; Department of Pathology and Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, USA.
Bant logo

© Copyright 2026, Nutrition Evidence

NED wishes to thank the following organisations for their support:

We use cookies to improve your experience and analyze site traffic with Google Analytics. By continuing to use our site, you agree to our use of cookies. Learn more.