Food Allergy Prevention and Treatment by Targeted Nutrition

Abstract

In view of the dramatic rise in the prevalence of food allergy globally, effective prevention strategies have become a public health priority. Several models have emerged around the etiology of food allergy, including the hygiene hypothesis, dual allergen exposure hypothesis, and vitamin D hypothesis. These form the basis for current and potential prevention strategies. Breastfeeding remains a key pillar of primary allergy prevention. Other nutritional interventions, including the use of whey-based, partially hydrolyzed formula in non-breastfed infants, also play an important role. In recent years, there has been a shift away from prolonged food allergen avoidance to the proactive allergen introduction from 4 months of age. This approach is supported by 2 pivotal randomized clinical trials showing that the early introduction of peanut and other food allergens significantly reduces the risk of food allergy. However, the implementation of this strategy at the population level still raises significant logistic problems, including patient selection and development of suitable food formats for young infants. Other prevention strategies, including vitamin D supplementation, are currently under evaluation. Maternal elimination diets during pregnancy and lactation are not recommended for allergy prevention. The treatment of food allergies has also seen major transformations. While strict allergen avoidance is still the key treatment principle, there is a greater focus on desensitization and tolerance induction by oral and epicutaneous immunotherapy. In addition, specialized hypoallergenic infant formulas for the treatment of infants with cow’s milk allergy have undergone reformulation, including the addition of lactose and probiotics in order to modulate the gut microbiome and early immune responses. Further research is needed to inform the most effective food allergy prevention strategies at the population level. In addition, the wider application of food allergen immunotherapy may provide better health outcomes and improved quality of life for families affected by food allergies.

Strategies and Future Opportunities for the Prevention, Diagnosis, and Management of Cow Milk Allergy

“…However, its effect on reducing the risk of AD has been reported in a meta-analysis ( 100 ) and in infants ( 102 ). No studies have reported the effect of supplementing strain-specific probiotics during pregnancy or early life in primary prevention of CMA ( 103 , 104 ). However, the effect of mixed strains of probiotics, or synbiotics (a mixture of pre- and pro-biotics) to achieve greater microbiota diversity has been shown to reduce the risk of necrotizing enterocolitis in premature infants.…”

“…There are significant differences in the molecular weights and profiles of peptides in eHF ( 106 , 107 ). A task force of the European Academy of Allergy and Clinical Immunology (EAACI) has therefore called for stricter standards for the definition of eHF marketed in Europe, including preclinical testing, quality assurance, and labelling requirements ( 104 ). In 2016, DRACMA updated their recommendation to include the provision of rice hydrolysate in the first-line management in countries where this formula is available ( 108 ).…”

Vitamin D and Microbiota: Is There a Link with Allergies?

“…Independent of eczema severity, skin S. aureus colonization was associated with hen′s egg and peanut sensitization and persistent allergy, with a weaker association seen for cow′s milk, in a study that followed children from infancy to six years of age [ 106 ]. As a matter of fact, although strict allergen avoidance is still the key treatment for food allergy, there is a greater focus on the preventive effect of the addition of lactose and probiotics to hypoallergenic infant formulas in order to modulate the gut microbiome and early immune responses in high-risk populations, either in families with a history of allergies, or in infants who are showing evidence of food sensitization or eczema [ 28 , 107 ]. Only a few trials of probiotics for the prevention or treatment of challenge-proved food allergies have been published.…”

“…According to the vitamin D hypothesis, adequate vitamin D l and supplementation in the first year of life can sensitize children against allergen reduce the risk of development of food allergies and asthma [27]. On the other hand, levels of vitamin D may also increase the risk of allergic sensitization by inhibitin maturation of dendritic cells and the development of T-helper 1 responses [28]. Res into the gut microbiome and vitamin D is therefore considered to be promising fo understanding, treatment, and prevention of autoimmune and allergic diseases [29] The effects of hypovitaminosis D and dysbiosis on immune system are depict Figure 3.…”

Tolerância de Mucosa: nova ou velha abordagem no tratamento das sensibilidades alimentares?

“…Nesse contexto, a utilização de probióticos parece ter efeito positivo em longo prazo, assim como a utilização de fibras prebióticas que serão fermentadas pelas bactérias da microbiota. A fermentação é que garante a produção dos AGCC que têm efeitos benéficos no controle de diferentes doenças inflamatórias 48,49,[50][51][52] ;…”