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Early intervention and prevention of allergic diseases
  • +13
  • Helen Brough,
  • Bruce Lanser,
  • Sayantani Sindher,
  • Joyce Teng,
  • Donald Leung,
  • Carina Venter,
  • Susan Chan,
  • Alexandra Santos,
  • Henry Bahnson,
  • Emma Guttman-Yassky,
  • Ruchi Gupta,
  • Gideon Lack,
  • Christina Ciaccio@bsd.uchicago.edu,
  • Vanitha Sampath,
  • Kari Nadeau,
  • Cathryn Nagler
Helen Brough
King's College London Faculty of Life Sciences and Medicine
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Bruce Lanser
National Jewish Health
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Sayantani Sindher
Stanford University School of Medicine
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Joyce Teng
Lucile Salter Packard Children's Hospital at Stanford
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Donald Leung
National Jewish Health Division of Allergy & Clinical Immunology
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Carina Venter
University of Colorado Denver Children's Hospital Colorado Research Institute
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Susan Chan
King's College London Faculty of Life Sciences and Medicine
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Alexandra Santos
King's College London Faculty of Life Sciences and Medicine
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Henry Bahnson
Benaroya Research Institute at Virginia Mason
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Emma Guttman-Yassky
Rockefeller University
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Ruchi Gupta
Ann and Robert H Lurie Children's Hospital of Chicago
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Gideon Lack
King's College London Faculty of Life Sciences and Medicine
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Christina Ciaccio@bsd.uchicago.edu
University of Chicago Department of Medicine
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Vanitha Sampath
Stanford University School of Medicine
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Kari Nadeau
Stanford University School of Medicine
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Cathryn Nagler
University of Chicago Pritzker School of Medicine
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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.