Early dietary exposures and feeding practices: role in pathogenesis and prevention of allergic disease?
- School of Paediatrics and Child Health Research, University of Western Australia, Perth, Western Australia
- Correspondence to Professor S L Prescott, School of Paediatrics and Child Health Research, University of Western Australia, Princess Margaret Hospital, PO Box D184, Perth, WA 6001, Australia; sprescott{at}meddent.uwa.edu.au
- Received 29 June 2009
- Accepted 30 August 2009
Abstract
Immune dysregulation has become a hallmark of the modern era. This has led to an epidemic of disease states that result from failed immune surveillance and inappropriate or maladaptive immune responses to self-antigens (autoimmunity) and environmental antigens (allergy). Although environmental change is clearly implicated, the specific causes are still unconfirmed. Any hope to reverse such immune dysfunction must be based on a clearer understanding of the causal pathways and the environmental factors that may be driving the concerning surge in disease rates. This review explores the role of modern dietary changes that, through their known documented immune effects, may play a role in either promoting or preventing disease. Food allergen avoidance has been largely unsuccessful, and most expert bodies no longer recommend delayed complementary feeding or the avoidance of any specific allergenic foods, unless symptoms develop and allergy is confirmed. Rather, focus has shifted to other factors that may influence the ability to develop immune tolerance. There is now evidence that specific nutrients, such as folate, have the capacity to promote an allergic phenotype by epigenetically altering gene expression during early development. A number of other dietary factors including n-3 polyunsaturated fatty acids, oligosaccharides, probiotics, vitamin D, retinoic acid and other antioxidants may also clearly influence immune function and immune development. This review summarises the current evidence, recommendations and future directions in the context of allergy, with the aim of highlighting the need to further investigate the role of diet and nutrition in disease pathogenesis and prevention.
Footnotes
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Competing interests SLP has been a speaker at meetings sponsored by SHS/Nutricia and Nestlé. She has been a member of the independent Scientific Advisory Board of Nestlé Nutrition Institute Oceania, on an expert panel on cows milk allergy for Nutricia Australia and an expert panel on omega-3 for M fatty acid sead Johnson. She has received travel assistance and speaker fees from these companies to present at or attend scientific meetings.
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Provenance and peer review Commissioned; externally peer reviewed.
