Introduction
Early onset atopic dermatitis (AD) has been strongly linked with food
allergy.1 The dual-allergen exposure hypothesis
postulates that food allergy pathogenesis arises from a disrupted skin
barrier in early life which promotes allergen penetrance, cutaneous
sensitization and downstream Th2 cytokine dysregulation and production
of antigen-specific IgEs, manifesting in clinical allergy upon oral
challenge.2 Conversely, oral exposure to food
allergens before this pathway has been established promotes tolerance.
Early introduction of allergenic foods, either single foods like egg or
peanut, 3, 4 or multiple foods5 to
infants at high-risk of food allergy have been shown to reduce the risk
of food allergy development.
Other strategies for food allergy prevention have centered mainly around
primary prevention of AD, and thus prevention of food allergy as a
secondary effect. However, recent studies have suggested that in the
presence of established AD, secondary prevention of food sensitization
or even food allergy might be achieved through aggressive treatment of
AD in early infancy.6, 7 This would potentially
restore the disrupted skin barrier before the development of cutaneous
sensitization. This review thus aims to summarize emerging strategies in
skin management for food allergy prevention.