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.