Dietary Interventions and Nutritional Factors in the Prevention of Allergic Diseases in Infants

Primary prevention strategies may play a role in reducing the burden of allergic diseases, especially in high-risk infants. Much has changed in the last two decades, moving from an avoidance approach to a proactive one, meaning that there is a possibility to actively modulate the immune system. The concept of allergen avoidance as a preventive measure has been challenged in the wake of recent randomized studies which shed light on the role of early oral exposure in inducing tolerance. It remains unknown whether the window of opportunity to induce tolerance varies depending on the food. Furthermore, growing evidence suggests that different nutritional factors may target the immune system via microbiota, offering a possible road map for allergy prevention.

As a result of these recent findings, primary prevention recommendations have recently been updated. Here we focus on the new recommendations, highlighting the changes from the previous report and critically discussing benefits and limits, as well as the possible implications for clinical practice. Much more data are needed on the impact of timing of the introduction of complementary foods on food allergy development, as well as on the role of different nutritional factors and dietary patterns in the prevention of allergic diseases. These and other knowledge gaps are addressed and future research directions are proposed.