Abstract
Atopic dermatitis is one of the most frequent chronic skin diseases worldwide and often develops within the first few years of life. Recent advancements in our knowledge of its pathophysiology have brought to light the role of genetic predisposition and environmental triggers. With the increasing prevalence of allergic diseases, there is a strong need for a better understanding of the various modifiable eliciting factors of such conditions. The concomitant rise in food allergy and insights into the skin barrier function has highlighted the role of nutrition and diet in the prevention and modification of allergic disorders. Furthermore, the identification of the skin as an important route of sensitization, and the risk of progression to asthma later in life, stress the significance of optimizing our management of skin inflammation in the prevention of allergies. Many nutritional factors, including the type of maternal diet during pregnancy, the duration of breastfeeding, the epicutaneous exposure of allergenic food proteins in the first few years of life, the timing of the introduction of complementary foods, the supplementation of vitamins and probiotics/prebiotics during prenatal and early life, have been assessed as potential targets for the prevention of atopy and eczema. Here, we review the latest data addressing prenatal and perinatal nutritional and dietary interventions in the primary prevention of atopic dermatitis. Also, we define knowledge gaps and targets for future research in the prevention of atopic dermatitis.
Highlights
Atopic dermatitis (AD) is a common inflammatory skin disease, which affects as many as one-fifth of all individuals [1] and is associated with a high financial and psychosocial burden for patients and their families [2, 3]
Recent findings in the pathogenesis of AD have revealed a complex interplay between impairment of the skin barrier function, environmental and nutritional factors, and immune dysregulation [6,7,8,9], which begins in early life
We focus on currently available evidence on the nutritional and dietary factors that could be involved in the occurrence of AD and could be targeted for the prevention of this disease (Figure 1)
Summary
Atopic dermatitis (AD) is a common inflammatory skin disease, which affects as many as one-fifth of all individuals [1] and is associated with a high financial and psychosocial burden for patients and their families [2, 3]. Two earlier RCTs reported no significant difference between pHF and eHF for the prevention of allergic diseases and AD in children [48, 49] This finding was in contrast to an earlier study by Oldaeus et al [50], who found a lower incidence of AD in at-risk infants fed with a casein-based eHF, compared with those receiving a whey-based pHF or standard cow’s milk formula (CMF). The GINI study, a prospective, randomized, double-blind trial, conducted among at-risk children, found a lower risk of AD at 3 and 6 years of life among those children who received a whey-based pHF or a casein-based eHF in their first 4 months, compared to those receiving CMF [51] This finding was exclusive to eczema as hydrolysate nutrition did not have a preventive effect on asthma or childhood wheezing [51].
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