Abstract
In exploring the ongoing controversy surrounding early diet and nutritional practices and the risk of allergic disease, it is important to begin by considering this in the wider context of increasing rates of many other diseases. Early nutrition has considerable implications for growth trajectory, neurodevelopment, and a microbiome profile that ideally promotes both metabolic and immune homeostasis. It is rapidly becoming clear that all of these factors are interconnected and that early nutrition can underpin the increasing propensity for many modern noncommunicable diseases (NCDs). Perhaps the greatest challenge of our time is overcoming the pandemic of NCDs, of which allergic disease is arguably one of the most common and the earliest to appear. Within the wider context of this growing burden of cardiovascular disease, obesity, metabolic disease, chronic lung disease, cancers, and so many other NCDs, the debate over the role of allergen exposure in the origins of allergic disease might seem underwhelming. However, as many other disciplines grapple with the maternal and infant dietary strategies to reduce obesity and cardiometabolic diseases, the mounting evidence that delayed complementary feeding might increase allergy risk is becoming a central issue in these interdisciplinary challenges. Already there is conflict and confusion over what constitutes optimal infant feeding guidelines, and there is an equal lack of clarity in defining dietary recommendations for pregnant and lactating women. Although there have been recommendations on many specific nutrients, some of these are now the subject of scrutiny. Moreover, the dramatic shift in philosophy toward consumption of allergenic foods, such as peanuts in pregnancy, has added to the confusion in both the public and professional domains. Within the space of only 10 years, we have moved from notions of avoidance for the prevention of sensitization to
Published Version
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