Abstract
There has been a dramatic rise in the prevalence of IgE-mediated food allergy over recent decades, particularly among infants and young children. The cause of this increase is unknown but one putative factor is a change in the composition, richness and balance of the microbiota that colonize the human gut during early infancy. The coevolution of the human gastrointestinal tract and commensal microbiota has resulted in a symbiotic relationship in which gut microbiota play a vital role in early life immune development and function, as well as maintenance of gut wall epithelial integrity. Since IgE mediated food allergy is associated with immune dysregulation and impaired gut epithelial integrity there is substantial interest in the potential link between gut microbiota and food allergy. Although the exact link between gut microbiota and food allergy is yet to be established in humans, recent experimental evidence suggests that specific patterns of gut microbiota colonization may influence the risk and manifestations of food allergy. An understanding of the relationship between gut microbiota and food allergy has the potential to inform both the prevention and treatment of food allergy. In this paper we review the theory and evidence linking gut microbiota and IgE-mediated food allergy in early life. We then consider the implications and challenges for future research, including the techniques of measuring and analyzing gut microbiota, and the types of studies required to advance knowledge in the field.
Highlights
Food allergy is one of the epidemics of the modern world
Determination of primarily food sensitization and subsequently challenge proven IgE-mediated food allergy status will provide an ideal cohort for gut microbiota analysis at an early life stage which has been lacking in previous studies
The microbiome that occupies the human gut and its role in health and disease has become the target of intense scrutiny in recent years and there is evidence of its importance in autoimmune disease, obesity and allergic disease in general
Summary
Food allergy is one of the epidemics of the modern world. Over the last twenty years rates of potentially life threatening reactions to food (anaphylaxis) have steadily risen in the developed world [1]. This association has been shown in several studies including the GABRIELA and PARSIFAL cohorts [10,11,12] It appears this early life farm exposure effect is mediated predominantly by microbial experience as children on farms are exposed to diverse microbial environments. It is plausible that such early life exposure modifies the composition of the human microbiome which may explain the association between non-pathogenic microbial experience, immune development and allergic disease. We assess the current evidence for the association between specific factors in the modern environment and both: (a) the composition of the gut microbiota and (b) IgE-mediated food allergy in children. There is a strong theoretical basis for the hypothesis that the composition of the gut microbiome during early life may influence the risk of food allergy. IgE-mediated food allergy is characterized by allergic sensitization and subsequent clinical allergic reaction following antigen re-exposure through the gut.
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