Food Allergies & Atopic Diseases

Dr. Xinxin Liu
Food Allergy : Cow's Milk Allergy

Food allergy is one the of the most common chronic diseases of childhood, especially if persistent, impacting growth and nutrition, quality of life, and may even be life threatening due to the risk of anaphylaxis.

Overall, the estimated childhood food allergy, is about 8% in the developed countries, such as US (Gupta et al., 2018). Cow’s milk allergy (CMA) is one of the most common types of food allergy in infants. IgE-mediated CMA affects approximately 2% of the population under 4 years of age worldwide (Rona et al., 2007). Data reviewed from the largest cohort studies in Europe, US and Australia conclude an estimated prevalence of up to 3% in infants (Flom and Sicherer 2019).

Dietary Management of Cow's Milk Allergy

Dietary management of CMA consists of 2 approaches, one is “passive” approach, consisting of elimination diet, the other one is “proactive” approach, meaning actively modulate the immune system. Gut microbiota dysbiosis induces altered gut function, which results in aberrant immune response towards allergic pathways instead of protective tolerogenic pathways (Plunkett and Nagler 2017).

Furthermore, the gut immune system, the so-called gut-associated lymphoid tissue (GALT), has 70 – 80% of the immune cells of the body (Castro and Arntzen, 1993), which make it the largest ‘immune organ” of the body. Targeting gut microbiota by using nutritional factors to actively immunomodulate the immune system opens therefore exciting research potential.

Atopic Dermatitis

Another common childhood disease, Atopic dermatitis (AD), is commonly associated with food allergy, as well as other atopic manifestations (allergic rhinitis and asthma). Presence of food sensitization and allergy early in life predicts a prognosis of severe AD.

AD has increased 2- to 3-fold in industrialized countries since the 70s, and is the most common skin disease in children, affecting up to 20% of children and up to 3% of adults (Nutten 2015). Evidence that the intake of probiotics, prebiotics or synbiotics is beneficial in AD prevention is gathering momentum (Szari and Quinn 2019) in the recent years, which represents a novel research strategy in AD management.


1. Castro, G. A., & Arntzen, C. J. (1993). Immunophysiology of the gut: a research frontier for integrative studies of the common mucosal immune system. American Journal of Physiology-Gastrointestinal and Liver Physiology, 265(4), G599-G610.

2. Catherine H. Plunkett, Cathryn R. Nagler; The Influence of the Microbiome on Allergic Sensitization to Food. J Immunol 15 January 2017; 198 (2): 581–589.

3. Flom JD, Sicherer SH. Epidemiology of Cow's Milk Allergy. Nutrients. 2019 May 10;11(5):1051.  

4. Gupta RS, Warren CM, Smith BM, et al. The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States. Pediatrics. 2018;142(6):e20181235

5. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66(suppl 1):8-16. doi:10.1159/000370220.

6. Rona RJ, Keil T, Summers C, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007;120(3):638–646.

7. Szari S, Quinn JA. Supporting a healthy microbiome for the primary prevention of eczema. Clin Rev Allergy Immunol2019; 57: 286–293.

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