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Diet and Lifestyle Factors Associated with Allergic Diseases in Early Life

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Immunology".

Deadline for manuscript submissions: closed (15 June 2025) | Viewed by 12102

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Special Issue Editor

Dr. Remo Frei

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Guest Editor

1. Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
2. Division of Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
Interests: allergy; immune regulation; microbiome; metabolome; short-chain fatty acids; inflammatory response; epithelial barrier integrity

Special Issue Information

Dear Colleagues,

The prevalence of allergic diseases has increased in the past few decades in Westernized countries. Nowadays, up to 30% of children suffer from at least one allergic disease, making allergies a significant public health concern. Allergies are a complex inflammatory disease characterized by a T-helper cell-type-2-driven phenotype, as well as epidermal and immune-related genotypes, skin barrier defects, immune dysregulation and microbial dysbiosis.

Epidemiological studies have shown that lifestyle factors such as growing up on a farm or nutrition diversity in the first year of life can beneficially influence the developing gut microbiome and metabolome; both factors have been connected to healthy immune homeostasis and epithelial barrier integrity development in children.

Understanding the influences of dietary and lifestyle factors on the development of the microbiome and the immune system is crucial to reversing the increase in allergy prevalence and developing preventive strategies. Therefore, this Special Issue, titled ‘Diet and Lifestyle Factors Associated with Allergic Diseases in Early Life’, will highlight these issues in greater depth.

Dr. Remo Frei
Guest Editor

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Keywords

allergy
lifestyle
nutrition
immune regulation
epithelial barrier function
microbiome
metabolome
risk factor
protective factor
early life
childhood

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Published Papers (5 papers)

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Research

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14 pages, 281 KB

Open AccessArticle

Can Faecal Eosinophil Cationic Protein and β-Defensin-2 Levels Be Useful in the Diagnosis and Follow-Up of Infants with Milk-Protein-Induced Allergic Proctocolitis?

by Grażyna Czaja-Bulsa, Monika Łokieć and Arleta Drozd

Nutrients 2025, 17(17), 2796; https://doi.org/10.3390/nu17172796 - 28 Aug 2025

Viewed by 851

Abstract

Objective: The aim of our study was to investigate whether faecal concentrations of eosinophil cationic protein (fECP) and human β-defensins (HBD2s) are significantly elevated in children with cow’s milk-protein-induced allergic colitis (MPIAP) and whether a monthly milk-free diet reduces these markers. Materials and methods: This was a single-centre, prospective, observational cohort study involving 70 infants with MPIAP, aged 1–3 months, and 30 healthy controls of the same age. The concentrations of fECP and HBD2 were measured using the ELISA method (IDK^® Eosinophil Cationic Protein and β-Defensins ELISA Kit, Immunodiagnostik AG, Germany). Diagnosis of MPIAP was confirmed with an open milk challenge test. Results: The concentrations of fECP and HBD2 proved useful in evaluating MPIAP treatment with a milk-free diet, where the resolution of allergy symptoms and a significant (p = 0.0000) decrease in the concentrations of both biomarkers were observed after 4 weeks of following the diet. The concentrations of fECP and HBD2 were still higher than those in the control group. High concentrations of fECP can be helpful in diagnosing MPIAP (100% sensitivity), but the low specificity of the assay means that there is a risk of diagnosing MPIAP in one in six children who do not have the disease. The concentrations of HBD2 have low sensitivity, so one in four children with MPIAP will not be confirmed to have the disease using this indicator. Conclusions: fECP and HBD2 can be used to monitor the resolution of colitis in infants with MPIAP treated with a milk diet, indicating a slower resolution of allergic inflammation than the resolution of allergic symptoms. Therefore, neither of the parameters are useful for the diagnosis of MPIAP. Full article

(This article belongs to the Special Issue Diet and Lifestyle Factors Associated with Allergic Diseases in Early Life)

13 pages, 691 KB

Open AccessArticle

Diet Diversity and Adherence to a Mediterranean Diet Pattern in Pregnancy Is Protective Against the Development of Early-Childhood Atopic Dermatitis

by Kristina Nadine Heye, Leonie Helen Bogl, Mari Sasaki, Remo Frei, Anna Breunig, Neeta Bühler, Christian Raphael Kahlert, Mehmet Goekkaya, Claudia Traidl-Hoffmann, Roger Lauener, CK-CARE study group and Caroline Roduit

Nutrients 2025, 17(13), 2243; https://doi.org/10.3390/nu17132243 - 7 Jul 2025

Viewed by 1293

Abstract

Background/Objectives: The role of maternal diet in atopic dermatitis (AD) requires better understanding, as AD often manifests early in life and precedes other allergic diseases. We evaluated the association between maternal diet and AD up to 2 years of age. Methods: A total of 116 mother–child dyads from the CARE birth cohort study were included. Maternal diet during pregnancy was assessed with a validated self-administered 97-item food frequency questionnaire, and dietary scores were calculated. AD was evaluated at ages 4 months, 1 year, and 2 years. The associations between maternal dietary patterns and AD were examined by logistic regression analysis adjusting for total energy intake, gender of the child, maternal antibiotic therapy during pregnancy, and history of atopic disease among both parents. Results: Of the 116 children, 27 (23.3%) developed AD by 2 years, 11 of whom (40.7%) had persistent AD within the first 2 years. AD risk was reduced with a higher Mediterranean diet score during pregnancy (upper median > 3 points versus lower median: adjusted OR 0.24, 95% CI 0.08–0.69, p = 0.009) and with greater dietary diversity, as measured by the number of items consumed (upper median > 53 items versus lower median: OR 0.19, 95% CI 0.06–0.58, p = 0.005). No association was found with macronutrients and micronutrients. Red meat consumption showed a positive association with the persistent AD phenotype (adjusted OR 5.04, 95% CI 1.47 to 31.36, p = 0.034). Conclusions: Adherence to a Mediterranean diet and a diverse diet during pregnancy may decrease the risk of developing early childhood AD. This highlights the synergistic role of nutrients in dietary patterns as they modulate immune development and disease susceptibility. Full article

(This article belongs to the Special Issue Diet and Lifestyle Factors Associated with Allergic Diseases in Early Life)

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11 pages, 263 KB

Open AccessArticle

Validation of a Food Frequency Questionnaire: VioScreen-Allergy

by Kaci Pickett-Nairne, Deborah Glueck, Jessica Thomson, Rick Weiss, Kelly N. Z. Fuller, Stefka Fabbri, Claudia Schaefer, Courtney Evans, Emily Bowhay, Monica Martinez, Wendy Moore, David Fleischer and Carina Venter

Nutrients 2024, 16(21), 3772; https://doi.org/10.3390/nu16213772 - 2 Nov 2024

Cited by 1 | Viewed by 2165

Abstract

Background/Objectives: An adapted version of an online pictorial food frequency questionnaire (FFQ), VioScreen-Allergy, assesses total dietary intake and intake of allergens and foods in the maternal diet index (MDI), linked to offspring allergy. This study assessed intermethod reliability, test–retest reliability, and external validity of the VioScreen-Allergy. Methods: Females of childbearing age were recruited at Denver Health and Children’s Hospital, Colorado, USA, and were asked to complete four 24 h recalls and two VioScreen-Allergy FFQs over the course of a month. All those with at least two 24 h dietary recalls and both VioScreen-Allergy assessments were analyzed. Energy-adjusted and non-adjusted linear mixed models (1) compared MDI scores and intake of nutrients and allergens as measures of intermethod reliability; (2) evaluated VioScreen-Allergy test–retest reliability as differences between repeated measurements; and (3) assessed external validity by modeling associations between VioScreen-Allergy-derived intake of beta-carotene and orange vegetables and Veggie Meter^®-assessed skin carotenoids. Bonferroni corrections controlled multiple comparisons within the assessment. Results: Of 53 participants enrolled, 25 demographically dissimilar participants were included in the analysis. There were no significant differences between 24 h recall and VioScreen-Allergy mean intakes of macronutrients, micronutrients, allergens, or MDI, except for Vitamin C, niacin, and cashew allergen protein. There were no significant differences between repeated measurements of VioScreen-Allergy, either energy-adjusted or unadjusted. Both beta-carotene and orange vegetable servings were significantly associated with Veggie Meter^®. Conclusions: Although non-significance could have been due to low power, clinical as well as statistical assessments of intermethod reliability, test–retest reliability, and external validity suggest that VioScreen-Allergy has reasonable utility for trials assessing food allergens and MDI in the context of overall intake. The VioScreen questionnaire can also be used in future studies to assess macro- and micronutrient intake. Additional validation studies assessing different portion sizes and foods eaten by infants and young children are currently undergoing. Full article

(This article belongs to the Special Issue Diet and Lifestyle Factors Associated with Allergic Diseases in Early Life)

Review

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16 pages, 285 KB

Open AccessReview

Cow’s Milk Allergy in Breastfed Infants: What We Need to Know About Mechanisms, Management, and Maternal Role

by Carlo Caffarelli, Arianna Giannetti, Enrico Vito Buono, Daniela Cunico, Roberta Carbone, Federica Tonello and Giampaolo Ricci

Nutrients 2025, 17(11), 1787; https://doi.org/10.3390/nu17111787 - 24 May 2025

Cited by 1 | Viewed by 5722

Abstract

Cow’s milk allergy is one of the most prevalent food allergies in infancy. Exclusive breastfeeding is the recommended source of nutrition for the first six months of life, but some infants may develop cow’s milk allergy due to the transfer of milk proteins such as β-lactoglobulin through breast milk. There are still many uncertainties about cow’s milk allergy in breastfed babies. The purpose of this review is to summarize the latest findings mainly focused on immunological mechanisms and challenges in diagnosis. We pointed out which clinical signs in breastfed infants are associated with immediate IgE responses and which are linked to delayed non-IgE mechanisms or mixed IgE/non-IgE-mediated reactions. Since standard IgE tests are often useless in non-IgE cases, diagnosis typically involves dietary elimination and cow’s milk challenge. This study addresses the controversial topic of maternal elimination diets, assessing the nutritional risks to both mothers and infants in relation to their possible benefits. It has also been discussed whether the microbiota signature could be a potential factor in both tolerance development and the risk of cow’s milk allergy in early life. Overall, accurate diagnosis and personalized treatment plans are vital to prevent overdiagnosis and ensure proper growth while maintaining the practice of breastfeeding. Full article

(This article belongs to the Special Issue Diet and Lifestyle Factors Associated with Allergic Diseases in Early Life)

Other

Jump to: Research, Review

7 pages, 268 KB

Open AccessBrief Report

Parental Motivation for Introducing Babies’ First Foods and Common Food Allergens

by Zoe Harbottle, Elly Malm Nilsson, Carina Venter, Michael A. Golding, Sandra Ekström and Jennifer L. P. Protudjer

Nutrients 2025, 17(11), 1812; https://doi.org/10.3390/nu17111812 - 27 May 2025

Cited by 1 | Viewed by 1313

Abstract

Background/Objectives: Findings from the Learning Early About Peanut trial prompted a shift in clinical practice guidelines to support the early and continuous introduction of allergenic foods to reduce the risk of food allergy. Our study aimed to describe the reasoning behind parents’ decisions on the introduction of first foods to their infants and the age at which parents first introduced common allergens. Methods: Parents of a child aged <18 years old with ≥1 food allergy, who lived in either Canada or the United States, were recruited via social media between March 2021 and February 2022 to participate in an online, anonymous survey. Data were analyzed descriptively and using binary logistic regression. Results: A total of 42 parents completed the survey, the majority being mothers (40/42; 95.2%). Children were, on average, 6.9 ± 0.7 years old. In total, 47.6% of parents introduced first foods between ages 4–5 months, whereas 52.4% introduced first foods at 6 months or older. Cereals were the most frequently introduced first food (54.8%; 23/42). Most parents (71.9%) selected first foods to introduce based on guidance from healthcare providers. Conclusions: For many parents, guidance from healthcare providers is the most influential factor in determining when and what to introduce as first foods to their infant. Although the paradigm shift in infant feeding practices has been well accepted by healthcare providers, this information has not been adequately translated to the general population. This emphasizes the need for healthcare providers to educate and reinforce the importance of early introduction to reduce the risk of food allergy. Full article

(This article belongs to the Special Issue Diet and Lifestyle Factors Associated with Allergic Diseases in Early Life)

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