Food Allergy (FA) is now one of the most common chronic diseases of
childhood often lasting throughout life and leading to significant
worldwide healthcare burden. The precise mechanisms responsible for the
development of this inflammatory condition are largely unknown; however,
a multifactorial aetiology involving both environmental and genetic
contributions is well accepted. A precise understanding of the
pathogenesis of FA is an essential first step to developing
comprehensive prevention strategies that could mitigate this epidemic.
As it is frequently preceded by atopic dermatitis and can be prevented
by early antigen introduction, the development of FA is likely
facilitated by the improper initial presentation of antigen to the
developing immune system. Primary oral exposure of antigens allowing for
presentation via a well-developed mucosal immune system, rather than
through a disrupted skin epidermal barrier, is essential to prevent FA.
In this review, we present the data supporting the necessity of 1) an
intact epidermal barrier to prevent epicutaneous antigen presentation,
2) the presence of specific commensal bacteria to maintain an intact
mucosal immune system and 3) maternal/infant diet diversity, including
vitamins and minerals, and appropriately timed allergenic food
introduction to prevent FA.