Allergy & Immunology

Food Allergies

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The Role of the Gut Microbiome in the Development of Food Allergies

clinical topic updates by Edwin Kim, MD, MS
Overview

The role of the gut microbiome in the development of food allergies is an area of continued research. Edwin Kim, MD, MS, provides insights into this relationship and how pre- and probiotics, along with other interventions, might help to prevent and manage food allergies.

Expert Commentary
“When it comes to the gut microbiome and food allergies, it seems like the best opportunity for success may be more on the side of prevention.”
— Edwin Kim, MD, MS

Gaining a better understanding of the role of the gut microbiome in food allergies is important, although how best to study that is still being teased out. We need to continue to improve our understanding of how best to interpret and analyze the truckloads of data that have come out in this field.

 

At this point, a lot of studies have suggested that there are certain classes of microbiota in the gut that may be more protective. And Clostridia is 1 genus that comes up very frequently as being seemingly protective against food allergies. The current thought is that having more of a certain combination of microbiota, or maybe a certain single class, may predispose the patient to the development of more of the regulatory part of the immune system, the regulatory T cells in particular. And this hopefully sets up an environment where the body is more likely to tolerate potential allergens, as opposed to having an allergic or inflammatory response to them.

 

With that in mind, there is a lot of interest in seeing if there is a way that we can set up a young child’s—or even an infant’s—gut microbiome to be in a more tolerogenic state so that they are more likely to tolerate potentially allergenic foods such as milk, eggs, or peanuts when they are first introduced, as opposed to becoming allergic. Possible interventions could include vaginal birth; prebiotics, probiotics, or both for infants and breastfeeding mothers; and, perhaps in the future, fecal microbiota transplantation.

 

When it comes to the gut microbiome and food allergies, it seems like the best opportunity for success may be more on the side of prevention. However, there have been some studies that have tried to look at changing the microbiome after someone has presented with a food allergy. For example, a study from Australia examined the idea of combining peanut oral immunotherapy (OIT) with a proprietary probiotic. A glass-half-full aspect of this study is that, although perhaps the overall efficacy was not very different, the safety of the probiotic and peanut OIT combination did seem better than that of peanut OIT alone. In particular, there seemed to be fewer gastrointestinal side effects than that reported in classic OIT studies, indicating that there still could be a role there on the therapeutic side. So, even if the efficacy does not ultimately get us to the full tolerance that we are looking for, if that is a way that we can reduce the number of side effects with OIT, there still may be a role for probiotics in the management of food allergies.

References

Bao R, Hesser LA, He Z, Zhou X, Nadeau KC, Nagler CR. Fecal microbiome and metabolome differ in healthy and food-allergic twins. J Clin Invest. 2021;131(2):e141935. doi:10.1172/JCI141935

 

Bunyavanich S, Shen N, Grishin A, et al. Early-life gut microbiome composition and milk allergy resolution. J Allergy Clin Immunol. 2016;138(4):1122-1130. doi:10.1016/j.jaci.2016.03.041

 

Cukrowska B, Ceregra A, Maciorkowska E, et al. The effectiveness of probiotic Lactobacillus rhamnosus and Lactobacillus casei strains in children with atopic dermatitis and cow’s milk protein allergy: a multicenter, randomized, double blind, placebo controlled study. Nutrients. 2021;13(4):1169. doi:10.3390/nu13041169

 

Currell A, Koplin JJ, Lowe AJ, et al. Mode of birth is not associated with food allergy risk in infants. J Allergy Clin Immunol Pract. 2022;10(8):2135-2143.e3. doi:10.1016/j.jaip.2022.03.031

 

Jensen C, Antonsen MF, Lied GA. Gut microbiota and fecal microbiota transplantation in patients with food allergies: a systematic review. Microorganisms. 2022;10(10):1904. doi:10.3390/microorganisms10101904

 

Loke P, Orsini F, Lozinsky AC, et al; PPOIT-003 Study Group. Probiotic peanut oral immunotherapy versus oral immunotherapy and placebo in children with peanut allergy in Australia (PPOIT-003): a multicentre, randomised, phase 2b trial. Lancet Child Adolesc Health. 2022;6(3):171-184. Published correction appears in Lancet Child Adolesc Health. 2022;6(5):e19.

 

Shu S-A, Yuen AWT, Woo E, et al. Microbiota and food allergy. Clin Rev Allergy Immunol. 2019;57(1):83-97. doi:10.1007/s12016-018-8723-y

 

Yang X, Zhou C, Guo C, et al. The prevalence of food allergy in cesarean-born children aged 0-3 years: a systematic review and meta-analysis of cohort studies. Front Pediatr. 2023;10:1044954. doi:10.3389/fped.2022.1044954

 

Zhang G-Q, Hu H-J, Liu C-Y, Zhang Q, Shakya S, Li Z-Y. Probiotics for prevention of atopy and food hypersensitivity in early childhood: a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016;95(8):e2562. doi:10.1097/MD.0000000000002562

Edwin Kim, MD, MS

    Associate Professor of Pediatrics and Medicine
    Chief, Division of Pediatric Allergy and Immunology
    Director, UNC Food Allergy Initiative
    Director, UNC Allergy and Immunology Fellowship Program
    University of North Carolina School of Medicine
    Chapel Hill, NC
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