The relationship between the gut microbiome and the development of food allergies is an active area of research, along with probiotics and prebiotics. Dr Terri F. Brown-Whitehorn discusses the use of probiotics and prebiotics in the prevention and management of food allergies.

The development of food allergies is complex and multifactorial. While the gut microbiome and the interaction with the immune system is of significant interest, genetics, environmental exposures, and diet play a role.

The relationship between the gut microbiome and food allergies (both development and management) is an active area of research. When thinking about the gut microbiome, one must consider the different strains/individual species and the diversity of those species. Both are important. The interaction between the microbiome, diet, and host are thought to modulate the immune response/system. Studies have shown different microbiota in patients with food allergies, those who have outgrown their food allergies, and those who never had food allergies, which may be due to food(s) being added or perhaps different clinical phenotypes. In addition, the microbiome is not thought to be static, changing with diet, age, and the use of antibiotics.

Studies of therapies that may modify the gut microbiome to either prevent food allergies or help manage food allergies are ongoing. Investigations to date have shown that this is not an easy task. As of 2024, we do not know enough to recommend specific probiotics, prebiotics, or dietary modifications. A Cochrane review of probiotics for infants to prevent food hypersensitivity found insufficient data for recommendation. In addition, some studies of prebiotics in infant formulas have not shown evidence of food allergy prevention. A study from Australia looking at the use of peanut oral immunotherapy with or without probiotics found that, while children in the 1- to 5-year-old cohort receiving probiotics had fewer gastrointestinal symptoms during therapy, there was no difference in sustained unresponsiveness between the groups. Studies in patients undergoing oral immunotherapy and those examining whether there are differences in microbiome over time are in process.

I look forward to additional research on the gut microbiome and food allergies, as well as on the interplay between environment and genetics.