Clinical Reviews in Allergy & Immunology

, Volume 57, Issue 3, pp 303–311 | Cite as

Possible Role of Environmental Factors in the Development of Food Allergies

  • Jodi ShrobaEmail author
  • Niharika Rath
  • Charles Barnes


The development of food allergies is thought to involve multiple factors, and it is unclear which conveys the most risk regarding this process. Since food allergy is a chronic disease without a cure at this time, understanding its development could provide an avenue for preventive practices and development of a curative treatment. Both historical and current data implicate maternal factors, genetics, and environmental exposures as major risk factors in the development of food allergy. An immature gut of the infant has been hypothesized as a possible route of sensitization. Breastfeeding until at least 6 months of age has been shown to have protective factors for the newborn and may possibly improve gut permeability. Newer studies such as the LEAP and EAT investigations also looked at early exposure and prevention of food allergies; their long-term results are critical in understanding early introduction and tolerance. Cutaneous exposure, oral exposure, and food protein exposure in house dust with their relation to the food allergy course are also a path of interest. Current research has shown sensitization can occur through impaired skin such as those with eczema and a filaggrin mutation. Tropomyosin and alpha-gal also are related to the complicated immunomodulatory factors involved in food allergy and allergic response. Cross-reactivity with plant allergens, sensitization to house dust mite and cockroach, and lone star tick bites can also induce food allergens in children and adults. Together, these factors provide a cohesive beginning to understanding how food allergies can occur and can influence further investigation into prevention, treatment, and eventual cure of food allergies.


Food allergy Breastfeeding House dust Environmental exposure Oral allergy syndrome Tropomyosin 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval and Informed Consent

This was a review article and not a study involving human subjects so IRB approval was not required.


  1. 1.
    Sicherer S, Sampson H (2014) Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol 133(2):291–307 quiz 308PubMedGoogle Scholar
  2. 2.
    Perkin M, Logan K, Tseng A, Raji B, Ayis S, Peacock J, Brough H, Marrs T, Radulovic S, Craven J, Flohr C, Lack G, EAT Study Team (2016) Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med 374(18):1733–1743PubMedGoogle Scholar
  3. 3.
    Grulee C, Sanford H (1936) The influence of breast and artificial feeding on infantile eczema. J Pediatr 9(2):223–225Google Scholar
  4. 4.
    Sicherer S (2002) The impact of maternal diets during breastfeeding on the prevention of food allergy. Curr Opin Allergy Clin Immunol 2(3):207–210PubMedGoogle Scholar
  5. 5.
    Munblit D, Verhasselt V (2016) Allergy prevention by breastfeeding: possible mechanisms and evidence from human cohorts. Curr Opin Allergy Clin Immunol 16(5):427–433PubMedGoogle Scholar
  6. 6.
    Newburg D, Walker W (2007) Protection of the neonate by the innate immune system of developing gut and of human milk. Pediatr Res 61(1):2–8PubMedGoogle Scholar
  7. 7.
    Kusunoki T, Morimoto M et al (2010) Breastfeeding and the prevalence of allergic diseases in schoolchildren: does reverse causation matter? Pediatr Allergy Immunol 21(1 Pt 1):60–66PubMedGoogle Scholar
  8. 8.
    Falth-Magnusson K, Kjellman N (1992) Allergy prevention by maternal elimination diet during late pregnancy—a 5-year follow-up of a randomized study. J Allergy Clin Immunol 89(3):709–713PubMedGoogle Scholar
  9. 9.
    Frank L, Marian A, Visser M, Weinberg E, Potter PC (1999) Exposure to peanuts in utero and in infancy and the development of sensitization to peanut allergens in young children. Pediatr Allergy Immunol 10(1):27–32PubMedGoogle Scholar
  10. 10.
    Kramer M, Kakuma R (2012) Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 9:CD000133Google Scholar
  11. 11.
    Hourihane J, Dean T et al (1996) Peanut allergy in relation to heredity, maternal diet, and other atopic diseases: results of a questionnaire survey, skin prick testing, and food challenges. BMJ 313(7056):518–521PubMedPubMedCentralGoogle Scholar
  12. 12.
    Jarvinen K, Westfall J et al (2015) Role of maternal dietary peanut exposure in development of food allergy and oral tolerance. PLoS One 10(12):e0143855PubMedPubMedCentralGoogle Scholar
  13. 13.
    Chmielewska A, Piescik-Lech M et al (2017) Systematic review: early infant feeding practices and the risk of wheat allergy. J Paediatr Child Health 53(9):889–896PubMedGoogle Scholar
  14. 14.
    Jarvinen K, Westfall J et al (2014) Role of maternal elimination diets and human milk IgA in the development of cow’s milk allergy in the infants. Clin Exp Allergy 44(1):69–78PubMedPubMedCentralGoogle Scholar
  15. 15.
    Hattevig G, Kjellman B et al (1989) Effect of maternal avoidance of eggs, cow’s milk and fish during lactation upon allergic manifestations in infants. Clin Exp Allergy 19(1):27–32PubMedGoogle Scholar
  16. 16.
    Hattevig G, Sigurs N, Kjellman B (1999) Effects of maternal dietary avoidance during lactation on allergy in children at 10 years of age. Acta Paediatr 88(1):7–12PubMedGoogle Scholar
  17. 17.
    Sigurs N, Hattevig G, Kjellman B (1992) Maternal avoidance of eggs, cow’s milk, and fish during lactation: effect on allergic manifestations, skin-prick tests, and specific IgE antibodies in children at age 4 years. Pediatrics 89(4 Pt 2):735–739PubMedGoogle Scholar
  18. 18.
    Hide D, Matthews S et al (1996) Allergen avoidance in infancy and allergy at 4 years of age. Allergy 51(2):89–93PubMedGoogle Scholar
  19. 19.
    Arshad S, Matthews s et al (1992) Effect of allergen avoidance on development of allergic disorders in infancy. Lancet 339(8808): 1493–1497Google Scholar
  20. 20.
    Du Toit G, Tsakok T et al (2016) Prevention of food allergy. J Allergy Clin Immunol 137(4):998–1010PubMedGoogle Scholar
  21. 21.
    Du Toit G, Roberts G et al (2015) Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 372(9):803–813PubMedPubMedCentralGoogle Scholar
  22. 22.
    Togias A, Cooper S (2017) Addendum guidelines for the prevention of peanut allergy in the U.S.: report of the national institute of allergy and infectious diseases sponsored expert panel. J Allergy Clin Immunol 139(1):29–44PubMedPubMedCentralGoogle Scholar
  23. 23.
    Tsai H, Kumar R et al (2009) Familial aggregation of food allergy and sensitization to food allergens: a family-based study. Clin Exp Allergy 39(1):101–109PubMedGoogle Scholar
  24. 24.
    Gupta R, Walkner M et al (2016) Food allergy sensitization and presentation in siblings of food allergic children. J Allergy Clin Immunol Pract 4(5):956–962PubMedPubMedCentralGoogle Scholar
  25. 25.
    Martino D, Saffery R et al (2016) Epigenetic modifications: mechanisms of disease and biomarkers of food allergy. Curr Opin Immunol 42:9–15PubMedGoogle Scholar
  26. 26.
    Yazdanbakhsh M, Kremsner P, van Ree R (2002) Allergy, parasites, and the hygiene hypothesis. Science 296(5567):490–494PubMedGoogle Scholar
  27. 27.
    Du Toit G, Sayre P et al (2016) Effect of avoidance on peanut allergy after early peanut consumption. N Engl J Med 374(15):1435–1443PubMedGoogle Scholar
  28. 28.
    Lack G (2012) Update on risk factors for food allergy. J Allergy Clin Immunol 129(5):1187–1197PubMedGoogle Scholar
  29. 29.
    Du Toit G, Roberts G et al (2013) Identifying infants at high risk of peanut allergy: the Learning Early About Peanut Allergy (LEAP) screening study. J Allergy Clin Immunol 131(1):135–143.e1–112PubMedGoogle Scholar
  30. 30.
    Brough H, Liu A et al (2015) Atopic dermatitis increases the effect of exposure to peanut antigen in dust on peanut sensitization and likely peanut allergy. J Allergy Clin Immunol 135(1):164–170PubMedPubMedCentralGoogle Scholar
  31. 31.
    Lester M (2014) Peanut protein in household dust is related to household peanut consumptions and is biologically active. Pediatrics 134(Suppl 3):S154PubMedGoogle Scholar
  32. 32.
    Trendelenburg V, Ahrens B, Wehrmann AK, Kalb B, Niggemann B, Beyer K (2013) Peanut allergen in house dust of eating area and 736 bed—a risk factor for peanut sensitization? Allergy 68(11):1460–7371462PubMedGoogle Scholar
  33. 33.
    Brough H, Makinson A et al (2013) Distribution of peanut protein in the home environment. J Allergy Clin Immunol 132(3):623–629PubMedGoogle Scholar
  34. 34.
    Johnson R, Barnes C (2013) Airborne concentrations of peanut protein. Allergy Asthma Proc 34(1):59–6PubMedGoogle Scholar
  35. 35.
    Brough H, Santos A et al (2013) Peanut protein in household dust is related to household peanut consumption and is biologically active. J Allergy Clin Immunol 132(3):630–638PubMedGoogle Scholar
  36. 36.
    Shroba J, Barnes C, Nanda M, Dinakar C, Ciaccio C (2017) Ara h2 levels in dust from homes of individuals with peanut allergy and individuals with peanut tolerance. Allergy Asthma Proc 38(3):192–196PubMedPubMedCentralGoogle Scholar
  37. 37.
    Brough H, Simpson A et al (2014) Peanut allergy: effect of environmental peanut exposure in children with filaggrin loss-of-function mutations. J Allergy Clin Immunol 134(4):867–875PubMedGoogle Scholar
  38. 38.
    Trendelenburg V, Tschirner S, Niggemann B, Beyer K (2018) Hen’s egg allergen in house and bed dust is significantly increased after hen’s egg consumption—a pilot study. Allergy 73(1):261–264PubMedGoogle Scholar
  39. 39.
    Lucendo A, Arias A et al (2014) Relation between eosinophilic esophagitis and oral immunotherapy for food allergy: a systematic review with meta-analysis. Ann Allergy Asthma Immunol 113(6):624–629PubMedPubMedCentralGoogle Scholar
  40. 40.
    Perales CC, Saez Gonzalez E et al (2017) Esophageal dysfunction and immunological changes induced by grass sublingual immunotherapy. Eur Ann Allergy Clin Immunol 49(1):28–30Google Scholar
  41. 41.
    Hill D, Dudley J et al (2017) The prevalence of eosinophilic esophagitis in pediatric patients with IgE-mediated food allergy. J Allergy Clin Immunol Pract 5(2):369–375PubMedGoogle Scholar
  42. 42.
    Sicherer S (2001) Clinical implications of cross-reactive food allergens. J Allergy Clin Immunol 108(6):881–889PubMedGoogle Scholar
  43. 43.
  44. 44.
    Nowak-Wegrzyn A. (2017) Pathogenesis of oral allergy syndrome (pollen-food allergy syndrome). UpToDate Accessed 10 Dec 2017
  45. 45.
    Bohle B (2007) The impact of pollen-related food allergens on pollen allergy. Allergy 62:3–10PubMedGoogle Scholar
  46. 46.
    Popescu F (2015) Cross-reactivity between aeroallergens and food allergens. World J Methodol 5(2):31–50PubMedPubMedCentralGoogle Scholar
  47. 47.
    Kondo Y, Urisu A (2009) Oral allergy syndrome. Allergol Int 58:485–491PubMedGoogle Scholar
  48. 48.
    Werfel T, Asero K, Ballmer-Weber K et al (2015) Position paper of the EAACI: food allergy due to immunological cross-reactions with common inhalant allergens. Allergy 70:1079–1090PubMedGoogle Scholar
  49. 49.
    Czarnecka-Operacz M, Jenerowicz D, Silny W (2008) Oral allergy syndrome in patients with airborne pollen allergy treated with specific immunotherapy. Acta Dermatovenerol Croat 16(1):19–24PubMedGoogle Scholar
  50. 50.
    Lopez-Matas M, Larramendi C et al (2016) In vivo diagnosis with purified tropomyosin in mite and shellfish allergic patients. Ann Allergy Asthma Immunol 116:538–543PubMedGoogle Scholar
  51. 51.
    Wang J, Calatroni A, Visness C et al (2011) Correlation of specific IgE to shrimp with cockroach and dust mite exposure and sensitization in an inner city population. Allergy Clin Immunol 128(4):834–837Google Scholar
  52. 52.
    Boquete M, Iraola V, Morales M, Pinto H, Francisco C, Carballás C, Carnés J (2011) Seafood hypersensitivity in mite sensitized individuals: is tropomyosin the only responsible allergen. Ann Allergy Asthma Immunol 106:223–229PubMedGoogle Scholar
  53. 53.
    Wong L, Huang C, Lee B (2016) Shellfish and house dust allergies: is the link tropomyosin. Allergy Asthma Immunol Res 8(2):101–106PubMedGoogle Scholar
  54. 54.
    Commins S, Platts-Mills T (2013) Delayed anaphylaxis to red meat in patients with IgE specific for galactose alpha-1, 3-galactose (alpha-gal). Curr Allergy Asthma Rep 13(1):72–77PubMedPubMedCentralGoogle Scholar
  55. 55.
    Platts-Mills T, Schuyler A, Hoyt A et al (2015) Delayed anaphylaxis involving IgE to galactose-alpha-1,3-galactose. Cur Allergy Asthma Rep 15(4):12Google Scholar
  56. 56.
    Sussman G, Sussman A, Sussman D (2010) Oral allergy syndrome. CMAJ 182(11):1210–1211PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Allergy, Asthma and ImmunologyChildren’s Mercy HospitalKansas CityUSA

Personalised recommendations