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Peer-reviewedCC BY 4.0Nutrients

Diet and the Food Allergy Exposome Across the Lifespan: Nutritional Transitions, Microbiome–Immune Pathways, and Emerging Clinical Phenotypes

  • Corina Porr1,2
  • Corina Suteu3
  • Maria Bârsan4
  • Alina Liliana Pintea5,6
  • Dorina Maria Farcaș3
  • Georgeta Pasca3
  • Doina Ileana Giurgiu5,7
7 affiliations
  1. 1Allergology Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
  2. 2Allergology Department, Clinical County Emergency Hospital of Sibiu, 550245 Sibiu, Romania
  3. 3Department of Psychiatric Neurosciences and Rehabilitation, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
  4. 4Department of Occupational Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
  5. 5Sibiu County Emergency Clinical Hospital, 550025 Sibiu, Romania
  6. 6Department of Dental Medicine and Nursing, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
  7. 7Neuroscience Research Centre, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
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Abstract

Food allergy is increasingly recognized across geographic regions and age groups, although temporal trends are difficult to separate from differences in diagnostic criteria and surveillance. This narrative review examines how diet and nutrition interact with the wider exposome to influence food allergy risk, oral tolerance, and clinical phenotypes across the lifespan. We critically synthesize evidence on early-life allergen introduction, dietary diversity, fiber and microbial metabolites, Westernized and ultra-processed dietary patterns, epithelial barrier dysfunction, medication exposures, pollution, and changing food systems. Randomized trials support early peanut introduction and, with greater heterogeneity, early egg introduction as preventive approaches; by contrast, causal evidence linking most other nutritional and environmental exposures to clinically confirmed food allergy remains limited. The diet–microbiome–immune axis offers plausible pathways connecting dietary substrates and microbial metabolites to epithelial integrity and immune regulation, but human mechanistic and longitudinal evidence remains incomplete. Globalization, migration, alternative protein sources, and climate-related exposures may reshape allergen encounters. Adult-onset food allergy, pollen–food allergy syndrome, alpha-gal syndrome, and cofactor-dependent reactions further illustrate how environmental influences may alter clinical expression beyond infancy. We propose an integrated life-course framework linking nutritional and non-nutritional exposures, underlying biological pathways, and emerging allergic phenotypes, while explicitly distinguishing intervention-supported findings from observational associations and mechanistic hypotheses. Future studies should combine standardized clinical outcomes with dietary assessment, environmental exposure measurements, functional microbiome profiling, metabolomics, and immune phenotyping to identify modifiable pathways relevant to food allergy prevention.

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Cite

BibTeXRIS
BibTeX
@article{porr2026diet,
  title = {{Diet and the Food Allergy Exposome Across the Lifespan: Nutritional Transitions, Microbiome–Immune Pathways, and Emerging Clinical Phenotypes}},
  author = {Corina Porr and Corina Suteu and Maria Bârsan and Alina Liliana Pintea and Dorina Maria Farcaș and Georgeta Pasca and Doina Ileana Giurgiu},
  journal = {Nutrients},
  year = {2026},
  month = nov,
  doi = {10.3390/nu18213692},
  url = {https://www.mdpi.com/2072-6643/18/21/3692},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Diet and the Food Allergy Exposome Across the Lifespan: Nutritional Transitions, Microbiome–Immune Pathways, and Emerging Clinical Phenotypes
AU  - Corina Porr
AU  - Corina Suteu
AU  - Maria Bârsan
AU  - Alina Liliana Pintea
AU  - Dorina Maria Farcaș
AU  - Georgeta Pasca
AU  - Doina Ileana Giurgiu
PY  - 2026
DA  - 2026/11/07
JO  - Nutrients
DO  - 10.3390/nu18213692
UR  - https://www.mdpi.com/2072-6643/18/21/3692
AB  - Food allergy is increasingly recognized across geographic regions and age groups, although temporal trends are difficult to separate from differences in diagnostic criteria and surveillance. This narrative review examines how diet and nutrition interact with the wider exposome to influence food allergy risk, oral tolerance, and clinical phenotypes across the lifespan. We critically synthesize evidence on early-life allergen introduction, dietary diversity, fiber and microbial metabolites, Westernized and ultra-processed dietary patterns, epithelial barrier dysfunction, medication exposures, pollution, and changing food systems. Randomized trials support early peanut introduction and, with greater heterogeneity, early egg introduction as preventive approaches; by contrast, causal evidence linking most other nutritional and environmental exposures to clinically confirmed food allergy remains limited. The diet–microbiome–immune axis offers plausible pathways connecting dietary substrates and microbial metabolites to epithelial integrity and immune regulation, but human mechanistic and longitudinal evidence remains incomplete. Globalization, migration, alternative protein sources, and climate-related exposures may reshape allergen encounters. Adult-onset food allergy, pollen–food allergy syndrome, alpha-gal syndrome, and cofactor-dependent reactions further illustrate how environmental influences may alter clinical expression beyond infancy. We propose an integrated life-course framework linking nutritional and non-nutritional exposures, underlying biological pathways, and emerging allergic phenotypes, while explicitly distinguishing intervention-supported findings from observational associations and mechanistic hypotheses. Future studies should combine standardized clinical outcomes with dietary assessment, environmental exposure measurements, functional microbiome profiling, metabolomics, and immune phenotyping to identify modifiable pathways relevant to food allergy prevention.
SN  - 2072-6643
ER  -