In-utero exposures and the evolving epidemiology of paediatric allergy

Emerging evidence suggests that the rising prevalence of early-onset 'noncommunicable' diseases, such as paediatric atopy, is related to modern environmental changes, the effects of which appear to commence in utero or even preconception. Here, we review how recent publications have contributed further to our understanding of the influence of in-utero exposures on the predisposition to immune dysregulation, with a particular focus on the evolving epidemiology of paediatric allergy.

New evidence suggests that inter-individual variations in immune function development are principally driven by nonheritable factors, for example periconceptional environment. One of the most significant influences is maternal nutrition during pregnancy. New studies further support a healthy balanced maternal diet that contains immunomodulatory nutrients, prebiotics and probiotics, which benefit multiple aspects of fetal development, including immune development. In addition, declining maternal biodiversity, maternal stress and exposures to environmental pollutants further interact to have adverse influences on the developing immune system.

The in-utero period appears to be a critical time point. Further investigations of gene-environmental interaction mechanisms are essential prior to further recommendations of early-life preventive strategies to reduce the growing global burden of allergic disease, as well as other 'noncommunicable' diseases.