Skin intervention for food allergy prevention: recent advances and clinical implications

PURPOSE OF REVIEW: Food allergy has increased globally, with infancy representing a critical window for prevention. Accumulating evidence has shifted attention toward the skin as a key route of allergen exposure, particularly in the context of atopic dermatitis. This review is timely given recent advances that have established the dual allergen exposure hypothesis as a clinical paradigm and growing interest in early skin-based interventions. RECENT FINDINGS: Observational and interventional studies consistently identify early-onset atopic dermatitis as the strongest risk factor for food allergy. Current evidence does not support modification of routine skin cleansing practices for the purpose of food allergy prevention. Randomized controlled trials evaluating moisturizers have shown no convincing evidence that moisturizer use directly prevents food allergy. Any potential benefit appears limited to modulation of atopic dermatitis risk and may depend on formulation, timing, and target population. In contrast, early, sufficient, and anti-inflammatory treatment of atopic dermatitis - including treatment of nonlesional skin - has demonstrated the strong evidence for reducing egg allergy risk in recent randomized controlled trials. SUMMARY: Skin-based interventions have a supportive but limited role in food allergy prevention. While moisturizers and skin cleansing alone are insufficient to prevent food allergy, early and adequate control of atopic dermatitis appears central to suppressing percutaneous sensitization. Effective prevention requires integrated, risk-stratified strategies combining optimal eczema management with appropriate food introduction and environmental considerations based on the dual allergy exposure theory. Further research is needed to establish well tolerated and sustainable prevention frameworks applicable to early life.