Figure 2.

Diet and the atopic march. Immune responses are typically Th2-dominated in the early stages of life (top panel), but Th1-responses start developing after birth. In atopic individuals, Th2 responses tend to be higher already from an early age. The likelihood that an individual will develop allergic disease is partly determined by genetic predisposition, but genetic drift cannot explain the rise in prevalence (Agache et al., 2019). In the so-called Atopic March, atopic dermatitis (AD) is often the first clinical manifestation of allergic disease, which is typically followed by food allergy, rhinitis, and asthma (Spergel, 2010), all being characterized by a Th2 immune response. AD is followed by the development of allergen specific IgE (develop) and/or food allergy. In contrast to IgE-mediated food allergies, inhalant allergies and asthma are developed later in childhood. The increased susceptibility to atopic disease (red panel) is thought to be mediated at least in part by the nutritional environment during early development. Beyond other known immunoregulatory dietary components, n-3 LCPUFA and fat soluble nutrients may also help to reduce the allergy risk, and it is hypothesized that adequate levels (in green) of EPA/DHA, vitamin A, D, E, and K1/2, luteolin, quercetin, resveratrol, and lycopene could play an important role in maintaining immune-homeostasis throughout life.