The Impact of Nutrition and Early Dietary Introduction on the Prevalence, Severity and Management of Atopic Dermatitis in Infants. A Narrative Review
DOI:
https://doi.org/10.12775/JEHS.2026.91.70760Keywords
atopic dermatitis, Diet, Nutrition, infantAbstract
Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease affecting up to 20% of children worldwide, characterized by epidermal barrier dysfunction and immune dysregulation. The increasing prevalence of AD has led to a discussion on efficacy of allergen avoidance versus early immune tolerance induction strategies.
Aim: This review aims to synthesize current evidence on prenatal and early-life nutritional interventions and their impact on the prevalence and severity of AD in infants.
Materials and Methods: A narrative review was conducted using a structured search of major electronic databases for studies published between January 2015 and March 2026. Eligible articles included original studies, systematic reviews, and meta-analyses addressing maternal diet, breastfeeding, complementary feeding, and micronutrient supplementation.
Results: Current evidence does not support maternal elimination diets as a preventive strategy but suggests that greater dietary diversity may reduce risk of AD. Role of breastfeeding in preventing AD remains inconclusive. Early introduction of allergenic products between 4 and 6 months promotes oral tolerance, although its impact on AD incidence is inconsistent. Vitamin D deficiency correlates with increased disease severity, and its supplementation may be beneficial. Findings regarding omega-3 fatty acids remain heterogeneous. Hydrolyzed formulas and elimination diets are not recommended for routine prevention of AD.
Conclusions: Nutritional strategies in AD are shifting toward proactive tolerance induction. Early dietary exposures play a key role in immune programming, although further research is needed to define optimal, individualized interventions.
References
Langan, S. M., Irvine, A. D., & Weidinger, S. (2020). Atopic dermatitis. Lancet (London, England), 396(10247), 345–360. https://doi.org/10.1016/S0140-6736(20)31286-1
Schoch, J. J., Anderson, K. R., Jones, A. E., Tollefson, M. M., & Section on Dermatology (2025). Atopic Dermatitis: Update on Skin-Directed Management: Clinical Report. Pediatrics, 155(6), e2025071812. https://doi.org/10.1542/peds.2025-071812
Nielsen, A. Y., Høj, S., Thomsen, S. F., & Meteran, H. (2024). Vitamin D Supplementation for Treating Atopic Dermatitis in Children and Adults: A Systematic Review and Meta-Analysis. Nutrients, 16(23), 4128. https://doi.org/10.3390/nu16234128
Han, H., Roan, F., & Ziegler, S. F. (2017). The atopic march: current insights into skin barrier dysfunction and epithelial cell-derived cytokines. Immunological reviews, 278(1), 116–130. https://doi.org/10.1111/imr.12546
Sybilski, A. J., Raciborski, F., Lipiec, A., Tomaszewska, A., Lusawa, A., Samel-Kowalik, P., Walkiewicz, A., Krzych, E., Komorowski, J., & Samoliński, B. (2015). Atopic dermatitis is a serious health problem in Poland. Epidemiology studies based on the ECAP study. Postepy dermatologii i alergologii, 32(1), 1–10. https://doi.org/10.5114/pdia.2014.40935
Ahn, C., & Huang, W. (2017). Clinical Presentation of Atopic Dermatitis. Advances in experimental medicine and biology, 1027, 39–46. https://doi.org/10.1007/978-3-319-64804-0_4
Weidinger, S., Beck, L. A., Bieber, T., Kabashima, K., & Irvine, A. D. (2018). Atopic dermatitis. Nature reviews. Disease primers, 4(1), 1. https://doi.org/10.1038/s41572-018-0001-z
Wollenberg, A., Kinberger, M., Arents, B., Aszodi, N., Avila Valle, G., Barbarot, S., Bieber, T., Brough, H. A., Calzavara Pinton, P., Christen-Zäch, S., Deleuran, M., Dittmann, M., Dressler, C., Fink-Wagner, A. H., Fosse, N., Gáspár, K., Gerbens, L., Gieler, U., Girolomoni, G., Gregoriou, S., … Flohr, C. (2022). European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations. Journal of the European Academy of Dermatology and Venereology : JEADV, 36(11), 1904–1926. https://doi.org/10.1111/jdv.18429
Nowicki, R. J., Trzeciak, M., Kaczmarski, M., Wilkowska, A., Czarnecka-Operacz, M., Kowalewski, C., Rudnicka, L., Kulus, M., Mastalerz-Migas, A., Peregud-Pogorzelski, J., Sokołowska-Wojdyło, M., Śpiewak, R., Adamski, Z., Czuwara, J., Kapińska-Mrowiecka, M., Kaszuba, A., Krasowska, D., Krêcisz, B., Narbutt, J., Majewski, S., … Woźniak, K. (2020). Atopic dermatitis. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society, Polish Society of Allergology, Polish Pediatric Society and Polish Society of Family Medicine. Part I. Prophylaxis, topical treatment and phototherapy. Postepy dermatologii i alergologii, 37(1), 1–10. https://doi.org/10.5114/ada.2020.93423
Trikamjee, T., Comberiati, P., D'Auria, E., Peroni, D., & Zuccotti, G. V. (2021). Nutritional Factors in the Prevention of Atopic Dermatitis in Children. Frontiers in pediatrics, 8, 577413. https://doi.org/10.3389/fped.2020.577413
Kramer, M. S., & Kakuma, R. (2012). Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. The Cochrane database of systematic reviews, 2012(9), CD000133. https://doi.org/10.1002/14651858.CD000133.pub3
Venter, C., Palumbo, M. P., Glueck, D. H., Sauder, K. A., O'Mahony, L., Fleischer, D. M., Ben-Abdallah, M., Ringham, B. M., & Dabelea, D. (2022). The maternal diet index in pregnancy is associated with offspring allergic diseases: the Healthy Start study. Allergy, 77(1), 162–172. https://doi.org/10.1111/all.14949
Tan, W., Amara, S., Venter, M., Wang, L., Bodén, S., Simonpietri Tesoro, M. E., Pickett-Nairne, K., Glueck, D., O'Mahony, L., Comotti, A., & Venter, C. (2025). Systematic review of maternal dietary patterns during pregnancy and offspring allergy. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 36(10), e70217. https://doi.org/10.1111/pai.70217
Lisiecka M. Z. (2025). Impact of Maternal Diet During Pregnancy on Allergic Predisposition in Offspring: Immune Programming Mechanisms. Journal of mother and child, 29(1), 175–186. https://doi.org/10.34763/jmotherandchild.20252901.d-25-00016
Molla A. (2014). Dietary Patterns and their Impact on Atopic Dermatitis: A Comprehensive Review. The Open Dermatology Journal, 18, e18743722306189. https://doi.org/10.2174/0118743722306189240520075943
Garcia-Larsen, V., Ierodiakonou, D., Jarrold, K., Cunha, S., Chivinge, J., Robinson, Z., Geoghegan, N., Ruparelia, A., Devani, P., Trivella, M., Leonardi-Bee, J., & Boyle, R. J. (2018). Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis. PLoS medicine, 15(2), e1002507. https://doi.org/10.1371/journal.pmed.1002507
Chen, L., Brustad, N., Luo, Y., Wang, T., Ali, M., Ebrahimi, P., Schoos, A. M., Vahman, N., Lovric, M., Rasmussen, M. A., Kolmert, J., Wheelock, C. E., Lasky-Su, J. A., Stokholm, J., Bønnelykke, K., & Chawes, B. (2024). Prenatal Fish Oil Supplementation, Maternal COX1 Genotype, and Childhood Atopic Dermatitis: A Secondary Analysis of a Randomized Clinical Trial. JAMA dermatology, 160(10), 1082–1090. https://doi.org/10.1001/jamadermatol.2024.2849
Venter, C., Agostoni, C., Arshad, S. H., Ben-Abdallah, M., Du Toit, G., Fleischer, D. M., Greenhawt, M., Glueck, D. H., Groetch, M., Lunjani, N., Maslin, K., Maiorella, A., Meyer, R., Antonella, M., Netting, M. J., Ibeabughichi Nwaru, B., Palmer, D. J., Palumbo, M. P., Roberts, G., Roduit, C., … O'Mahony, L. (2020). Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 31(8), 889–912. https://doi.org/10.1111/pai.13303
El-Heis, S., D'Angelo, S., Curtis, E. M., Healy, E., Moon, R. J., Crozier, S. R., Inskip, H., Cooper, C., Harvey, N. C., Godfrey, K. M., & MAVIDOS Trial Group (2022). Maternal antenatal vitamin D supplementation and offspring risk of atopic eczema in the first 4 years of life: evidence from a randomized controlled trial. The British journal of dermatology, 187(5), 659–666. https://doi.org/10.1111/bjd.21721
Brandwein, M., Enten Vissoker, R., Jackson, H., Rogan, T., Pitcock, J., Krinkin, E., & Venter, C. (2024). Redefining the Role of Nutrition in Infant Food Allergy Prevention: A Narrative Review. Nutrients, 16(6), 838. https://doi.org/10.3390/nu16060838
Lodge, C. J., Tan, D. J., Lau, M. X., Dai, X., Tham, R., Lowe, A. J., Bowatte, G., Allen, K. J., & Dharmage, S. C. (2015). Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta paediatrica (Oslo, Norway : 1992), 104(467), 38–53. https://doi.org/10.1111/apa.13132
Little, C., Blattner, C. M., & Young, J., 3rd (2017). Update: Can breastfeeding and maternal diet prevent atopic dermatitis?. Dermatology practical & conceptual, 7(3), 63–65. https://doi.org/10.5826/dpc.0703a14
Koplin, J. J., Soriano, V. X., & Peters, R. L. (2021). Real-World LEAP Implementation. Current allergy and asthma reports, 22(6), 61–66. https://doi.org/10.1007/s11882-022-01032-3
Du Toit, G., Roberts, G., Sayre, P. H., Bahnson, H. T., Radulovic, S., Santos, A. F., Brough, H. A., Phippard, D., Basting, M., Feeney, M., Turcanu, V., Sever, M. L., Gomez Lorenzo, M., Plaut, M., Lack, G., & LEAP Study Team (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. The New England journal of medicine, 372(9), 803–813. https://doi.org/10.1056/NEJMoa1414850
Perkin, M. R., Logan, K., Marrs, T., Radulovic, S., Craven, J., Flohr, C., Lack, G., & EAT Study Team (2016). Enquiring About Tolerance (EAT) study: Feasibility of an early allergenic food introduction regimen. The Journal of allergy and clinical immunology, 137(5), 1477–1486.e8. https://doi.org/10.1016/j.jaci.2015.12.1322
Skjerven, H. O., Rehbinder, E. M., Vettukattil, R., LeBlanc, M., Granum, B., Haugen, G., Hedlin, G., Landrø, L., Marsland, B. J., Rudi, K., Sjøborg, K. D., Söderhäll, C., Staff, A. C., Carlsen, K. H., Asarnoj, A., Bains, K. E. S., Carlsen, O. C. L., Endre, K. M. A., Granlund, P. A., Hermansen, J. U., … Carlsen, K. C. L. (2020). Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet (London, England), 395(10228), 951–961. https://doi.org/10.1016/S0140-6736(19)32983-6
Roduit, C., Frei, R., Depner, M., Schaub, B., Loss, G., Genuneit, J., Pfefferle, P., Hyvärinen, A., Karvonen, A. M., Riedler, J., Dalphin, J. C., Pekkanen, J., von Mutius, E., Braun-Fahrländer, C., Lauener, R., & PASTURE study group (2014). Increased food diversity in the first year of life is inversely associated with allergic diseases. The Journal of allergy and clinical immunology, 133(4), 1056–1064. https://doi.org/10.1016/j.jaci.2013.12.1044
Yamamoto-Hanada, K., & Ohya, Y. (2024). Skin and oral intervention for food allergy prevention based on dual allergen exposure hypothesis. Clinical and experimental pediatrics, 67(10), 477–485. https://doi.org/10.3345/cep.2023.00045
Tham, E. H., Chia, M., Riggioni, C., Nagarajan, N., Common, J. E. A., & Kong, H. H. (2024). The skin microbiome in pediatric atopic dermatitis and food allergy. Allergy, 79(6), 1470–1484. https://doi.org/10.1111/all.16044
Halken, S., Muraro, A., de Silva, D., Khaleva, E., Angier, E., Arasi, S., Arshad, H., Bahnson, H. T., Beyer, K., Boyle, R., du Toit, G., Ebisawa, M., Eigenmann, P., Grimshaw, K., Hoest, A., Jones, C., Lack, G., Nadeau, K., O'Mahony, L., Szajewska, H., … European Academy of Allergy and Clinical Immunology Food Allergy and Anaphylaxis Guidelines Group (2021). EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update). Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 32(5), 843–858. https://doi.org/10.1111/pai.13496
Devulapalli C. S. (2025). Modulatory role of vitamin D in atopic dermatitis and allergic rhinitis. World journal of clinical pediatrics, 14(4), 112145. https://doi.org/10.5409/wjcp.v14.i4.112145
Niseteo, T., Hojsak, I., Ožanić Bulić, S., & Pustišek, N. (2024). Effect of Omega-3 Polyunsaturated Fatty Acid Supplementation on Clinical Outcome of Atopic Dermatitis in Children. Nutrients, 16(17), 2829. https://doi.org/10.3390/nu16172829
Song T. W. (2019). Should partially hydrolyzed infant formula be given to the general infant population for the primary prevention of allergic disease?. Korean journal of pediatrics, 62(9), 340–341. https://doi.org/10.3345/kjp.2019.00255
Boyle, R. J., Ierodiakonou, D., Khan, T., Chivinge, J., Robinson, Z., Geoghegan, N., Jarrold, K., Afxentiou, T., Reeves, T., Cunha, S., Trivella, M., Garcia-Larsen, V., & Leonardi-Bee, J. (2016). Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ (Clinical research ed.), 352, i974. https://doi.org/10.1136/bmj.i974
Osborn, D. A., Sinn, J. K., & Jones, L. J. (2018). Infant formulas containing hydrolysed protein for prevention of allergic disease. The Cochrane database of systematic reviews, 10(10), CD003664. https://doi.org/10.1002/14651858.CD003664.pub6
Nicolaou, N., Pancheva, R., Karaglani, E., Sekkidou, M., Marinova-Achkar, M., Popova, S., Tzaki, M., Kapetanaki, A., Iacovidou, N., Boutsikou, T., Iliodromiti, Z., Papaevangelou, V., Sardeli, O., Xepapadaki, P., Papathoma, E., Thijs-Verhoeven, I., Kudla, U., Ulfman, L. H., Schaafsma, A., & Manios, Y. (2022). The Risk Reduction Effect of a Nutritional Intervention With a Partially Hydrolyzed Whey-Based Formula on Cow's Milk Protein Allergy and Atopic Dermatitis in High-Risk Infants Within the First 6 Months of Life: The Allergy Reduction Trial (A.R.T.), a Multicenter Double-Blinded Randomized Controlled Study. Frontiers in nutrition, 9, 863599. https://doi.org/10.3389/fnut.2022.863599
Singh, A. M., Anvari, S., Hauk, P., Lio, P., Nanda, A., Sidbury, R., & Schneider, L. (2022). Atopic Dermatitis and Food Allergy: Best Practices and Knowledge Gaps-A Work Group Report from the AAAAI Allergic Skin Diseases Committee and Leadership Institute Project. The journal of allergy and clinical immunology. In practice, 10(3), 697–706. https://doi.org/10.1016/j.jaip.2021.12.037
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Copyright (c) 2026 Joanna Makowska, Jerzy Darmoń, Maria Windyga, Anna Sieczka, Natalia Piegza, Karolina Domańska, Aleksandra Papuga, Makary Hejduk
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