Taking a prebiotic approach to early immunomodulation for allergy prevention

Introduction: With increasing focus on nutritional strategies to counter the rising global burden of allergic disease, there has been a particular focus on prebiotic nutrients that are selectively utilized by host microorganisms to confer potential immunomodulatory benefits for disease prevention. Areas covered: In this review we examine maternal and infant dietary sources of prebiotics with a particular focus on non-digestible oligosaccharides, which undergo microbial fermentation by commensal gut bacteria to produce short chain fatty acids (SCFA). We summarize the major proposed health benefits of SCFA in early life immune development, together with the current evidence for maternal and/or infant prebiotic consumption in abrogating the risk of early childhood allergic diseases. Medline searches (to August 2017) for English language papers included prebiotics and SCFA search terms in combination with relevant allergic disease terms. Expert commentary: The potential beneficial effects of maternal and infant prebiotic consumption for allergy prevention are promising, but still require considerably further investigation through highquality randomised controlled trials and detailed mechanistic studies. This should be coupled with more research on the biological effects of human milk oligosaccharides (HMO), including their influence on infant immune development, and the maternal nutritional factors that optimise HMO composition and infant outcomes.