A role for early oral exposure to house dust mite allergens through breast milk in IgE-mediated food allergy susceptibility

Akila Rekima, Chrystelle Bonnart, Patricia Macchiaverni, Jessica Metcalfe, Meri K Tulic, Nicolas Halloin, Samah Rekima, Jon Genuneit, Samantha Zanelli, Samara Medeiros, Debra J Palmer, Susan Prescott, Valerie Verhasselt

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Successful prevention of food allergy requires the identification of the factors adversely affecting the capacity to develop oral tolerance to food antigen in early life.

OBJECTIVES: This study sought to determine whether oral exposure to Dermatophagoides pteronyssinus through breast milk affects gut mucosal immunity with long-term effects on IgE-mediated food allergy susceptibility.

METHODS: Gut immunity was explored in 2-week-old mice breast-fed by mothers exposed to D pteronyssinus, protease-inactivated D pteronyssinus, or to PBS during lactation. We further analyzed oral tolerance to a bystander food allergen, ovalbumin (OVA). In a proof-of-concept study, Der p 1 and OVA levels were determined in 100 human breast milk samples and the association with prevalence of IgE-mediated egg allergy at 1 year was assessed.

RESULTS: Increased permeability, IL-33 levels, type 2 innate lymphoid cell activation, and Th2 cell differentiation were found in gut mucosa of mice nursed by mothers exposed to D pteronyssinus compared with PBS. This pro-Th2 gut mucosal environment inhibited the induction of antigen-specific FoxP3 regulatory T cells and the prevention of food allergy by OVA exposure through breast milk. In contrast, protease-inactivated D pteronyssinus had no effect on offspring gut mucosal immunity. Based on the presence of Der p 1 and/or OVA in human breast milk, we identified groups of lactating mothers, which mirror the ones found in mice to be responsible for different egg allergy risk.

CONCLUSIONS: This study highlights an unpredicted potential risk factor for the development of food allergy, that is, D pteronyssinus allergens in breast milk, which disrupt gut immune homeostasis and prevents oral tolerance induction to bystander food antigen through their protease activity.

Original languageEnglish
Pages (from-to)1416-1429.e11
JournalJournal of Allergy and Clinical Immunology
Issue number5
Publication statusPublished - May 2020
Externally publishedYes


  • Administration, Oral
  • Adult
  • Allergens/administration & dosage
  • Animals
  • Antigens, Dermatophagoides/administration & dosage
  • Arthropod Proteins/administration & dosage
  • CD4-Positive T-Lymphocytes
  • Cysteine Endopeptidases/administration & dosage
  • Dermatophagoides pteronyssinus/immunology
  • Disease Susceptibility
  • Double-Blind Method
  • Egg Hypersensitivity/immunology
  • Female
  • Humans
  • Immunoglobulin E/immunology
  • Infant, Newborn
  • Interleukin-33
  • Intestine, Small/immunology
  • Male
  • Mice, Inbred BALB C
  • Mice, Transgenic
  • Milk/immunology
  • Ovalbumin/administration & dosage
  • Pregnancy
  • protease
  • breast-feeding
  • House dust mite
  • food allergy


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