Debbie Palmer

Maternal prebiotic supplementation during pregnancy and lactation modifies the microbiome and short chain fatty acid profile of both mother and infant

Improving maternal gut health in pregnancy and lactation is a potential strategy to improve immune and metabolic health in offspring and curtail the rising rates of inflammatory diseases linked to alterations in gut microbiota. Here, we investigate the effects of a maternal prebiotic supplement (galacto-oligosaccharides and fructo-oligosaccharides), ingested daily from <21 weeks' gestation to six months' post-partum, in a double-blinded, randomised placebo-controlled trial. 

Histological predictors of outcome for cutaneous squamous cell carcinoma in renal transplant patients: A case-control study

Cutaneous squamous cell carcinoma is a significant cause of morbidity for immunosuppressed patients such as organ transplant recipients; however, histological parameters which predict the likelihood of tumor progression are typically based on general population studies in which immunosuppressed patients represent only a small fraction of cases. 

Associations between sun exposure, skin pH, and epidermal permeability in pregnancy: A longitudinal observational study

Little is known about how sun exposure may affect the maternal skin barrier during pregnancy when many hormonal and physiological changes occur. In this longitudinal observational study, 50 pregnant women were recruited at 18-24 weeks' gestation, 25 in summer-autumn, and 25 in winter-spring. At three time points in pregnancy at 18-24, 28-30, and 36-38 weeks' gestation, participants completed a validated sun exposure questionnaire and had skin permeability and surface pH measured on the volar forearm.

Metagenomic Characterisation of the Gut Microbiome and Effect of Complementary Feeding on Bifidobacterium spp. in Australian Infants

Complementary feeding induces dramatic ecological shifts in the infant gut microbiota toward more diverse compositions and functional metabolic capacities, with potential implications for immune and metabolic health. The aim of this study was to examine whether the age at which solid foods are introduced differentially affects the microbiota in predominantly breastfed infants compared with predominantly formula-fed infants. 

Egg-sensitised infants have elevated CD4+ effector memory T regulatory cells from birth

IgE-mediated sensitisation to egg is common in infants. In some cases, the processes leading to egg sensitisation are established in early life, even before introduction to solid foods. The underlying mechanisms remain poorly understood. 

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines update – X – Breastfeeding a baby with cow's milk allergy

Cow's milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow's milk allergy, it is critical to examine the evidence for and against any form of cow's milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow's milk proteins detectable in human milk cause infant cow's milk allergy symptoms.

Feasibility and safety of introducing cashew nut spread in infant diets-A randomized trial

To reduce peanut allergy prevalence, infant feeding guidelines now recommend introducing peanuts in an age-appropriate form (such as peanut butter) as part of complementary feeding. However, due to a lack of randomized trial evidence, most infant feeding and food allergy prevention guidelines do not include tree nuts. The aims of this trial were to determine safety and feasibility of dosage consumption recommendations for infant cashew nut spread introduction.

Human Milk Microbiome and Microbiome-Related Products: Potential Modulators of Infant Growth

Infant growth trajectory may influence later-life obesity. Human milk provides a wide range of nutritional and bioactive components that are vital for infant growth. Compared to formula-fed infants, breastfed infants are less likely to develop later-onset obesity, highlighting the potential role of bioactive components present in human milk.

Changes to the Gut Microbiome in Young Children Showing Early Behavioral Signs of Autism

The human gut microbiome has increasingly been associated with autism spectrum disorder (ASD), which is a neurological developmental disorder, characterized by impairments to social interaction.

Study Protocol for a Randomised Controlled Trial Investigating the Effects of Maternal Prebiotic Fibre Dietary Supplementation from Mid-Pregnancy to Six Months’ Post-Partum on Child Allergic Disease Outcomes

Infant allergy is the most common early manifestation of an increasing propensity for inflammation and immune dysregulation in modern environments. Refined low-fibre diets are a major risk for inflammatory diseases through adverse effects on the composition and function of gut microbiota. This has focused attention on the potential of prebiotic dietary fibres to favourably change gut microbiota, for local and systemic anti-inflammatory effects.

PrEggNut Study: protocol for a randomised controlled trial investigating the effect of a maternal diet rich in eggs and peanuts from <23 weeks' gestation during pregnancy to 4 months' lactation on infant IgE-mediated egg and peanut allergy outcomes

Clinical studies supported by immunological data indicate early life intervention strategies to be promising in reducing the growing global burden of food allergies. The events that predispose to food allergy, including the induction of allergen-specific immune responses, appear to be initiated early in development.

Pre-and Postnatal Vitamin D Status and Allergy Outcomes in Early Childhood

The dramatic increase in the prevalence of allergic disease in recent decades reflects environmental and behavioural changes that have altered patterns of early immune development. The very early onset of allergic diseases points to the specific vulnerability of the developing immune system to environmental changes and the development of primary intervention strategies is crucial to address this unparalleled burden.

Circulating Epithelial Cell Cytokines Are Associated With Early-Onset Atopic Dermatitis

Food Proteins in Human Breast Milk and Probability of IgE-Mediated Allergic Reaction in Children During Breastfeeding: A Systematic Review

Previous reports suggested that food proteins present in human milk (HM) may trigger symptoms in allergic children during breastfeeding, but existing evidence has never been reviewed systematically.

Fecal sample collection methods and time of day impact microbiome composition and short chain fatty acid concentrations

Associations between the human gut microbiome and health outcomes continues to be of great interest, although fecal sample collection methods which impact microbiome studies are sometimes neglected. Here, we expand on previous work in sample optimization, to promote high quality microbiome data. To compare fecal sample collection methods, amplicons from the bacterial 16S rRNA gene (V4) and fungal (ITS2) region, as well as short chain fatty acid (SCFA) concentrations were determined in fecal material over three timepoints.

Maternal Late-Pregnancy Serum Unmetabolized Folic Acid Concentrations Are Not Associated with Infant Allergic Disease: A Prospective Cohort Study

The increase in childhood allergic disease in recent decades has coincided with increased folic acid intakes during pregnancy. Circulating unmetabolized folic acid (UMFA) has been proposed as a biomarker of excessive folic acid intake. We aimed to determine if late-pregnancy serum UMFA and total folate concentrations were associated with allergic disease risk in the offspring at 1 y of age in a population at high risk of allergy.

The influence of sunlight exposure and sun protecting behaviours on allergic outcomes in early childhood

The dramatic rise in allergic disease has occurred in tandem with recent environmental changes and increasing indoor lifestyle culture. While multifactorial, one consistent allergy risk factor has been reduced sunlight exposure. However, vitamin D supplementation studies have been disappointing in preventing allergy, raising possible independent effects of ultraviolet (UV) light exposure.

Longitudinal egg-specific regulatory T- and B-cell development: Insights from primary prevention clinical trials examining the timing of egg introduction

Egg allergy affects almost 1 in 10 Australian infants. Early egg introduction has been associated with a reduced risk in developing egg allergy; however, the immune mechanisms underlying this protection remain unclear.

Circulating Epithelial Cell Cytokines Are Associated With Early-Onset Atopic Dermatitis

Lower Cord Blood IL-17 and IL-25, but Not Other Epithelial Cell-Derived Cytokines Are Associated with Atopic Dermatitis in Infancy

There is a growing need for early biomarkers that may predict the development of atopic dermatitis (AD). As alterations in skin barrier may be a primary event in disease pathogenesis, epithelial cell (EC) cytokines expression patterns may be a potential biomarker in early life to target allergy preventive strategies towards "at-risk" infants. The aim of this longitudinal investigation was to examine from birth over the course of infancy levels of the EC cytokines: thymic stromal lymphopoietin (TSLP), interleukin (IL)-33, IL-25, and IL-17 in infants at high-risk of AD due to maternal atopy.

High-Fiber Diet during Pregnancy Characterized by More Fruit and Vegetable ConsumptionHigh-Fiber Diet during Pregnancy Characterized by More Fruit and Vegetable Consumption

Higher dietary fiber intakes during pregnancy may have the potential health benefits of increasing gut microbiome diversity, lowering the risk of glucose intolerance and pre-eclampsia, achieving appropriate gestational weight gain, and preventing constipation. In this observational cohort study, we have assessed the dietary fiber intakes of 804 women in late pregnancy, using a semi-quantitative food frequency questionnaire (SQ-FFQ). Overall, the median (interquartile range) dietary fiber intake was 24.1 (19.0-29.7) grams per day (g/day). Only 237/804 (29.5%) women met the recommended Adequate Intake (AI) of dietary fiber during pregnancy of 28 g/day.

Study protocol for a randomised controlled trial evaluating the effect of folic acid supplementation beyond the first trimester on maternal plasma unmetabolised folic acid in late gestation

Taking folic acid containing supplements prior to and during early pregnancy reduces the risk of neural tube defects. Neural tube defects occur prior to 28 days postconception, after which, there is no proven benefit of continuing to take folic acid. However, many women continue to take folic acid containing supplements throughout the pregnancy.

Introducing the ORIGINS project: a community-based interventional birth cohort

Non-communicable diseases (NCDs) pose the greatest threat to human health globally. The dramatic rise in early onset NCDs - such as childhood obesity, the allergy epidemic and an increasing burden of mental ill health in children and youth - reflect the profound early impact of modern environments on developing systems.

Pediatric Burn Survivors Have Long-Term Immune Dysfunction With Diminished Vaccine Response

Epidemiological studies have demonstrated that survivors of acute burn trauma are at long-term increased risk of developing a range of morbidities. The mechanisms underlying this increased risk remain unknown. This study aimed to determine whether burn injury leads to sustained immune dysfunction that may underpin long-term morbidity. Plasma and peripheral blood mononuclear cells were collected from 36 pediatric burn survivors >3 years after a non-severe burn injury (<10% total body surface area) and from age/sex-matched non-injured controls.

In “high-risk” infants with sufficient vitamin d status at birth, infant vitamin D supplementation had no effect on allergy outcomes: A randomized controlled trial

Early infancy oral vitamin D supplementation does not appear to reduce the development of early childhood allergic disease

Ovalbumin in breast milk is associated with a decreased risk of IgE-mediated egg allergy in children

Showed for the first time that the presence of an egg-derived allergen in breast milk is associated with a reduced risk of egg allergy in children at 2.5 years of age

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

This study highlights an unpredicted potential risk factor for the development of food allergy, that is, D pteronyssinus allergens in breast milk

Analytical bias in the measurement of plasma 25-hydroxyvitamin D concentrations in infants

To our knowledge, this is the first study to show that the reported 25(OH)D concentration may be influenced by both age and assay type

The challenges of developing and optimising an assay to measure 25-hydroxyvitamin D in saliva

We have developed an LC-MS/MS assay that accurately measures saliva 25(OH)D3 levels, which correlated with serum levels

Prebiotics: mechanisms and preventive effects in allergy

In this review, we describe both the mechanisms and the therapeutic evidence from preclinical and clinical studies exploring the role of prebiotics in allergy prevention

Maternal Fiber Dietary Intakes during Pregnancy and Infant Allergic Disease

Maternal resistant starch consumption was differentially associated with infant phenotypes, with reduced risk of infant wheeze, but increased risk of eczema

Direct infant UV light exposure is associated with eczema and immune development

This study is the first to demonstrate an association between greater direct UV light exposures in early infancy with lower incidence of eczema

The ORIGINS Project

ORIGINS is a new birth cohort study, collecting detailed information about the early environment's influence on a broad range of non-communicable diseases

Prenatal omega-3 LCPUFA and symptoms of allergic disease and sensitization throughout early childhood

Maternal supplementation with 900 mg of ω-3 LCPUFA did not change the progression of IgE-mediated allergic disease symptoms or sensitization

Taking a prebiotic approach to early immunomodulation for allergy prevention

In this review we examine maternal and infant dietary sources of prebiotics with a particular focus on non-digestible oligosaccharides, which undergo SCFA.

Early introduction of food reduces food allergy – Pro and Con

When an infant is developmentally ready, a variety of nutritious foods should be introduced including the ‘more allergenic’ foods during infancy

Randomized controlled trial of early regular egg intake to prevent egg allergy

We aimed to determine whether regular consumption of egg protein from 4-6 month old reduced the risk of IgE-mediated egg allergy in infants without eczema.

Association Between Family Characteristics and the Effect of Timing of Regular Egg Introduction in Infant Egg Allergy

A recent systematic review of 5 randomized clinical trials, found that early egg introduction was associated with reduced egg allergy.

Maternal dietary intake in pregnancy and lactation and allergic disease outcomes in offspring

As the prevalence of allergic disease dramatically rises worldwide, prevention strategies are increasingly being considered.

Early nutrition and its effect on allergy development

Nutrition is one of the most easily modifiable environmental factors during early life that may play a role in allergic disease prevention.

Effects of maternal dietary egg intake during early lactation on human milk ovalbumin concentration: A randomized controlled trial

Increased maternal egg ingestion is associated with increased breastmilk ovalbumin, and markers of immune tolerance in infants

Early life nutrition and the opportunity to influence long-term health: an Australasian perspective

There is significant data to support the hypothesis that early life nutrition in the fetus, infant and young child can have profound effects on long-term health

iming of Introduction of Solids and Early-Onset Allergic Disease

Strategies to prevent early-life food allergen sensitisation prior to commencement of solid foods are needed and should be the focus of future research

25-hydroxyvitamin D status of pregnant women is associated with the use of antenatal vitamin supplements and ambient ultraviolet radiation

Vitamin D deficiency in a predominantly white Caucasian cohort of pregnant women is less prevalent than has been reported in other studies

Elevated IL-5 and IL-13 responses to egg proteins predate the introduction of egg in solid foods in infants with eczema

Elevated egg-specific Th2 cytokine responses were established prior to egg ingestion at 4months and were not significantly altered by introduction of egg

In-utero exposures and the evolving epidemiology of paediatric allergy

This paper discusses the rising prevalence of allergic disease in children. This review article considers recent findings in the field of paediatric immune...

Nutritional approaches for the primary prevention of allergic disease: An update

The dramatic rise in early childhood allergic diseases indicates the specific vulnerability of the immune system to early life environmental changes.

In utero and postnatal vitamin D exposure and allergy risk

This review article examines the evidence of the impact of in utero and postnatal vitamin D exposure on allergy risk in childhood

Nutritional Influences on Epigenetic Programming. Asthma, Allergy, and Obesity

Reliance on increasing use of dietary supplementation and fortification (eg, with folate) to compensate for increased consumption of processed foods is also...

25-hydroxyvitamin D3 status is associated with developing adaptive and innate immune responses in the first 6 months of life

Vitamin D status in early life has been linked to the risk of allergic disease in multiple observational studies.