Head, Early Life & Life-Course Health Program; Team Lead, Nutrition in Early Life
BSc BND PhD
Areas of research expertise: Maternal and paediatric nutrition, paediatric allergic disease and intervention trials
Debbie Palmer’s research focuses on nutritional strategies for allergy prevention.
After ten years of clinical paediatric dietetic experience and specialising in food allergy treatment, Debbie commenced her research career. Over the past decade, she has conducted eleven intervention trials focusing on maternal and infant diets and assessed the allergic disease development outcomes in young children.
Her previous studies have investigated:
- maternal fish oil supplementation during pregnancy
- optimal exposure of egg protein through breast milk to infants during lactation
- optimal timing of egg introduction into the solid food diet of infants
- oral vitamin D supplementation to infants.
Her current research activities include conducting randomised controlled trials focusing on nutritional interventions for the prevention of allergic disease, including:
- maternal prebiotic supplementation during pregnancy and lactation
- maternal intakes of egg and peanut during pregnancy and lactation
- infant introduction to cashew nut spread in infancy.
-
Projects
-
Publications
November 2023
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.
Published research Breastfeeding Nutrition Nutrition in Early Life Food Allergy Allergy Maternal dietJuly 2023Feasibility 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.
Published research Nutrition in Early Life ORIGINS Food Allergy Subsite: ORIGINS ProjectDecember 2022Human 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.
Published research Breastfeeding Early Childhood Development Nutrition in Early LifeJuly 2022Changes 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.
Autism Spectrum Disorders Published research Nutrition Nutrition in Early LifeJuly 2022Study 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.
Published research Early Childhood Development Nutrition in Early Life ORIGINS Allergy Maternal dietJune 2022PrEggNut 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.
Published research Nutrition in Early Life ORIGINS Food AllergyApril 2022Pre-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.
Vitamin D and Sunlight Nutrition in Early Life ORIGINS Diabetes and Obesity AllergyFebruary 2022Food 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.
Published research Breastfeeding Nutrition in Early Life Food Allergy Allergy Immunology and Breast FeedingJuly 2021Fecal 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.
Published research Nutrition in Early LifeJune 2021Maternal 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.
Published research Subsite: ORIGINS ProjectMay 2021The 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.
Asthma Published research Vitamin D and Sunlight Nutrition in Early Life ORIGINSMay 2021Longitudinal 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.
Published research Nutrition in Early Life ORIGINSJanuary 2021Lower 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.
Published research Nutrition in Early Life ORIGINSDecember 2020High-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.
Published research Nutrition Nutrition in Early LifeNovember 2020Study 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.
Published research Early Childhood Development Nutrition Nutrition in Early LifeSeptember 2020Introducing 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.
July 2020Pediatric 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.
Published research Nutrition in Early Life Vaccine Trials Group Subsite: Wesfarmers Centre of Vaccines and Infectious DiseasesJune 2020In “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
Published research Vitamin D and Sunlight Inflammation Nutrition in Early Life ORIGINS Diabetes and ObesityJune 2020Ovalbumin 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
Published research Nutrition in Early Life ORIGINS Food AllergyMay 2020A 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
Published research Nutrition in Early Life ORIGINS Food AllergyJanuary 2020Analytical 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
Published research Vitamin D and Sunlight Nutrition in Early Life ORIGINSNovember 2019The 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
Published research Vitamin D and Sunlight Inflammation Nutrition in Early Life Cardiometabolic Sunhealth Diabetes and ObesityAugust 2019Prebiotics: 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
Published research Nutrition in Early Life Food AllergyAugust 2019Maternal 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
Published research Nutrition Nutrition in Early Life ORIGINSMarch 2019Direct 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
Published research Inflammation Nutrition in Early Life ORIGINSJanuary 2019The 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
Published research ORIGINSJune 2018Prenatal 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
Published research Nutrition in Early Life Food AllergyJanuary 2018Taking 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.
Published research Nutrition in Early Life ORIGINSMay 2017Early 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
Published research Nutrition in Early Life ORIGINS Food AllergyMay 2017Randomized 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.
Published research Allergy & Infectious Diseases ORIGINSMay 2017Association 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.
Published research Allergy & Infectious Diseases ORIGINSMarch 2017Maternal 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.
Nutrition in Early LifeJanuary 2017Early 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.
Published research Allergy & Infectious DiseasesDecember 2016Effects 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
Published research Nutrition in Early Life ORIGINS Food AllergyOctober 2016Early 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
Published research Nutrition Nutrition in Early LifeSeptember 2016iming 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
Published research Nutrition in Early Life Food AllergyJanuary 201625-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
Published research Vitamin D and Sunlight Nutrition in Early Life ORIGINSJanuary 2016Elevated 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
Published research Nutrition in Early Life ORIGINS Food AllergyOctober 2015In-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...
Published research Nutrition in Early Life ORIGINS Food AllergyJanuary 2015Nutritional 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.
Published research Nutrition Vitamin D and Sunlight Nutrition in Early Life ORIGINSDecember 2014In 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
Published research Vitamin D and Sunlight Nutrition in Early Life ORIGINSAugust 2014Nutritional 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...
Published research Nutrition Nutrition in Early Life ORIGINS Food AllergyJanuary 201425-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.
Published research Vitamin D and Sunlight Nutrition in Early Life ORIGINS