Studies from several countries have reported an association between latitudes further from the equator and
proxy markers of food allergy prevalence. As latitudes further from the equator are associated with lower sun exposure
and vitamin D status (VDS), it has been proposed that low VDS may be a risk factor for food allergy. A range of basic
science evidence supports the biological plausibility of this hypothesis; and recent work has identified a cross sectional
association between low VDS and challenge proven food allergy in infants. Overall, however, the evidence regarding the
relationship between VDS and food allergy remains controversial and the limited longitudinal data are discouraging. In
this review we consider the evidence for and against low VDS as a risk factor for food allergy and discuss the possibility
that other factors (including genetic variables) may contribute to the inconsistent nature of the available observational
evidence. We then discuss whether genetic and/or environmental factors may modify the potential influence of VDS on
food allergy risk. Finally, we argue that given the rising burden of food allergy, the balance of available evidence
regarding the potential relevance of VDS to this phenomenon, and the inherent limitations of the existing observational
data, there is a compelling case for conducting randomised clinical trials of vitamin D supplementation for the prevention
of food allergy during early life.
Keywords: Food allergy, genetic factors, gut microbiome, vitamin D status.
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