REVIEWImpact of the exposome on food allergy developmentMoran, Timothy P.a,b Author Information aCenter for Environmental Medicine, Asthma and Lung Biology bDepartment of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA Correspondence to Timothy P. Moran, MD, PhD, 116 Manning Dr, CB# 7231, University of North Carolina, Chapel Hill, NC 27599, USA. Tel: +1 919 445 6822; E-mail: [email protected] Current Opinion in Allergy and Clinical Immunology ():10.1097/ACI.0000000000000889, January 12, 2023. | DOI: 10.1097/ACI.0000000000000889 Buy PAP Metrics Abstract Purpose of review The increasing global prevalence of food allergy indicates that environmental exposures are likely contributing to food allergy development. This review summarizes recent studies on how specific factors within the external exposome may impact the development of food allergy. Recent findings There is strong evidence that nonoral exposure to food allergens within the living environment is a risk factor for food sensitization and food allergy. The role of air pollution in food allergy development remains unclear, as cohort studies have not found consistent relationships between air pollutant exposure and food sensitization. Early-life microbial exposures linked to a rural lifestyle are likely protective against food allergy development, possibly through alteration of the infant microbiome. In contrast, factors associated with urbanization and decreased exposure to microbes may contribute to food allergy development. Recent studies on the role of residential greenness in food allergy development suggest either no relationship or a possible increased risk for food allergy. Summary The external exposome comprises a number of exposures that can modify food allergy risk. Improved understanding of how complex environmental exposures interact with genetic factors will be necessary for developing effective interventions aimed at preventing food allergy development in children. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.