Confronting the Allergic March

This education is about:

• Etiology of the allergic march
• Role of the microbiome in development of the immune and gastrointestinal systems 
• The link between intestinal permeability and food allergy 
• Presentation and diagnosis of cow’s milk protein allergy (CMPA)
• Novel strategies for management of CMPA
• Techniques that encourage development of cow’s milk allergen tolerance

Why it matters:
Cow’s milk protein allergy (CMPA) is a common diagnosis among infants and can develop as a part of the allergic march. In recent years, a better understanding of the allergic march has led to the identification of the gut microbiome and intestinal permeability as important drivers of allergen sensitization. Early interventions that target colonization of the gut microbiome and support an optimal gut barrier may help to both prevent CMPA and accelerate the induction of tolerance to cow’s milk protein. These strategies can ultimately improve the outcomes and quality of life of infants and families.

• Profile

  Alessio Fasano, MD

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  Alessio Fasano, MD, is a professor of nutrition at Harvard T.H. Chan School of Public Health, a professor of pediatrics at Harvard Medical School in Boston, and a pediatrician at Massachusetts General Hospital, also in Boston, where he holds several positions at MassGeneral Hospital for Children. They include the W. Allan Walker Chair and division chief in Pediatric Gastroenterology and Nutrition, director of the Center for Celiac Research and Treatment, director of the Mucosal Immunology and Biology Research Center, and associate chief for Basic, Clinical and Translational Research. Dr. Fasano is also on the faculty of the University of Maryland School of Medicine in Baltimore.

  Dr. Fasano received his medical degree and completed a residency and internship at the University of Naples School of Medicine in Naples, Italy. He completed additional internships in pediatrics, emergency medicine, and pediatric social medicine at other hospitals in Italy.

  Dr. Fasano is recognized internationally for his research in the fields of celiac disease and gluten intolerance, including his groundbreaking study that established the prevalence of celiac disease in the United States as 1 in 133 people, a rate nearly 100 times greater than the previous estimate. He also led a University of Maryland School of Medicine team responsible for the discovery of zonulin, a protein that modulates the permeability of tight junctions between cells of the wall of the digestive tract that is known to be a major factor in the condition known as “leaky gut.”

  At the Center for Celiac Research and Treatment, Dr. Fasano and his team care for patients of all ages with gluten-related disorders, including celiac disease, wheat allergy and gluten sensitivity, as well as for infants and children with challenging gastrointestinal problems. His research encompasses basic science, focused on bacterial pathogenesis, gut microbiome and intestinal mucosal biology, as well as translational science focused on interventional clinical trials in autoimmune and inflammatory diseases, such as celiac disease. For example, the intersection of his research and clinical work led to the development of an anti-tissue transglutaminase (tTG) diagnostic test that is now used, worldwide, as a primary blood-screening tool for celiac disease.  

  In his role as director of the Mucosal Immunology and Biology Research Center, Dr. Fasano leads a team of scientists researching cystic fibrosis, celiac disease, shigella vaccine, necrotizing enterocolitis, autism spectrum disorder, and the role of the gut microbiome in health and disease.

  Dr. Fasano is a sought-after speaker at national and international conferences and has published more than 360 peer-reviewed papers. He is an ad hoc reviewer for several prestigious medical journals including JAMA, Pediatrics, Lancet, New England Journal of Medicine, Journal of Pediatrics, American Journal of Gastroenterology, and GUT. Dr. Fasano is also the author of educational materials for a lay audience including the books Gluten Freedom and Gut Feelings: The Microbiome and Our Health.

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  Alessio Fasano, MD

  W. Allan Walker Chair of Pediatric Gastroenterology and Nutrition
  Professor of Pediatrics, Harvard Medical School
  Professor of Nutrition, Harvard T.H. Chan School of Public Health
  Chief of the Division of Pediatric Gastroenterology and Nutrition 
  Associate Chief for Research, Department of Pediatrics
  MassGeneral Hospital for Children 
  Director of the Center for Celiac Research and Treatment
  Director of the Mucosal Immunology and Biology Research Center
  Massachusetts General Hospital - East