Summary
This narrative review synthesises evidence supporting the epithelial barrier hypothesis as a mechanistic explanation for the rising prevalence of allergic and autoimmune diseases in developed nations. The authors examine how multiple domains of the external exposome—including air pollution, microplastics, dietary compositional shifts, climate change, biodiversity loss, and chemical pollutants—disrupt skin and mucosal epithelial barriers. The review emphasises that modernisation, urbanisation, and globalisation have fundamentally altered human exposure profiles over recent decades, with particular attention to dietary fatty acids and airborne/environmental substances (detergents, pollen, ozone, nanoparticles, tobacco smoke) as barrier-disrupting agents.
Regional applicability
The review addresses global patterns of allergic disease rise in industrialised nations, which includes the United Kingdom. The exposome factors discussed (air quality, dietary habits, chemical exposures, climate trends) are directly relevant to UK policy and public health context, though the paper does not provide UK-specific epidemiological data or recommendations tailored to UK health systems.
Key measures
Mechanistic pathways linking exposome factors to epithelial barrier disruption and allergic disease; prevalence and severity of allergic conditions (atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, asthma)
Outcomes reported
The review examines how external exposome factors (air pollution, microplastics, dietary changes, chemical exposures, biodiversity loss) disrupt epithelial barriers and contribute to increased prevalence of allergic and inflammatory diseases. It synthesises evidence linking environmental exposures to atopic dermatitis, food allergy, allergic rhinitis, asthma, and related conditions through the epithelial barrier hypothesis framework.
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