The role of fermented foods in managing food allergies in children and adults: a systematic review
Journal
Frontiers in Nutrition
Date Issued
2026-01-05
Author(s)
Hyseni, Bahtir
Papadimitriou, Konstantinos
Issa, Aline
Tonay, Ayşe Nur
Ergün, Burcu Gündüz
Gonzalez-Domenech, Carmen Maria
Arranz, Elena
Pula, Endra Luzha
Erem, Erenay
Garcia-Gutierrez, Enriqueta
Bouchaud, Gregory
Szajewska, Hania
Yıldırım, Hatice Kalkan
Künili, İbrahim Ender
Markiewicz, Lidia
Caruana Grech Perry, Mario
Kilic-Akyilmaz, Meral
El Jalil, Mounaim Halim
Merabti, Ryma
Karagül Yüceer, Yonca
Gulsunoglu-Konuskan, Zehra
Akpınar, Aslı
Karakaş-Budak, Barçın
Chassard, Christophe
Pracer, Smilja
Vergères, Guy
Bavaro, Simona Lucia
DOI
10.3389/fnut.2025.1689636
Abstract
Introduction
Fermented foods are among the oldest foods produced, and several different health benefits are attributed to their consumption even in the absence of concrete clinical evidence. To address this gap, this systematic review focuses on the effects of the consumption of fermented foods on food allergies.
Methods
This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the relevant European Food Safety Authority guidelines. A systematic search strategy was established and registered in a study protocol in Open Science Framework. Scopus, MEDLINE, and Cochrane Library were searched with specific strings targeting human studies focusing on Fermented food and food allergies. Inclusion and exclusion criteria were defined based on the People Intervention Comparison Outcome elements. The Cadima tool was used to perform screening and selection of articles. A standard template was used for data extraction. Risk of bias assessment was performed using the Risk of Bias 2.0 Tool, Risk of Bias in Non-randomized Studies - of Interventions, or Newcastle–Ottawa Scale protocols. Additionally, a narrative section was written based on the European Food Safety Authority guidelines for the mechanism of action and product characteristics for evidence support.
Results
From a total of 558 initial records, 10 studies were finally selected. Fermented foods evaluated were fermented soy products, baked goods, fruit-based beverages, vinegar-treated foods, oat-based drinks, and dairy products (yogurt, cheese). In several studies, a reduced allergenicity was reported that was related to fermentation-mediated hydrolysis of allergenic proteins of gluten or soy. Additional mechanisms were related to anti-allergic immunomodulatory effects or favorable shifts in gut microbiota composition. In one case, fermented food consumption led to aggravation of the allergic response, presumably due to the compounds generated during soy fermentation. Risk of bias assessment revealed that most studies were performed with important methodological limitations.
Conclusion
While fermented foods hold promise in reducing food allergenicity and promoting tolerance, current evidence is limited to draw solid conclusions. Rigorous, well-designed human clinical trials, complemented by mechanistic studies
in vitro
and
in vivo
, are needed to clarify the role of fermented foods as dietary or even clinical tools to combat food allergies.
Systematic review registration
https://osf.io/hgjaf/10.17605/OSF.IO/HGJAF
.
Fermented foods are among the oldest foods produced, and several different health benefits are attributed to their consumption even in the absence of concrete clinical evidence. To address this gap, this systematic review focuses on the effects of the consumption of fermented foods on food allergies.
Methods
This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the relevant European Food Safety Authority guidelines. A systematic search strategy was established and registered in a study protocol in Open Science Framework. Scopus, MEDLINE, and Cochrane Library were searched with specific strings targeting human studies focusing on Fermented food and food allergies. Inclusion and exclusion criteria were defined based on the People Intervention Comparison Outcome elements. The Cadima tool was used to perform screening and selection of articles. A standard template was used for data extraction. Risk of bias assessment was performed using the Risk of Bias 2.0 Tool, Risk of Bias in Non-randomized Studies - of Interventions, or Newcastle–Ottawa Scale protocols. Additionally, a narrative section was written based on the European Food Safety Authority guidelines for the mechanism of action and product characteristics for evidence support.
Results
From a total of 558 initial records, 10 studies were finally selected. Fermented foods evaluated were fermented soy products, baked goods, fruit-based beverages, vinegar-treated foods, oat-based drinks, and dairy products (yogurt, cheese). In several studies, a reduced allergenicity was reported that was related to fermentation-mediated hydrolysis of allergenic proteins of gluten or soy. Additional mechanisms were related to anti-allergic immunomodulatory effects or favorable shifts in gut microbiota composition. In one case, fermented food consumption led to aggravation of the allergic response, presumably due to the compounds generated during soy fermentation. Risk of bias assessment revealed that most studies were performed with important methodological limitations.
Conclusion
While fermented foods hold promise in reducing food allergenicity and promoting tolerance, current evidence is limited to draw solid conclusions. Rigorous, well-designed human clinical trials, complemented by mechanistic studies
in vitro
and
in vivo
, are needed to clarify the role of fermented foods as dietary or even clinical tools to combat food allergies.
Systematic review registration
https://osf.io/hgjaf/10.17605/OSF.IO/HGJAF
.
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