Individualized Nutritional and Microbiome-Oriented Management of Food Allergy-Associated Atopic Dermatitis in Children: A Prospective Real-World Observational Cohort Study.

Atopic dermatitis (AD) and food allergy frequently coexist during early childhood and are increasingly linked through interactions within the gut-skin axis. We evaluated the clinical outcomes of an integrated nutritional and microbiome-oriented management strategy in children with food allergy-associated AD under real-world conditions. This prospective, two-center, real-world observational cohort study included 85 children (median age, 11 months) with AD diagnosed according to the Hanifin-Rajka criteria and confirmed IgE- and/or non-IgE-mediated food allergy. Participants received individualized nutritional and microbiome-oriented management comprising elimination diets, conventional topical therapy, microbiome-directed interventions, and nutritional supplementation tailored to their clinical, allergological, and microbiological profile. Disease severity was assessed using the Scoring Atopic Dermatitis (SCORAD) index at baseline and after approximately 1 and 3 months of follow-up. Cow's milk, egg, and wheat were the predominant food allergens, and 69.4% of children were polyallergic. SCORAD decreased significantly during follow-up, with a mean relative reduction of 51.6% and 63.5% of participants achieving a SCORAD50 response. Food allergy burden independently predicted baseline disease severity, whereas documented gut dysbiosis was associated with polyallergy and greater absolute clinical improvement, although this association lost statistical significance after adjustment for baseline disease severity and should therefore not be interpreted as a favorable prognostic effect of dysbiosis. Baseline SCORAD remained the strongest independent predictor of clinical improvement. Integrated nutritional and microbiome-oriented management was associated with substantial clinical improvement and may represent a valuable adjunct to standard care in children with food allergy-associated AD. Because of the observational, uncontrolled design, these findings describe associations rather than causal treatment effects. These findings support further evaluation of personalized nutritional strategies in randomized controlled trials.