Precise identification of food allergy and atopic dermatitis (AD) endotypes in infants is needed to target treatments effectively. Therefore, we investigated markers associated with changes in the microbiota and immune responses within the gut-skin axis of immunoglobulin E (IgE) and non-IgE-mediated cow's milk allergy (CMA) patients with AD. We report that the skin microbiota of patients with IgE CMA differs significantly from healthy controls (HCs) and from patients with non-IgE CMA, despite similar AD severity. Regarding the immune response to bacteria, we found a significant increase in soluble CD14 in patients with non-IgE CMA compared to patients with IgE CMA. Patients with a non-IgE CMA have more regulatory T cells in their blood that migrate into the intestine than patients with IgE CMA. These findings provide insights into the complex interplay between the damaged epithelial barrier, microbiome, and immune responses in CMA patients with AD.

CEITEC Central European Institute of Technology Masaryk University Brno Czech Republic

Department of Dermatovenerology 2nd Faculty of Medicine Charles University Bulovka University Hospital Prague Czech Republic

Department of Immunology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Paediatric Dermatology Motol University Hospital Prague Czech Republic

Institute of Clinical Immunology and Allergology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Laboratory of Animal Evolutionary Biology Faculty of Science Department of Zoology Charles University Prague Czech Republic

Laboratory of Cellular and Molecular Immunology Institute of Microbiology of the Czech Academy of Sciences Prague Czech Republic

Laboratory of Gnotobiology Institute of Microbiology of the Czech Academy of Sciences Novy Hradek Czech Republic

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