Abstract
Our aim is to assess the efficacy of fecal calprotectin (fCP) and fecal eosinophil-derived neurotoxin (fEDN) as diagnostic markers of cow’s milk protein allergy (CMPA) and for monitoring the infants’ response to a non-IgE mediated cow’s milk protein (CMP)-free diet. We prospectively recruited infants aged 0 to 9 months. Stool samples were taken from 30 infants with CMPA, 19 with mild functional gastrointestinal disorders, 28 healthy infants, and 28 children who presented mild infections. Despite the fact that levels of fCP and fEDN in CMPA infants were higher than in healthy infants at month 0, differences for both parameters did not reach statistical significance (p-value 0.119 and 0.506). After 1 month of an elimination diet, no statistically significant differences in fCP with basal levels were found (p-values 0.184) in the CMPA group. We found a high variability in the fCP and fEDN levels of young infants, and discrepancies in individual behavior of these markers after a CMP-free diet was started. It seems that neither fCP nor fEDN levels are helpful to discriminate between healthy infants and those with signs or symptoms related to non-IgE-mediated CMPA. Additionally, it is debatable if on an individual basis, fCP or fEDN levels could be used for clinical follow-up and dietary compliance monitoring. However, prospective studies with larger populations are needed to draw robust conclusions.
Highlights
Food allergy is defined as an adverse reaction caused by a specific immune response that occurs following exposure to a given food [1]
Our aim is to assess the efficiency of fecal calprotectin (fCP) and fecal eosinophil-derived neurotoxin (fEDN) as diagnostic markers of cow’s milk protein allergy (CMPA), and for monitoring the infants’ response to a Cow’s milk protein (CMP)-free diet
At M0, the fCP levels in Group 1 (G1) were 60% higher than those in healthy controls (G3), they were not statistically significantly (estimate = 0.494, CI95% (−0.101; 1.085), p-value = 0.119)
Summary
Food allergy is defined as an adverse reaction caused by a specific immune response that occurs following exposure to a given food [1]. Cow’s milk protein (CMP) is the leading cause of food allergy in infants and children younger than 3 years [2]. Non-IgE-mediated cow’s milk protein allergy (CMPA) may cause enteropathy, proctocolitis, food protein-induced enterocolitis syndrome (FPIES) or minor nonspecific gastrointestinal (GI) manifestations, such as regurgitation, dyspepsia, abdominal pain, or persistent constipation, and early satiety, anorexia, and food refusal. Due to the non-specific nature of symptoms and the lack of a confirmatory diagnostic test, diagnosis relies on assessing whether symptoms resolve after the suspected allergen has been excluded from the diet, followed by a clinical relapse after reintroduction of the food allergen [1].
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