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Fecal Calprotectin and Eosinophil-Derived Neurotoxin in Children with Non-IgE-Mediated Cow's Milk Protein Allergy
María Roca1, Ester Donat1,2, Ana Rodriguez Varela3
1Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain.
Insights
Fecal calprotectin (fCP) and fecal eosinophil-derived neurotoxin (fEDN) do not reliably diagnose cow's milk protein allergy (CMPA) in infants or monitor dietary response. High variability limits their clinical utility for non-IgE mediated CMPA.
Area of Science:
- Pediatrics
- Gastroenterology
- Immunology
Background:
- Cow's milk protein allergy (CMPA) is a common condition in infants, often presenting with gastrointestinal symptoms.
- Non-IgE mediated CMPA diagnosis and monitoring can be challenging.
- Biomarkers like fecal calprotectin (fCP) and fecal eosinophil-derived neurotoxin (fEDN) are explored for diagnostic and monitoring purposes.
Purpose of the Study:
- To evaluate the efficacy of fCP and fEDN as diagnostic markers for CMPA in infants.
- To assess the utility of fCP and fEDN in monitoring infant response to a cow's milk protein (CMP)-free diet.
- To determine if these markers can differentiate CMPA infants from healthy infants or those with other gastrointestinal issues.
Main Methods:
- Prospective study involving infants aged 0-9 months.
- Inclusion of infants diagnosed with CMPA, mild functional gastrointestinal disorders, healthy infants, and infants with mild infections.
- Collection and analysis of stool samples for fCP and fEDN levels at baseline and after a 1-month CMP-free diet for the CMPA group.
Main Results:
- fCP and fEDN levels were higher in CMPA infants compared to healthy infants at baseline, but differences were not statistically significant (p=0.119 and p=0.506).
- No statistically significant changes in fCP levels were observed after a 1-month elimination diet in the CMPA group (p=0.184).
- High variability and inconsistent individual marker behavior were noted after initiating a CMP-free diet.
Conclusions:
- Neither fCP nor fEDN levels are sufficiently effective in discriminating between healthy infants and those with non-IgE mediated CMPA.
- The individual utility of fCP and fEDN for clinical follow-up and monitoring dietary compliance remains debatable.
- Further prospective studies with larger cohorts are necessary to draw definitive conclusions on the role of these biomarkers.
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.
