Roca María, Donat Ester, Rodriguez Varela Ana, Carvajal Eva, Cano Francisco, Armisen Ana, Ekoff Helena, Cañada-Martínez Antonio José, Rydell Niclas, Ribes-Koninckx Carmen
Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain.
Pediatric Gastrohepatology Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain.
J Clin Med. 2021 Apr 9;10(8):1595. doi: 10.3390/jcm10081595.
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 (value 0.119 and 0.506). After 1 month of an elimination diet, no statistically significant differences in fCP with basal levels were found (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.
我们的目的是评估粪便钙卫蛋白（fCP）和粪便嗜酸性粒细胞衍生神经毒素（fEDN）作为牛奶蛋白过敏（CMPA）诊断标志物以及监测婴儿对无免疫球蛋白E（IgE）介导的无牛奶蛋白（CMP）饮食反应的有效性。我们前瞻性招募了0至9个月大的婴儿。从30名患有CMPA的婴儿、19名患有轻度功能性胃肠疾病的婴儿、28名健康婴儿以及28名患有轻度感染的儿童中采集粪便样本。尽管在第0个月时，CMPA婴儿的fCP和fEDN水平高于健康婴儿，但这两个参数的差异均未达到统计学意义（值分别为0.119和0.506）。在进行1个月的排除饮食后，CMPA组中fCP与基础水平相比未发现有统计学意义的差异（值为0.184）。我们发现幼儿的fCP和fEDN水平存在很大变异性，并且在开始无CMP饮食后这些标志物的个体行为存在差异。似乎fCP和fEDN水平都无助于区分健康婴儿与有非IgE介导的CMPA体征或症状的婴儿。此外，就个体而言，fCP或fEDN水平是否可用于临床随访和饮食依从性监测仍存在争议。然而，需要进行更大规模人群的前瞻性研究才能得出可靠的结论。
