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Current status of fecal calprotectin as a diagnostic or monitoring biomarker for cow’s milk protein allergy in children: a scoping review

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Abstract

Background

There are few approved biomarkers for diagnosis and monitoring of cow’s milk protein allergy (CMPA), thus the oral food challenge remains to be the golden diagnostic standard. A potential biomarker is fecal calprotectin, a cytosolic protein, elevating in the presence of intestinal mucosal inflammation. We aimed to undertake a scoping review of the evidence pertaining to the current status of fecal calprotectin used for diagnosis and monitoring CMPA in children, and tried to indicate the aspects needed to be concerned in the future investigations and researches.

Methods

A scoping review was performed using the literature searched from PUBMED, EMBASE, and Web of Science Databases until July 2019 on the studies about the application of fecal calprotectin as a biomarker of CMPA in children. Studies were examined according to the inclusion and exclusion criteria. Data were extracted, and a narrative synthesis was conducted to summarize and analyze.

Results

Thirteen studies with different study design embracing 1238 children were included. The age range was from infants to adolescents. Most children with CMPA presented gastrointestinal symptoms, among which hematochezia was most common. Amount of data suggested that infants with CMPA represented elevated levels of fecal calprotectin, particularly with distinct significance in non-IgE-mediated CMPA groups. Decreases of fecal calprotectin after elimination diet were demonstrated in enrolled studies. However, no matter in the CMPA positive or negative groups, the changes of fecal calprotectin before or after challenge showed no significance. Contradictory results were generated from studies on the role of fecal calprotectin in predicting allergic disease.

Conclusions

Available evidence is not sufficient to confirm the utilization of fecal calprotectin both in diagnosis and monitoring of CMPA and predicting for allergic disease. More clinical and bench researches with elaborate design should be conducted and the exact cut-off values of fecal calprotectin in different groups remain to be determined.

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Funding

This study was supported by Science and Technology Project of the Health Planning Committee of Sichuan Province, China (17PJ278).

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Authors and Affiliations

  1. Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 1617, Riyue Avenue, Chengdu 610091, China

    Li-Jing Xiong, Xiao-Li Xie, Yang Li & Xiao-Zhi Deng

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  1. Li-Jing Xiong
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  2. Xiao-Li Xie
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  3. Yang Li
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Contributions

LJX and YL contributed to the literature searching, analysis, and drafting the article; XLX and XZD contributed to conception and revising it critically for important intellectual content, and final approval of the version to be published.

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Correspondence to Xiao-Li Xie.

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All authors read and approved the manuscript for publication. No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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Xiong, LJ., Xie, XL., Li, Y. et al. Current status of fecal calprotectin as a diagnostic or monitoring biomarker for cow’s milk protein allergy in children: a scoping review. World J Pediatr 17, 63–70 (2021). https://doi.org/10.1007/s12519-020-00364-2

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  • DOI: https://doi.org/10.1007/s12519-020-00364-2

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