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Sharifi M, Mohammad Esagh R, Jouybari R M, Mansori K. Changes in Fecal Calprotectin Levels in Infants with Cow’s Milk Protein Allergy Before and After Dietary Therapy. J Adv Med Biomed Res 2026; 34 (1) :8-14
URL: http://journal.zums.ac.ir/article-1-7637-en.html
Changes in Fecal Calprotectin Levels in Infants with Cow’s Milk Protein Allergy Before and After Dietary Therapy
Mahdie Sharifi1 , Rozeh Mohammad Esagh *2 , Reza Mahdian Jouybari1 , Kamyar Mansori3
1- Department of Pediatrics, School of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
2- Department of Pediatrics, School of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran , dr.rozeh@zums.ac.ir
3- Department of Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
Abstract:   (68 Views)

Background & Objective: In early infancy, adverse reactions to cow’s milk proteins whether driven by IgE-dependent or cell-mediated immune pathways are among the leading causes of food-related gut inflammation. This investigation sought to quantify shifts in fecal calprotectin, a neutrophil-derived protein reflecting mucosal immune activity, in a cohort of infants with physician-confirmed cow’s milk protein allergy (CMPA), assessed immediately prior to and one month following rigorous dietary exclusion of all cow’s milk–derived components.
 Materials & Methods: This cross-sectional study included 63 infants (aged 1–18 months) with CMPA referred to the pediatric gastroenterology clinic of Ayatollah Mousavi Hospital in Zanjan, Iran, in 2024. Diagnosis was based on clinical symptoms (e.g., bloody stool) and confirmed by a positive elimination-challenge test. Fecal Calprotectin levels were measured using a commercial ELISA kit before and one month after starting a cow's milk protein-free diet (using specialized formula or maternal dietary elimination). Statistical analysis was performed using SPSS version 26, with a P-value <0.05 considered significant.
Results:  The mean age (±SD) of the infants was 3.78 (±2.28) months, with 31 (49.2%) boys and 32 (50.8%) girls. Regarding feeding type, 40 infants (63.5%) received Neocate LCP formula, 13 (20.6%) received Pepti Junior formula, and 10 (15.9%) were exclusively breastfed by mothers on a milk-free diet. The most frequent clinical symptom was bloody stool (65.1%, n=41), followed by gastroesophageal reflux disease (GERD) (39.7%, n=25) and dermatitis (39.7%, n=25). The mean fecal Calprotectin level decreased significantly from 479.41 ± 368.76 μg/g before the intervention to 130.39 ± 95.55 μg/g one month after the intervention (P<0.001). A significant reduction in Calprotectin was observed across all feeding types.
Conclusion:  Fecal Calprotectin levels decreased significantly following dietary intervention in infants with CMPA. This suggests that fecal Calprotectin may serve as a useful, non-invasive biomarker for monitoring intestinal inflammation and therapeutic response in these patients.

Keywords: Calprotectin, Cow's Milk Protein Allergy, Diet Therapy, Fecal Biomarker, Infant
Full-Text [PDF 345 kb]   (40 Downloads)    
Type of Study: Original Research Article | Subject: Clinical Medicine
Received: 2025/07/5 | Accepted: 2026/02/8 | Published: 2026/02/28
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