Increased concentration of fecal α1-antitrypsin is associated with cow's milk allergy in infants with atopic eczema


Heli Majamaa, Department of Dermatology, Tampere University Hospital, PO Box 2000, FIN-33521 Tampere, Finland.


Background The use of fecal α1-antitrypsin in the monitoring of intestinal inflammation in infants with atopic eczema and food allergy was evaluated.

Methods The study material comprised 26 atopic infants with confirmed food allergy. Fecal samples were collected before an elimination diet and 3 months later for the determination of α1-antitrypsin.

Results Nine (35%) of the 26 patients demonstrated an increased fecal concentration of α1-antitrypsin (median 3 mg/g; range 2.8–6.4 mg/g). In all nine patients (100%) the oral cow's milk challenge was positive as opposed to only six (35%) in those with normal α1-antitrypsin concentration (P = 0.0024). No further connections between α1-antitrypsin and other food allergies were detected. As a result of an adequate elimination diet, the fecal concentration of α1-antitrypsin was normalized in seven patients, with a favourable clinical response in atopic eczema in six and no improvement in one patient.

Conclusions Our results indicate that serial determinations of fecal α1-antitrypsin provide a useful non-invasive tool for the detection and follow-up of intestinal inflammation in a certain group of atopic infants with cow's milk allergy and severe inflammation of the gut.