Increased concentration of fecal alpha(1)-antitrypsin is associated with cow's milk allergy in infants with atopic eczema

Background The use of fecal alpha (1)-antitrypsin in the monitoring of inte stinal inflammation in infants with atopic eczema and food allergy was eval uated. Methods The study material comprised 26 atopic infants with confirmed food allergy. Fecal samples were collected before an elimination diet and 3 mont hs later for the determination of alpha (1)-antitrypsin. Results Nine (35%) of the 26 patients demonstrated an increased fecal conce ntration of alpha (1)-antitrypsin (median 3 mg/g; range 2.8-6.4 mg/g). In a ll nine patients (100%) the oral cow's milk challenge was positive as oppos ed to only six (35%) in those with normal alpha (1)-antitrypsin concentrati on (P = 0.0024). No further connections between alpha (1)-antitrypsin and o ther food allergies were detected. As a result of an adequate elimination d iet, the fecal concentration of alpha (1)-antitrypsin was normalized in sev en patients, with a favourable clinical response in atopic eczema in six an d no improvement in one patient. Conclusions Our results indicate that serial determinations of fecal alpha (1)-antitrypsin provide a useful non-invasive tool for the detection and fo llow-up of intestinal inflammation in a certain group of atopic infants wit h cow's milk allergy and severe inflammation of the gut.