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Cow's milk protein intolerance and chronic constipation in children
1Divisions of Allergy, Clinical Immunology and Rheumatology, UNIFESP - EPM, São Paulo, SP, Brazil. silviadaher@hotmail.com
Summary
Cow's milk protein (CMP) allergy is a potential cause of chronic constipation in children. Eliminating CMP from the diet resolved constipation in 28% of children, suggesting CMP allergy should be considered.
Area of Science:
- Pediatric Gastroenterology
- Allergology
- Clinical Nutrition
Background:
- Chronic constipation is a common pediatric issue.
- Cow's milk protein (CMP) allergy is a recognized condition in infants and children.
- The link between CMP allergy and chronic constipation requires further investigation.
Purpose of the Study:
- To investigate the role of cow's milk protein allergy in children with chronic constipation.
- To evaluate the efficacy of a CMP-free diet in managing chronic constipation in pediatric patients.
Main Methods:
- A cohort of 25 children (3 months–11 years) with chronic constipation underwent clinical evaluation and allergy testing (serum IgE, RAST, skin-prick tests).
- Participants were placed on a CMP-free diet for 4 weeks, followed by a CMP challenge in responsive patients.
- Rectal biopsies were performed in two infants diagnosed with allergic colitis.
Main Results:
- Constipation resolved in 7 out of 25 children (28%) during the CMP-free diet.
- Constipation recurred in these 7 children within 48–72 hours after CMP reintroduction (challenge).
- Elevated total IgE levels were noted in 71% of children who improved, with positive skin-tests or specific IgE in 29% each.
Conclusions:
- Cow's milk protein allergy or intolerance should be considered in the differential diagnosis of chronic refractory constipation in children.
- A CMP-free diet can be an effective diagnostic and therapeutic tool for identifying CMP-related constipation.
- Further research is needed to elucidate the precise mechanisms underlying CMP-induced constipation.