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Food allergy-related paediatric constipation: the usefulness of atopy patch test
Ekaterini I Syrigou1, Constantinos Pitsios, Ioanna Panagiotou
1Department of Allergy, Sotiria General Hospital, Athens, Greece. esyrigou@hotmail.com
Insights
Food allergy is a significant cause of chronic constipation in children unresponsive to laxatives. An elimination diet, particularly for wheat and egg allergies, can resolve constipation, with tolerance achieved after 12 months.
Area of Science:
- Pediatric Gastroenterology
- Allergology
- Clinical Nutrition
Background:
- Chronic constipation affects many children, often remaining unresponsive to standard laxative therapy.
- The role of food allergy as an underlying cause of pediatric constipation is not fully understood.
- Non-IgE mediated food allergies may contribute to functional gastrointestinal disorders in children.
Purpose of the Study:
- To investigate food allergy as a cause of chronic constipation in pediatric patients.
- To determine the required duration of an elimination diet for achieving tolerance to causative food allergens.
- To assess the utility of the atopy patch test (APT) in identifying non-IgE mediated food allergies linked to constipation.
Main Methods:
- Prospective evaluation of 54 children (6 months–14 years) with chronic constipation refractory to laxatives.
- Allergy testing included skin prick tests (SPT), serum specific IgE, and atopy patch tests (APT) for common food allergens.
- Food allergen elimination diet based on positive APT results, followed by oral food challenges and extended dietary periods.
Main Results:
- 32 out of 54 children had positive APT results, with wheat and egg being the most common allergens.
- Constipation improved in 28/32 children after an 8-week elimination diet, with relapses upon oral food challenge.
- Tolerance to food allergens was achieved in 6/28 after 6 months, 25/28 after 12 months, and all participants after 2 years.
- APT was effective in identifying non-IgE mediated food allergies causing constipation, with no correlation to IgE levels.
Conclusions:
- Food allergy is a significant etiological factor in pediatric chronic constipation unresponsive to conventional treatment.
- The atopy patch test (APT) is a valuable tool for diagnosing non-IgE mediated food allergy-related constipation.
- A 12-month strict elimination diet is generally sufficient for achieving tolerance to causative food allergens in children with constipation.
Abstract:
The aims of this study were to evaluate the implication of food allergy as a cause of paediatric constipation and to determine the diet period needed to tolerate the constipation-causing foods. Fifty-four children aged 6 months to 14 years (median, 42 months) suffering from chronic constipation (without anatomic abnormalities, cοeliac disease or hypothyroidism), unresponsive to a 3-month laxative therapy, were prospectively evaluated. All participants were evaluated for allergy to cow's milk, egg, wheat, rice, corn, potato, chicken, beef and soy, using skin tests (SPT), serum specific IgE and atopy patch test (APT). A withdrawal of the APT-positive foods was instructed. Thirty-two children had positive APT; 15 were positive to one; six, to two and 11, to three or more food allergens, wheat and egg being the commonest. After withdrawing the APT-positive foods for an 8-week period, constipation had improved in 28/32 children, but a relapse of constipation was noticed after an oral food challenge, so they continued the elimination diet. Tolerance to food allergens was achieved in only 6/28 after 6 months, compared to 25/28 after 12 months and to all after a 2-year-long elimination. Food allergy seems to be a significant etiologic factor for chronic constipation not responding to treatment, in infants and young children. APT was found to be useful in evaluating non-IgE allergy-mediated constipation, and there was no correlation of APT with IgE detection. Tolerance was adequately achieved after 12 months of strict food allergen elimination.
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