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Chronic constipation as a symptom of cow milk allergy
G Iacono1, A Carroccio, F Cavataio
1Cattedra di Patologia Medica II, Universitá di Palermo Ospedale Pediatrico G. Di Cristina, Italy.
Insights
Cow milk protein allergy (CMPA) may cause chronic constipation in infants. Removing cow milk protein (CMP) resolved constipation in most infants, with symptoms returning upon reintroduction, suggesting an allergic link.
Area of Science:
- Pediatrics
- Allergy and Immunology
- Gastroenterology
Background:
- Chronic constipation is common in infants, often labeled "idiopathic".
- Cow milk protein allergy (CMPA) is a potential, though often overlooked, cause of gastrointestinal distress in infants.
Purpose of the Study:
- To investigate the relationship between infant constipation and cow milk protein allergy (CMPA).
- To determine if a cow milk protein (CMP)-free diet can alleviate chronic constipation in infants.
Main Methods:
- Studied 27 infants with chronic constipation on unrestricted and CMP-free diets.
- Monitored stool frequency, symptom resolution, and reintroduction challenges.
- Assessed medical history, allergy-specific laboratory tests, and endoscopic/histologic findings.
Main Results:
- 21 of 27 infants showed symptom resolution on a CMP-free diet.
- Constipation recurred in 21 infants within 48-72 hours upon CMP reintroduction.
- 15/21 improved infants had a history of CMPA and positive allergy tests, compared to 1/6 non-improvers.
Conclusions:
- Constipation in infants can be linked to an allergic pathogenesis, specifically cow milk protein allergy.
- Dietary elimination of CMP is an effective diagnostic and therapeutic strategy for CMPA-related infant constipation.
- Further investigation into allergic mechanisms underlying infant constipation is warranted.
Abstract:
Twenty-seven consecutive infants (mean age, 20.6 months) with chronic "idiopathic" constipation were studied to investigate the possible relation between constipation and cow milk protein allergy (CMPA). The infants were initially observed on an unrestricted diet, and the number of stools per day was recorded. Subsequently the infants were put on a diet free of cow milk protein (CMP) for two periods of 1 month each, separated by two challenges with CMP. During the CMP-free diet, there was a resolution of symptoms in 21 patients; during the two consecutive challenges, constipation reappeared within 48 to 72 hours. In another six patients the CMP-free diet did not lead to improvement of constipation. Only four of the patients who improved on the CMP-free diet had concomitant symptoms of suspected CMPA, but a medical history of CMPA was found in 15 of the 21 patients cured and in only one of the six patients whose condition had not improved (p < 0.05); in addition, in 15 of the 21 cured patients, results of one or more laboratory tests (specific IgE, IgG, anti-beta-lactoglobulin, circulating eosinophils) were positive at the time of diagnosis, indicating hypersensitivity, compared with one of the six patients whose condition did not improve (p < 0.05). The endoscopic and histologic findings at the time of diagnosis showed proctitis with monocytic infiltration in two patients cured with the CMP-free diet; after 1 month on this diet, they were completely normal. We conclude that constipation in infants may have an allergic pathogenesis.