Constipation and Cow's Milk Allergy: A Review of the Literature

Abstract

The causal association between cow's milk allergy (CMA) and constipation is not well established. Some guidelines describe constipation as a possible symptom of CMA, while others do not mention it. We conducted a literature review and found 10 prospective clinical trials. In all of them, an oral food challenge was performed, and 2 of them were randomized. These studies reported that a cow's milk (CM) protein-free diet has a beneficial effect on constipation, with a rate of successful outcomes ranging from 28 to 78%. The hypothetic pathogenic mechanism lies in increased anal pressure at rest, probably caused by allergic inflammation of the internal sphincter area due to mucosal eosinophil and mast cell infiltration. Eighty percent of patients reach tolerance within 1 year after the diagnosis of CMA-related constipation. We believe that a CM-free diet for 2-4 weeks should be proposed for children with chronic functional constipation, even if it is not severe or resistant to laxatives.

Non‐IgE‐mediated gastrointestinal allergies—Do they have a place in a new model of the Allergic March

“…Constipation can also occur as a result of non‐IgE‐mediated food allergies; 45% of children in a retrospective study on patients with confirmed non‐IgE‐mediated allergies (diagnosis based on elimination diet followed by reintroduction) by Meyer et al presented with this as one of their symptoms. However, studies investigating the association between food allergy and constipation are limited to 10 studies summarized in a systematic review . This systematic review only included studies that were randomized controlled, or having at least a control group, or having an oral food challenge after the improvement of symptoms following an elimination diet.…”

“…This has recently been confirmed through a primary care cohort, establishing the association between EoE and the Allergic March, that found that asthma was interdependently and cumulatively associated with EoE . In allergic dysmotility disorders, evidence of an association was also found: a study on a small cohort of children, with an average age of 6 years, with cow's milk–induced constipation found that over 40% of children had a history of asthma and systematic review in 2010 has highlighted an association between GORD and asthma, with a weighted average prevalence of asthma in children with GORD of 22% . In the FPIES cohort from Caubet et al, 25% had this as co‐morbid disorder.…”

Food Protein-Induced Non-Immunoglobulin E-Mediated Allergic Colitis in Infants and Older Children: What Cytokines Are Involved?

“…In this context, a fundamental principle underlying the development of an immunologic reaction to food antigens is the concept of oral tolerance. Most children with cow's milk allergy outgrow their symptoms over time, with the development of oral tolerance [28]. Given the bimodal age distribution and the fact that it is a non-IgE-mediated condition unlike most other food allergies, the nature of the defects in tolerance might be quite different in FPIAP, even in its individual forms, i.e.…”

Alergija na hranu u dečjoj dobi – klinički aspekt

“…Alergijski proktitis/proktokolitis je, uz ekcem, najraniji klinički oblik alergije na proteine kravljeg mleka [21,27,28]. U česte manifestacije alergije na antigene kravljeg mleka spadaju gastroezofagusni refluks, opstipacija i abdominalne kolike, dok su druge znatno ređe ili izuzetno retke [27,30]. Nekad jedini znak alergije na proteine kravljeg mleka može biti odbijanje mlečnih obroka ili sideropenijska anemija rezistentna na oralnu primenu gvožđa.…”