Constipation in children and allergy to cow’s milk – adapted from the Journal of Pediatrics, January 1995 – Tips from Other Journals
Chronic constipation in infants and young children is frequently ascribed to psychogenic causes or an intestinal motility disorder. However, it has been suggested that allergy to proteins in cow’s milk may play a role in this disorder. Iacono and colleagues conducted a prospective study to determine whether a relationship exists between chronic constipation in children and allergy to cows milk protein.
The study included 27 children under three years of age with chronic idiopathic constipation. The diagnosis was based on a history of reduced frequency of stools (one evacuation every three to seven days) and pain that accompanied the passage of hard stool. At the time of diagnosis, all children were being fed a commercial formula derived from cow’s milk. Children continued to receive this diet during the first seven days of the study, and then the children were started on a diet free of cow’s milk protein. After one month of this exclusion diet, patients whose symptoms had lessened underwent a cow’s milk challenge for a maximum of 10 days. A second 10-day milk challenge was performed after one additional month of the cow’s milk protein-free diet. Parents recorded descriptions of stool, stool frequency and any accompanying pain with passage of stool.
During the first month of the exclusion diet, 21 of the 27 children had significant improvement in symptoms. Following reintroduction of cow’s milk, symptoms returned in all of these children and then abated again when the exclusion diet was reinstated. During the second challenge, symptoms again returned to all of these children. Researchers observed elevations in either IgE anti-[beta]-lactoglobulin values, circulating IgE or circulating eosinophils in 15 of the 21 children who had symptomatic relief with the exclusion diet, and in one of the six children who did not have symptomatic relief.
The authors conclude that some cases of idiopathic constipation in young children are actually a manifestation of allergy to cow’s milk protein. In this study, associated laboratory abnormalities and subsequent normalization of these values after a trial of exclusion diet supports the relationship between constipation and allergy to cow’s milk protein. The authors call for further investigation into the immune mechanisms associated with constipation. (Journal of Pediatrics, January 1995, vol. 126, p. 34.)
COPYRIGHT 1995 American Academy of Family Physicians
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