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.

1.
Rome Foundation: Guidelines - Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders. J Gastrointestin Liver Dis 2006;15:307-312.
2.
Meyer R, Fleming C, Dominguez-Ortega G, Lindley K, Michaelis L, Thapar N, Elawad M, Chakravarti V, Fox AT, Shah N: Manifestations of food protein induced gastrointestinal allergies presenting to a single tertiary paediatric gastroenterology unit. World Allergy Organ J 2013;6:13.
3.
Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA Jr, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM: Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010;126:S1-S58.
4.
Sicherer SH, Sampson HA: Food allergy. J Allergy Clin Immunol 2010;125:S116-S125.
5.
Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, Bozzola M, Bradsher J, Compalati E, Ebisawa M, Guzman MA, Li H, Heine RG, Keith P, Lack G, Landi M, Martelli A, Rancé F, Sampson H, Stein A, Terracciano L, Vieths S: World Allergy organization (WAO) diagnosis and rationale for action against Cow's milk allergy (DRACMA) guidelines. World Allergy Organ J 2010;3:57-161.
6.
Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, Ruemmele FM, Staiano A, Schäppi MG, Vandenplas Y; European Society of Pediatric Gastroenterology, Hepatology, and Nutrition: Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr 2012;55:221-229.
7.
Iacono G, Carroccio A, Cavataio F, Montalto G, Cantarero MD, Notarbartolo A: Chronic constipation as a symptom of cow milk allergy. J Pediatr 1995;126:34-39.
8.
Iacono G, Cavataio F, Montalto G, Florena A, Tumminello M, Soresi M, Notarbartolo A, Carroccio A: Intolerance of cow's milk and chronic constipation in children. N Engl J Med 1998;339:1100-1104.
9.
Daher S, Tahan S, Solé D, Naspitz CK, Da Silva Patrício FR, Neto UF, De Morais MB: Cow's milk protein intolerance and chronic constipation in children. Pediatr Allergy Immunol 2001;12:339-342.
10.
Turunen S, Karttunen TJ, Kokkonen J: Lymphoid nodular hyperplasia and cow's milk hypersensitivity in children with chronic constipation. J Pediatr 2004;145:606-611.
11.
Iacono G, Bonventre S, Scalici C, Maresi E, Di Prima L, Soresi M, Di Gesù G, Noto D, Carroccio A: Food intolerance and chronic constipation: manometry and histology study. Eur J Gastroenterol Hepatol 2006;18:143-150.
12.
Borrelli O, Barbara G, Di Nardo G, Cremon C, Lucarelli S, Frediani T, Paganelli M, De Giorgio R, Stanghellini V, Cucchiara S: Neuroimmune interaction and anorectal motility in children with food allergy-related chronic constipation. Am J Gastroenterol 2009;104:454-463.
13.
El-Hodhod MA, Younis NT, Zaitoun YA, Daoud SD: Cow's milk allergy related pediatric constipation: appropriate time of milk tolerance. Pediatr Allergy Immunol 2010;21:e407-e412.
14.
Irastorza I, Ibañez B, Delgado-Sanzonetti L, Maruri N, Vitoria JC: Cow's-milk-free diet as a therapeutic option in childhood chronic constipation. J Pediatr Gastroenterol Nutr 2010;51:171-176.
15.
Syrigou EI, Pitsios C, Panagiotou I, Chouliaras G, Kitsiou S, Kanariou M, Roma-Giannikou E: Food allergy-related paediatric constipation: the usefulness of atopy patch test. Eur J Pediatr 2011;170:1173-1178.
16.
Dehghani SM, Ahmadpour B, Haghighat M, Kashef S, Imanieh MH, Soleimani M: The role of cow's milk allergy in pediatric chronic constipation: a randomized clinical trial. Iran J Pediatr 2012;22:468-474.
17.
Chin KC, Tarlow MJ, Allfree AJ: Allergy to cows' milk presenting as chronic constipation. Br Med J (Clin Res Ed) 1983;287:159.
18.
Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, van Cauwenberge P, van Hage-Hamsten M, Wüthrich B; EAACI (the European Academy of Allergology and Cinical Immunology) nomenclature task force: A revised nomenclature for allergy: an EAACI position statement from the EAACI nomenclature task force. Allergy 2001;56:813-824.
19.
Suzuki S, Homma T, Kurokawa M, Matsukura S, Adachi M, Wakabayashi K, Nozu F, Tazaki T, Kimura T, Matsuura T, Fukuda M, Shiozawa E, Takimoto M: Eosinophilic gastroenteritis due to cow's milk allergy presenting with acute pancreatitis. Int Arch Allergy Immunol 2012;158(suppl 1):75-82.
20.
Hagel AF, deRossi T, Zopf Y, Konturek P, Dauth W, Kressel J, Hahn EG, Raithel M: Mast cell tryptase levels in gut mucosa in patients with gastrointestinal symptoms caused by food allergy. Int Arch Allergy Immunol 2013;160:350-355.
21.
Murch S: Allergy and intestinal dysmotility - evidence of genuine causal linkage? Curr Opin Gastroenterol 2006;22:664-668.
22.
Allen KJ, Davidson GP, Day AS, Hill DJ, Kemp AS, Peake JE, Prescott SL, Shugg A, Sinn JK, Heine RG: Management of cow's milk protein allergy in infants and young children: an expert panel perspective. J Paediatr Child Health 2009;45:481-486.
23.
Morita H, Nomura I, Matsuda A, Saito H, Matsumoto K: Gastrointestinal food allergy in infants. Allergol Int 2013;62:297-307.
24.
Simeone D, Miele E, Boccia G, Marino A, Troncone R, Staiano A: Prevalence of atopy in children with chronic constipation. Arch Dis Child 2008;93:1044-1047.
25.
American Academy of Pediatrics, Committee on Nutrition: Soy protein-based formulas: recommendations for use in infant feeding. Pediatrics 1998;101:148-153.
26.
Bhatia J, Greer F; American Academy of Pediatrics Committee on Nutrition: Use of soy protein-based formulas in infant feeding. Pediatrics 2008;121:1062-1068.
27.
Smaldini P, Curciarello R, Candreva A, Rey MA, Fossati CA, Petruccelli S, Docena GH: In vivo evidence of cross-reactivity between cow's milk and soybean proteins in a mouse model of food allergy. Int Arch Allergy Immunol 2012;158:335-346.
28.
Kemp AS, Hill DJ, Allen KJ, Anderson K, Davidson GP, Day AS, Heine RG, Peake JE, Prescott SL, Shugg AW, Sinn JK; Australian consensus panel: Guidelines for the use of infant formulas to treat cows milk protein allergy: an Australian consensus panel opinion. Med J Aust 2008;188:109-112.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.