title: Cow's milk protein intolerance and chronic constipation in children.
abstract: Cow's milk protein (CMP) allergy was investigated in 25 children (age-range 3 months to 11 years) with chronic constipation. A diagnosis of constipation was made on the basis of a history of painful elimination of hard stools for at least 1 month, whether or not associated with a reduced frequency of stools or soiling. The children were evaluated using clinical parameters and the following laboratory tests: total serum immunoglobulin E (IgE); specific IgE (radioallergosorbent test [RAST]) for whole cow's milk, alpha-lactoalbumin, beta-lactoglobulin, and a food group; and skin-prick tests with whole milk, alpha-lactoalbumin, beta-lactoglobulin, and casein. Following the evaluation, the children were submitted to a CMP-free diet for a period of 4 weeks. In seven patients (28%), constipation disappeared during the CMP-free diet and reappeared within 48-72 h following challenge with cow's milk. In two infants a rectal biopsy revealed allergic colitis and they therefore did not undergo the challenge. High serum levels of total IgE were observed in five of the children who showed a clinical improvement (71%), a positive skin-test in two (29%), and detectable specific IgE in two (29%). These results suggest that CMP allergy or intolerance should be considered as a cause of chronic refractory constipation in children, although the underlying mechanism still require further investigation.
authors.affiliation: Divisions of Allergy, Clinical Immunology and Rheumatology, UNIFESP - EPM, São Paulo, SP, Brazil. silviadaher@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Daher
authors.forename: S
authors.initials: S
authors.lastname: Tahan
authors.forename: D
authors.initials: D
authors.lastname: Solé
authors.forename: C K
authors.initials: CK
authors.lastname: Naspitz
authors.forename: F R
authors.initials: FR
authors.lastname: Da Silva Patrício
authors.forename: U F
authors.initials: UF
authors.lastname: Neto
authors.forename: M B
authors.initials: MB
authors.lastname: De Morais
mesh_terms: D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003248:Constipation / Q000209:etiology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D016269:Milk Hypersensitivity / Q000097:blood / Q000150:complications*; D011852:Radioallergosorbent Test; D012882:Skin Tests
chemical_list: D007073:Immunoglobulin E