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Functional Constipation and Cow's-Milk Allergy

Sopo, Stefano Miceli*; Arena, Roberta*; Scala, Guglielmo

Journal of Pediatric Gastroenterology and Nutrition: September 2014 - Volume 59 - Issue 3 - p e34
doi: 10.1097/MPG.0000000000000460
Letters to the Editor

*Department of Pediatrics, Agostino Gemelli Hospital, Catholic University of Sacred Heart, Rome

Allergology Unit, Loreto Crispi Hospital, Naples, Italy

To the Editor:

We read the recommendations from the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition on evaluation and treatment of functional constipation in infants and children (1). Tabbers et al (1) identified 4 studies (2–5) describing that a significant percentage of children affected by constipation and cow's-milk protein allergy (CMPA) improved after CMP elimination diet and 1 study (6), conversely, which did not confirm this association. The authors affirm: “evidence is conflicting for allergy testing to diagnose CM allergy in children with functional constipation” and “based on expert opinion, a 2- to 4-week trial of avoidance of CMP may be indicated in the child with intractable constipation.”

We recently conducted a review of the literature (7) and we found 6 more studies (8–13). The most recent study we considered (13) is the second randomized study on constipation and CMPA. Overall, we evaluated 10 studies, with a total of 505 patients enrolled, that have consistently showed a benefit after cow's-milk–free diet in a percentage of children, varying from 28% to 78%. No specific features have been found in the “responders” group, not even persistent constipation after laxative therapy. We believe that the available scientific evidence for a causal relation between CMPA and functional constipation is now sufficient to formulate a grade A recommendation. We believe that a 2- to 4-week restricted diet should not be considered only after all of the other options had failed, but should be instead proposed and discussed with patients and their families as a first-line therapeutic strategy.

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© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,