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Review
. 2022 Mar 21;14(6):1317.
doi: 10.3390/nu14061317.

Cows' Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review

Frances Connor  1   2 , Silvia Salvatore  3 , Enza D'Auria  4 , Maria Elisabetta Baldassarre  5 , Miriam Acunzo  4 , Gaia Di Bella  3 , Ilaria Farella  6 , Simona Sestito  7 , Licia Pensabene  7
Affiliations
Review

Cows' Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review

Frances Connor et al. Nutrients. .

Abstract

Constipation is a very common disorder, mostly functional in nature, that may persist for years in up to 35-52% of children. Food allergy prevalence, severity and persistence are increasing over time, and cows' milk protein is the commonest food allergen recognised to affect gastrointestinal motility in children. There is mounting evidence of the role of cows' milk (CM) allergy (CMA) in children with constipation. With this narrative review, we aim to provide clinicians with an updated and critical overview of food allergy-associated constipation. We searched Embase, Medline and the Cochrane Library, using keywords related to the topic. Only reviews and studies including children aged 0-17 years that were published in English were considered. Constipation has been reported in 4.6% of infants with CMA; the prevalence of food allergy underlying chronic constipation in children resistant to conventional treatment and presenting to tertiary clinics ranges between 28% and 78%. The identification of predisposing risk factors and of a specific phenotype of food allergy-induced constipation remains elusive. No allergic tests, radiological or motility investigations achieve sufficient sensitivity and specificity to screen children for CMA-related constipation. A 4-week cows' milk protein (CMP) elimination diet may be considered for children with chronic constipation resistant to conventional treatment and who lack alarm sign/symptoms of organic diseases. In subjects with ameliorated symptoms on CMP elimination, the diagnosis of CMA should be confirmed by a food challenge to avoid an unnecessary protracted diet.

Keywords: allergic disease; children; constipation; cows’ milk allergy; food allergy.

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Conflict of interest statement

The authors declare no conflict of interest in relation to this manuscript. S. Salvatore has participated as a consultant and/or a speaker and/or an advisory board member for: Danone-Mellin, DVA, Nestlé, Noos and United Pharmaceuticals (Novalac). M.E.B. has participated as a consultant and/or a speaker for Aurora BioFarma. F. Connor has participated as a speaker for Nestlé. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; or in the writing of the manuscript and in the decision to publish the results.

Figures

Figure 1
Figure 1
Response rates to CMP elimination diet and challenge in children with constipation, according to age of study participants, showing higher response rates in younger patients. Y axis indicates response to diet as a percentage. X axis indicates age of study participants in years, by measures of central tendency (mean age in blue or median age in orange). Bubble size indicates number of participants. Study details are in Table 1 above.
Figure 2
Figure 2
Schematic showing proportions of children in tertiary clinics responding to initial phases of management for chronic constipation.
See this image and copyright information in PMC

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