Cow's‐Milk–free Diet as a Therapeutic Option in Childhood Chronic Constipation

Irastorza, Iñaki; Ibáñez, Berta; Delgado-Sanzonetti, Lissette; Maruri, Natalia; Vitoria, Juan Carlos

doi:10.1097/mpg.0b013e3181cd2653

Cited by 36 publications

(51 citation statements)

References 21 publications

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“…Furthermore, it was recently shown that CM-sensitized mice without previous exposure to SP elicited hypersensitivity signs immediately after the oral administration of SP, suggesting that immunochemical cross-reactivity might be clinically relevant [27]. Consistent with these indications, Irastorza et al [14] did not allow their patients to ingest soy. However, in 2009, Australian GL on the diet management of CMA [28] suggested soy milk as the first choice for children older than 6 months without failure to thrive, in order to resolve constipation (and, more generally, gastrointestinal syndromes such as gastroesophageal reflux disease, allergic eosinophilic gastroenteritis, food protein-induced enteropathy, and colics).…”

Section: Discussionmentioning

confidence: 50%

“…The terms ‘constipation' and ‘milk hypersensitivity' were searched also as Medical Subject Headings (MeSH terms). We identified 110 studies and 10 [7,8,9,10,11,12,13,14,15,16] were eligible for our review. Their most relevant features are showed in table 1.…”

Section: Research Strategymentioning

confidence: 99%

“…The study of Irastorza et al [14] was not randomized and can be considered a ‘before-after' case series. Sixty-nine children with chronic functional constipation (not necessarily resistant to laxative treatments) were enrolled.…”

Section: Summary Of the Most Significant Studiesmentioning

confidence: 99%

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Constipation and Cow's Milk Allergy: A Review of the Literature

Sopo

Arena²,

Greco³

et al. 2014

Int Arch Allergy Immunol

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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.

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Section: Discussionmentioning

confidence: 50%

Section: Research Strategymentioning

confidence: 99%

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Constipation and Cow's Milk Allergy: A Review of the Literature

Sopo

Arena²,

Greco³

et al. 2014

Int Arch Allergy Immunol

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“…Irastorza et al (33) found in an open-label crossover study that 27 (39%) patients responded to a three-week CMP-elimination diet. Afterwards, all of them experienced constipation within two to five days during the three-week cow's milk challenge.…”

Section: Food Allergy and Fcmentioning

confidence: 99%

Allergy in Children with Functional Constipation and Irritable Bowel Syndrome

et al. 2016

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Context: Functional constipation (FC) and irritable bowel syndrome (IBS) represent very common pediatric functional gastrointestinal disorders (FGIDs). Controversial results have suggested a potential role of food allergy as a trigger of functional bowel symptoms. Evidence Acquisition: This review summarizes the literature regarding the role of allergic diseases in children with FC and IBS and discusses the hypothesis of the pathogenesis of constipation due to cow's milk protein allergy (CMPA). We searched systematic reviews, guidelines, or original data in PubMed, MEDLINE, and the Cochrane central register of controlled trials. Results: The pathogenesis of FGIDs remains elusive and is likely multifactorial. Among these factors, adverse reactions to food may play a pathogenic role. Some features, such as abnormal bowel motility, visceral hypersensitivity, and changes in mucus composition caused by inflammation of the gastrointestinal wall, have been found both in IBS or FC and in food allergy. Since 1978, an increasing number of reports have suggested a relationship between CMPA and FC. Two randomized controlled studies conducted in children showed that CMPA may induce chronic FC; one study indicated that fermentable oligosaccharide, disaccharide, and monosaccharide polyols (FODMAP) foods may play a role in triggering IBS. Conclusions: Food allergy in children with chronic constipation should be identified using an oral food challenge after being on a diet free of cow's milk. A diet low in FODMAPs might also be recommended for children with IBS. This approach could be suggested for children with chronic FC and IBS, especially when they do not respond to standard treatment. However, it should also be considered that a minority of patients with FC or IBS could respond to an elimination diet. Further studies are needed to understand the complex pathogenic mechanisms of FGIDs; they also might be helpful to recognize markers for identifying children with IBS and FC caused by foods and to improve their management.

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“…Research has provided conflicting results [77][78] . Therefore, testing for CMP allergy is not recommended.…”

Section: Investigationsmentioning

confidence: 99%