Cow’s milk protein intolerance and chronic constipation in children Daher S, Tahan S, Sole´ D, Naspitz CK, Patrı´cio FRS, Fagundes-Neto U, Morais MB. Cow’s milk protein intolerance and chronic constipation in children. Pediatr Allergy Immunol 2001: 12: 339–342. # Munksgaard 2001 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, a-lactoalbumin, b-lactoglobulin, and a food group; and skin-prick tests with whole milk, a-lactoalbumin, b-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. Silvia Daher 1 , Soraia Tahan 2 , Dirceu Sole ´ 1 , Charles K. Naspitz 1 , Francy Reis Da Silva Patrı´cio 3 , Ulysses Fagundes Neto 2 and Mauro Batista De Morais 2 Divisions of 1 Allergy, Clinical Immunology and Rheumatology and 2 Gastroenterology, Department of Pediatrics and 3 Department of Pathology, UNIFESP – EPM, Sa ˜ o Paulo, SP, Brazil Key words: cow’s milk protein intolerance; chronic constipation; cow’s milk allergy Silvia Daher, MD, Rua Bela Cintra 1920-apto 41, 01415–002, Sa ˜ o Paulo, SP, Brazil Tel.: +55-11-55791590 Fax: +55-11-5701590 E-mail: silviadaher@hotmail.com Accepted 21 March 2001 Adverse reactions to cow’s milk protein (CMP) have been associated with various etiologic mechanisms, and two main types have been recognized: allergy and intolerance. Reactions induced by an abnormal immune response are defined as CMP allergy, while those caused by nonimmunological mechanisms are considered to be CMP intolerance (1). A broad spectrum of clinical manifestations has been associated with CMP allergy and/or intoler- ance, including gastrointestinal, respiratory, cuta- neous, and even anaphylactic, reactions. However, the most common are gastrointestinal symptoms such as vomiting, diarrhea, malabsorp- tion, failure to thrive, intestinal loss of blood and/ or protein, and abdominal pain (1). Several authors have suggested that chronic constipation may represent a manifestation of CMP allergy (2,3), and Iaconno et al. (4,5) have reported clinical improvement of constipation in a group of children submitted to a CMP-free diet. In view of these observations, the aim of this study was to investigate CMP allergy or intolerance in children with chronic constipation. Patients and methods The group evaluated consisted of 40 children (age- range 3 months to 11 years) with chronic con- stipation who consecutively attended the Constipation Clinic (as outpatients) of the Division of Gastroenterology of the Department of Pediatrics, UNIFESP-EPM. None of the patients presented any clinical evidence of organic constipation. Diagnosis of chronic 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 (6). The clinical data collected included information on intestinal habits, any personal or family history Pediatr Allergy Immunol 2001: 12: 339–342 Printed in UK. All rights reserved Copyright # Munksgaard 2001 PEDIATRIC ALLERGY AND IMMUNOLOGY ISSN 0905-6157 339