Functional constipation related to cow’s milk allergy in children. A management proposal

Main Article Content

Mariannita Gelsomino
Ester Del Vescovo
Giulia Bersani
Stefano Miceli Sopo


cow’s milk allergy; elimination diet; functional constipation


Functional constipation (FC) is one of the most common disorders in childhood and has a neg-ative impact on the quality of life of children. Scientific evidence regarding a causal relation-ship between FC and cow’s milk allergy is controversial, as it is also reported by the latest European Society for Paediatric Gastroenterology, Hepatology and Nutrition-North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN–NASPGHAN) rec-ommendations. In the case of FC, routine allergometric tests are not recommended and the cows’ milk-free diet is only proposed in the case of laxative-resistant constipation and only following the advice of an expert. Instead, after a careful review of the literature and in view of the many clinical cases encountered in our clinical practice, we believe that it is useful to propose cows’ milk-free diet as first line for the treatment of FC at least in pre-school children and in children with a personal or family history of atopy or with a previous diagnosis of cow’s milk protein allergy.

Abstract 40 | PDF Downloads 30 XML Downloads 0 HTML Downloads 1


1. Koppen IJ, Vriesman MH, Saps M. Prevalence of functional defecation disorders in children: A systematic review and meta-analysis. J Pediatr. 2018;198:121–30.e6 https://doi. org/10.1016/j.jpeds.2018.02.029
2. Kovacic K, Sood MR, Mugie S. A multicenter study on childhood constipation and fecal incontinence: Effects on quality of life. J Pediatr. 2015;166:1482–7.
3. Tabbers MM, Di Lorenzo C, Berger M. E 169 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; North American Society for Pediatric Gastroenterology. Evaluation and treatment of functional constipation in infants and chil-dren: Evidence- based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58:258–74.
4. Miceli Sopo S, Arena R, Greco M. Constipation and cow’s milk allergy: A review of the literature. Int Arch Allergy Immunol. 2014;164(1):40–5.
5. Hyams JS, Di Lorenzo C, Saps M. Functional disorders: Children and adolescents. Gastroenterology. 2016;150:1456– 68.
6. Hyams JS, Milla PG, Benninga M. Childhood functional gas-trointestinal disorders: Neonate/toddler. Gastroenterology. 2006;130:1519–26.
7. National Collaborating Centre for Women’s and Children’s Health (UK). Constipation in Children and Young People. Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care. NICE Clinical Guidelines, No. 99. London: RCOG Press; 2010. https://www.
8. Luo Y, Zhang GQ, Li ZY. The diagnostic value of APT for food allergy in children: A systematic review and meta-analysis. Pediatr Allergy Immunol. 2019;30:451–61.
9. Irastorza I, Ibañez B , Delgado-Sanzonetti L. Cow’s-milk-free diet as a therapeutic option in childhood chronic constipation. Pediatr Gastroenterol Nutr. 2010 Aug;51(2):171–6.
10. Fiocchi A, Brozek J, Schünemann H. World Allergy Organization (WAO) special committee on food allergy. World Allergy Organ Diagn Immunol. 2010 Jul;21(Suppl 21):1–125.
11. Yang QH, Zheng BS, Zhou SM. Clinical features of cow’s milk protein allergy in infants presenting mainly with gastrointestinal symptoms: An analysis of 280 cases. Zhongguo Dang Dai Er Ke Za Zhi. 2019;21:271–6. issn.1008-8830.2019.03.016
12. Kamer B, Dólka E, Pyziak K. Food allergy as a cause of consti-pation in children in the first three years of life – own obser-vations. Med Wieku Rozwoj. 2011;15(2):157–61. https://doi. org/10.1097/00042737-200602000-00002
13. Iacono G, Cavataio F, Montalto G. Intolerance of cow’s milk and chronic constipation in children. N Engl J Med. 1998;339:1100–4.
14. Dehghani SM, Ahmadpour B, Haghighat M. The role of cow’s milk allergy in pediatric chronic constipation: A randomized clinical trial. Iran J Pediatr. 2012;22:468–74.
15. Simeone D, Miele E, Boccia G. Prevalence of atopy in children with chronic constipation. Arch Dis Child. 2008;93:1044–7.