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Food allergy-related paediatric constipation: the usefulness of atopy patch test


The aims of this study were to evaluate the implication of food allergy as a cause of paediatric constipation and to determine the diet period needed to tolerate the constipation-causing foods. Fifty-four children aged 6 months to 14 years (median, 42 months) suffering from chronic constipation (without anatomic abnormalities, cοeliac disease or hypothyroidism), unresponsive to a 3-month laxative therapy, were prospectively evaluated. All participants were evaluated for allergy to cow's milk, egg, wheat, rice, corn, potato, chicken, beef and soy, using skin tests (SPT), serum specific IgE and atopy patch test (APT). A withdrawal of the APT-positive foods was instructed. Thirty-two children had positive APT; 15 were positive to one; six, to two and 11, to three or more food allergens, wheat and egg being the commonest. After withdrawing the APT-positive foods for an 8-week period, constipation had improved in 28/32 children, but a relapse of constipation was noticed after an oral food challenge, so they continued the elimination diet. Tolerance to food allergens was achieved in only 6/28 after 6 months, compared to 25/28 after 12 months and to all after a 2-year-long elimination. Food allergy seems to be a significant etiologic factor for chronic constipation not responding to treatment, in infants and young children. APT was found to be useful in evaluating non-IgE allergy-mediated constipation, and there was no correlation of APT with IgE detection. Tolerance was adequately achieved after 12 months of strict food allergen elimination.

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  1. 1.

    Baker SS, Liptak GS, Colletti RB et al (1999) Constipation in infants and children evaluation and treatment. J Pediatr Gastroenterol Nutr 29:612–626

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Caffarelli C, Coscia A, Baldi F et al (2007) Characterization of irritable bowel syndrome and constipation in children with allergic diseases. Eur J Pediatr 166:1245–1252

    PubMed  Article  Google Scholar 

  3. 3.

    Carroccio A, Scalici C, Maresi E et al (2005) Chronic constipation and food intolerance: a model of proctitis causing constipation. Scand J Gastroenterol 40:33–42

    PubMed  Article  Google Scholar 

  4. 4.

    Daher S, Tahan S, Solé D et al (2001) Cow's milk protein intolerance and chronic constipation in children. Pediatr Allergy Immunol 12:339–342

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    De Boissieu D, Waguet JC, Dupont C (2003) The atopy patch tests for detection of cow's milk allergy with digestive symptoms. J Pediatr 142:203–205

    PubMed  Article  Google Scholar 

  6. 6.

    Heine RG, Verstege A, Mehl A et al (2006) Proposal for a standardized interpretation of the atopy patch test in children with atopic dermatitis and suspected food allergy. Pediatr Allergy Clin Immunol 17:213–217

    Article  Google Scholar 

  7. 7.

    Hyman PE, Milla PJ, Benninga MA et al (2006) Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 130:1519–1526

    PubMed  Article  Google Scholar 

  8. 8.

    Iacono G, Carroccio A, Cavataio F et al (1995) Chronic constipation as a symptom of cow milk allergy. J Pediatr 126:34–39

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Iacono G, Cavataio F, Montalto G et al (1998) Intolerance of cow's milk and chronic constipation in children. N Engl J Med 339:1100–1104

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Loening-Baucke V (2005) Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr 146:359–363

    PubMed  Article  Google Scholar 

  11. 11.

    Mehl A, Rolinck-Werninghaus C, Staden U et al (2006) The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. J Allergy Clin Immunol 118:923–929

    PubMed  Article  Google Scholar 

  12. 12.

    Perackis K, Celik-Bilgili S, Staden U et al (2003) Influence of age on the outcome of the atopy patch test with food in children with atopic dermatitis. J Allergy Clin Immunol 112:625–627

    PubMed  Article  Google Scholar 

  13. 13.

    Rasquin A, Di Lorenzo C, Forbes D et al (2006) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130:1527–1537

    PubMed  Article  Google Scholar 

  14. 14.

    Roma-Giannikou E, Adamidis D, Gianniou M et al (1999) Epidemiology of chronic constipation in Greek children. Hell J Gastroenterol 12:58–62

    Google Scholar 

  15. 15.

    Sicherer SH (2003) Clinical aspects of gastrointestinal food allergy in childhood. Pediatrics 111:1609–1616

    PubMed  Google Scholar 

  16. 16.

    Spergel JM, Brown-Whitehorn T, Beausoleil JL et al (2007) Predictive values for skin prick test and atopy patch test for eosinophilic esophagitis. J Allergy Clin Immunol 119:509–511

    PubMed  Article  Google Scholar 

  17. 17.

    Sub-Committee on Skin Tests of the European Academy of Allergology and Clinical Immunology (1989) Skin tests used in type I allergy testing Position paper. Allergy 44:1–59

    Article  Google Scholar 

  18. 18.

    Turjanmma K, Darsow U, Niggemann B et al (2006) EAACI/GA2LEN position paper: present status of the atopy patch test. Allergy 61:1377–1384

    Article  Google Scholar 

  19. 19.

    Turunen S, Karttunen TJ, Kokkonen J (2004) Lymphoid nodular hyperplasia and cow's milk hypersensitivity in children with chronic constipation. J Pediatr 145:606–611

    PubMed  Article  Google Scholar 

  20. 20.

    Wistokat-Wülfing A, Schmidt D, Darsow U et al (1999) Atopy patch test reactions are associated with T lymphocyte-mediated allergen-specific immune responses in atopic dermatitis. Clin Exp Allergy 29:513–521

    PubMed  Article  Google Scholar 

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Conflict of interest

No financial sponsorship was used for the research. The authors do not have any conflict of interest.

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Correspondence to Ekaterini I. Syrigou.

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Syrigou, E.I., Pitsios, C., Panagiotou, I. et al. Food allergy-related paediatric constipation: the usefulness of atopy patch test. Eur J Pediatr 170, 1173–1178 (2011).

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  • Constipation
  • Allergy
  • Atopy patch test
  • Diet
  • Child