Children with constipation: cow's milk intolerance in more than one third

A study recently published in the Journal of Pediatric Gastroenterology and Nutrition reminds us that bovine (cow's) milk allergy or intolerance can cause childhood constipation even though the laboratory tests are negative. The authors first note:

"It has been reported that a number of children with constipation respond to a diet free of cow's-milk (CM) proteins, although evidence is lacking to support an immunoglobulin E-mediated mechanism."

They found that thirty-five of 69 children (51%) improved during an initial CM-free diet phase with a significant increase in bowel movements per week; 39% developed constipation during the CM challenge and improved during the second CM-free phase. Interestingly...

"Seventy-eight percent of the children with developmental delay responded to the CM-free diet."

The authors conclude:

"A clear association between CM consumption and constipation has been found in more than one third of children. However, analytical parameters do not demonstrate an immunoglobulin E-mediated immunologic mechanism."

I want to draw your attention to the final comment about the absence of IgE antibodies. I have found any kind of antibody test (IgE, IgG, IgA) to be unreliable for the diagnosis of food allergy or intolerance due to numerous factors that can prevent their expression, resulting in false negatives (the allergy is present but undetected by the test). The immunological 'gold standard' is the elimination-provocation protocol (as conducted in this study).