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Eur J Pediatr (2011) 170:11731178 DOI 10.1007/s00431-011-1417-6
ORIGINAL PAPER
Food allergy-related paediatric constipation: the usefulness of atopy patch test
Ekaterini I. Syrigou & Constantinos Pitsios & Ioanna Panagiotou &
Georgios Chouliaras & Sofia Kitsiou & Mary Kanariou & Eleftheria Roma-Giannikou
Received: 27 September 2010 /Accepted: 1 February 2011 /Published online: 25 February 2011 # Springer-Verlag 2011
Abstract 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, celiac 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.
Keywords Constipation . Allergy. Atopy patch test . Diet . Child
Introduction
Chronic constipation is a common problem in children, particularly in the younger ones; it has been calculated to affect 2.9% of infants and up to 10.9% of toddlers during the second year of life [10, 14]. It can shortly be described as a difficulty in defaecation present for two or more weeks with scybalous, pebble-like, mainly hard stools or firm stools two or fewer times per week,...