The ENIGMA (Exploring non-IgE mediated Allergy) Task Force (TF) was established in 2018 with the primary aim to assess the available research and publish practical consensus guidelines on non-IgE mediated food allergic conditions, where limited guidance is available and/or where controversy exists. To date, this TF has published consensus guidelines on the management of non-IgE mediated allergies in breastfed children (link below) and is about to submit a completed consensus guideline to the ExCom on the diagnosis and management of food protein induced gastroesophageal reflux disease (attached). In line with these publications, we are hoping to continue with this TF and aim to address the controversial topic of non-IgE mediated allergies and constipation. The current EAACI guideline on diagnosis and management of food allergy includes constipation as a possible symptom for non-IgE mediated allergy and so do most guidelines on cow’s milk allergy. However, it is known that almost 30% of infant and toddlers may present with functional gastrointestinal disorders, which includes constipation and a poor diet, low in fibre and fluid may also lead to constipation. Cow’s milk, the most common culprit in nonIgE mediated allergies and also the most studied allergen in constipation, has a challenge proven incidence in non-IgE mediated allergies, based on the EuroPrevall study, ranging between 0.13-0.72%. There is therefore a real clinical risk of over-diagnosis leading to the elimination of cow’s milk, which provides critical nutrients, in particular in the young. This TF will aim to use the same method of a modified Delphi approach, to develop a consensus based practical guideline on the diagnosis and management of food protein induced constipation.

Chair: Rosan Meyer
Secretary: Carina Venter