Lactose Intolerance: Common Misunderstandings

Lactose intolerance primarily refers to a syndrome having different symptoms upon the consumption of foods containing lactose. It is one of the most common form of food intolerance and occurs when lactase activity is reduced in the brush border of the small bowel mucosa. Individuals may be lactose intolerant to varying degrees, depending on the severity of these symptoms. When lactose is not digested, it can be fermented by gut microbiota leading to symptoms of lactose intolerance that include abdominal pain, bloating, flatulence, and diarrhea with a considerable intraindividual and interindividual variability in the severity of clinical manifestations. These gastrointestinal symptoms could be similar to cow’s milk allergy and could be wrongly labeled as symptoms of “milk allergy.” There are important differences between lactose intolerance and cow’s milk allergy; therefore, a better knowledge of these differences could limit misunderstandings in the diagnostic approach and in the management of these conditions.

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Development of Food Allergies with Special Reference to Cow's Milk Allergy

PEDIATRICS ◽

10.1542/peds.75.1.177 ◽

1985 ◽

Vol 75 (1) ◽

pp. 177-181

Author(s):

Tony Foucard

Keyword(s):

Wide Spectrum ◽

Gastrointestinal Symptoms ◽

Cow’S Milk Allergy ◽

Food Allergies ◽

Cow’S Milk ◽

Gradual Change ◽

Milk Allergy ◽

Early Introduction ◽

Cow's Milk ◽

Cow's Milk Allergy

Using strict criteria, the incidence of cow's milk sensitivity is probably 1% to 2% during the first 2 years of life. Although there is a wide spectrum of sensitivity symptoms caused by cow's milk, two major groups of infants are discernible. One group consists of infants who react to small amounts of cow's milk within a few minutes up to one hour, usually with gastrointestinal symptoms or urticaria. These infants are often atopic and have positive findings on skin prick tests and radioallergosorbent test (RAST) reactions to cow's milk allergens. The other group consists of children whose reaction to cow's milk occurs one hour or longer after intake of cow's milk or cow's milk-based formula. These reactions are usually not immunoglobulin (Ig)E-mediated and different immune and nonimmune mechanisms probably cause the symptoms. The risk of developing cow's milk sensitivity seems to be influenced by the atopic constitution of the infant and the age at which cow's milk is introduced. Early exposure to cow's milk increases the risk, not only of adverse reactions to this milk but also of developing allergies to other foods. It is suggested that early introduction of cow's milk may enhance the risk of future respiratory allergies. Allergists are still not in agreement as to whether the weaning process should be rapid or should consist of a gradual change from breast milk to cow's milk in order to minimize the risk of cow's milk allergy.

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How mothers perceive infants with unspecific gastrointestinal symptoms suggestive of cow's milk allergy?

Acta Paediatrica ◽

10.1111/apa.12577 ◽

2014 ◽

Vol 103 (5) ◽

pp. 524-528 ◽

Cited By ~ 3

Author(s):

Laura Merras-Salmio ◽

Eeva T. Aronen ◽

Mikael Kuitunen ◽

Anna S. Pelkonen ◽

Mika J. Mäkelä ◽

...

Keyword(s):

Gastrointestinal Symptoms ◽

Cow’S Milk Allergy ◽

Cow’S Milk ◽

Milk Allergy ◽

Cow's Milk ◽

Cow's Milk Allergy

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Semi-Elemental and Elemental Formulas for Enteral Nutrition in Infants and Children with Medical Complexity—Thinking about Cow’s Milk Allergy and Beyond

Nutrients ◽

10.3390/nu13124230 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4230

Author(s):

Elvira Verduci ◽

Silvia Salvatore ◽

Ilia Bresesti ◽

Elisabetta Di Profio ◽

Erica Pendezza ◽

...

Keyword(s):

Enteral Nutrition ◽

Preterm Infants ◽

Gastrointestinal Symptoms ◽

Infants And Children ◽

Cow’S Milk Allergy ◽

Cow’S Milk ◽

Milk Allergy ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

Medical Complexity

Children with medical complexities, such as multi-system disorders and/or neurological impairments, often experience feeding difficulties and need enteral nutrition. They frequently have impaired motility and digestive–absorbing functions related to their underlying condition. If a cow’s milk allergy (CMA) occurs as a comorbidity, it is often misdiagnosed, due to the symptoms’ overlap. Many of the commercialized mixtures intended for enteral nutrition are composed of partially hydrolyzed cow’s milk proteins, which are not suitable for the treatment of CMA; thus, the exclusion of a concomitant CMA is mandatory in these patients for obtaining symptoms relief. In this review, we focus on the use of elemental and semi-elemental formulas in children with neurological diseases and in preterm infants as clinical “models” of medical complexity. In children with neurodisabilities, when gastrointestinal symptoms persist despite the use of specific enteral formula, or in cases of respiratory and/or dermatological symptoms, CMA should always be considered. If diagnosis is confirmed, only an extensively hydrolyzed or amino-acid based formula, or, as an alternative, extensively hydrolyzed nutritionally adequate formulas derived from rice or soy, should be used. Currently, enteral formulas tailored to the specific needs of preterm infants and children with neurological impairment presenting concomitant CMA have not been marketed yet. For the proper monitoring of the health status of patients with medical complexity, multidisciplinary evaluation and involvement of the nutritional team should be promoted.

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No difference in symptoms during challenges with homogenized and unhomogenized cow's milk in subjects with subjective hypersensitivity to homogenized milk

Journal of Dairy Research ◽

10.1017/s0022029903006125 ◽

2003 ◽

Vol 70 (2) ◽

pp. 175-179 ◽

Cited By ~ 9

Author(s):

Laura Paajanen ◽

Tuula Tuure ◽

Tuija Poussa ◽

Riitta Korpela

Keyword(s):

Lactose Intolerance ◽

The Other ◽

Cow’S Milk Allergy ◽

Cow’S Milk ◽

Milk Allergy ◽

Double Blind ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

Ige Mediated

It has been hypothesized that certain consumers tolerate untreated cow's milk, but react to processed (i.e. homogenized and pasteurized) cow's milk although they do not suffer from IgE-mediated cow's milk allergy or lactose intolerance. The aim of the study was to compare the tolerance of unhomogenized and homogenized cow's milk in lactose tolerant adults who had repeatedly experienced better tolerance of unhomogenized than homogenized milk. Forty-four subjects were challenged with homogenized and unhomogenized cow's milk for five days in a randomized, double-blind, cross-over study. No differences in the symptoms during the challenges were found. Roughly half the subjects tolerated the homogenized milk better and the other half tolerated the unhomogenized milk better. The results of this study show no difference in the tolerance of homogenized and unhomogenized milk in adults with self-reported symptoms suggestive of hypersensitivity to homogenized milk.

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