Dairy Allergy, Sensitivity and Intolerance




Lactose intolerance is estimated to affect 70% of the world's population. [1]  It is 
more common among black, Asian, Hispanic and American Indian populations. [2]  
It is caused by a deficiency in the enzyme lactase, needed to digest the lactose (sugars) 
in dairy products.  Milk allergy, on the other hand, is caused by an immune response 
to the proteins in milk.   Some gastrointestinal symptoms, such as bloating, gas, 
nausea and diarrhea may be shared by both conditions.  In fact, untreated milk 
allergy and other gastrointestinal diseases such as celiac disease, can eventually 
lead to lactose intolerance through destruction of the intestine's ability to produce 
the enzyme lactase.  In addition to gastointestinal symptoms, milk allergy may 
manifest itself in hives, wheezing, coughing, runny nose, watery eyes, itchy skin 
rash (usually around the mouth) and colic in babies. [3]  Babies who struggle with 
colic may also benefit from milk sensitivity testing (IgG), as well as those who have 
frequent vomiting, spitting up, eczema, crying, mucousy stools, slower than 
expected growth and poor sleep. [4]


Testing



Lactose Intolerance:

(1)  Lactose Intolerance Test.  This test requires you to drink a large amount of 
lactose at your doctor's office.  Over the following couple of hours, your blood will 
be drawn and the amount of glucose will be measured.  If it does not rise, that means 
your body is not digesting the lactose and you may be lactose intolerant.


(2)  Hydrogen Breath Test.  This test also requires that you drink a large amount 
of lactose.  Your doctor will then measure the amount of hydrogen present in your 
breath at regular intervals.  Large amounts of hydrogen may indicate an intolerance.


(3)  Stool Acidity Test.  This test doesn't require ingestion of lactose, making 
it more suitable for babies and children.  It measures the amount of acid in the 
stool.  High levels may indicate an intolerance.  


Allergy and Sensitivity:

Your doctor may conduct IgE skin or blood testing, especially if the reaction you are 
having to dairy occurs within a couple hours of ingestion.  In addition, IgG antibodies, 
or delayed reactions, can be identified through food sensitivity blood tests.  Finally, 
stool testing such as the test offered through Enterolab can also identify dairy 
sensitivity.


Treatment


The treatment for allergy or sensitivity to dairy is avoidance.  Severe allergic reactions
may require that you carry an EpiPen (injectible epinephrene) in case of exposure.
Some doctors recommend antihistamines for less severe reactions.  In the case of 
dairy sensitivity, dairy may be reintroduced after a period of avoidance (recommendations
vary from 3 months to one year).  Reactions should be monitored closely to determine
if dairy is safe.


The treatment for lactose intolerance is more flexible than for allergy and sensitivity,
and may depend on how severe the symptoms are.  Avoidance is one option that has
become easier with so many lactose free items on the market.  Some people find
relief taking the digestive enzyme lactase in capsule form when they eat dairy.  
Probiotics may also help, but many contain dairy in them, so watch your ingredients.  
For further information about the treatment of lactose intolerance, visit the 
Mayo Clinic.


If you must avoid dairy, it is important to make sure you are getting enough calcium.
Calcium rich foods include sesame seeds, broccoli, leafy greens, soybeans, oatmeal, and
canned salmon and sardines.  Additional food sources and information about supplementation
are provided at the Linus Pauling Institute and the National Institute of Health.   Adequate
levels of vitamin D are required to ensure the calcium you eat, or take as a supplement,
is properly absorbed.  These issues should be discussed with your doctor or a dietitian.
Vitamin D deficiency is increasingly gaining recognition as a contributor to a variety of
health conditions, and doctors who are knowledgable on this issue are testing those at
risk for deficiency.  For more information about vitamin D deficiency, visit the Linus
Pauling Institute.


References:
1.  Michael Lasalandra and Lawrence S. Friedman, A Harvard Medical School Book, The Sensitive Gut (New York: Fireside, 2001), 156.
2.  
Mayo Clinic, Lactose Intolerance Risk Factors, 2008.
3.  
Mayo Clinic, Milk Allergy Symptoms, 2009.
4.  Judy Converse, MPH, RD, LD,
 Special-Needs Kids Eat Right, Strategies to Help Kids

 on the Autism Spectrum Focus, Learn and Thrive (New York; Penguin Group, 2009) 102.
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