Cow milk is not responsible for most gastrointestinal immune-like syndromes—evidence from a population-based study

Abstract

In an unselected cohort of young adults, 8% reported food-related gastrointestinal symptoms. The finding of immunologic activity implied the existence of a food-related gastrointestinal syndrome but not one induced by CM.

Milk allergy is a minor cause of milk avoidance due to perceived hypersensitivity among schoolchildren in Northern Sweden

“…Even though a former study showed a higher‐than‐expected prevalence of lactase downregulation (14%) among Swedish schoolchildren , others have shown that over‐reporting of lactose intolerance is frequent even in populations in which lactase downregulation is common . These findings suggest that symptoms of lactose intolerance might be caused by underlying mechanisms other than lactase downregulation . Further evaluation of these children including genotype testing and oral challenges would be necessary to differentiate symptoms caused by lactase downregulation from lactose intolerance like symptoms due to other gastrointestinal conditions like irritable bowel disease .…”

“…These findings suggest that symptoms of lactose intolerance might be caused by underlying mechanisms other than lactase downregulation (9). Further evaluation of these children including genotype testing and oral challenges would be necessary to differentiate symptoms caused by lactase downregulation from lactose intolerance like symptoms due to other gastrointestinal conditions like irritable bowel disease (7,9,11).…”

“…A possible study limitation was the lack of further evaluation of the milk hypersensitivity phenotypes with oral challenges and genotype testing for lactase nonpersistence . This could have resulted in an over‐diagnosis, especially of the probable lactose intolerance phenotype , while the tolerance cut‐off level of 100 mL of cow's milk might have resulted in an under‐diagnosis of current milk allergy . Also, as the interviews included questions about events from further back in time, the answers could be affected by recall bias.…”

“…Despite this, the prevalence of reported milk hypersensitivity remains high in older children and adolescents in many studies, ranging from 0.1 to 13% . As the onset of cow's milk allergy is uncommon after the first years of life , the majority of perceived symptoms following ingestion of dairy products in school‐aged children are most likely to be explained by food hypersensitivity phenotypes other than milk allergy . However, this has not been thoroughly explored.…”

“…However, the prevalence of lactose intolerance has not been well studied . During the last few decades, there has also been an increased awareness in the population regarding foods, cow's milk in particular, as possible triggers of various symptoms and diseases . Even when they are partially avoided, the elimination of dairy products may result in negative effects on nutritional status and quality of life .…”