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Dairy intolerance

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Milk Intolerance

  • both health care professionals and parents frequently use milk intolerance to describe a whole host of symptoms most commonly seen in infants who are fed commercially prepared formulas. In actuality, milk intolerance is a broad and generic term that includes the more specific maladies of lactose intolerance, cow's milk protein intolerance (CMPI), and cow's milk allergy (CMA)
    • lactose intolerance
      • a result of lactase deficiency and is a form of carbohydrate malabsorption
      • when lactase is absent or deficient, hydrolysis of the sugar lactose is incomplete
      • because it is osmotically active, the undigested sugar will pull fluid into the intestine
        • hydrogen and lactic acid, in addition to other organic acids, are produced when colonic bacteria act on the undigested sugar
        • the combined osmotic effect of the undigested sugar and organic acids results in the passage of acidic diarrheal stools
        • these stools can produce significant skin irritation and breakdown
        • infants with lactose intolerance may also present with abdominal distension and vomiting
    • cow's milk protein intolerance (CMPI), and cow's milk allergy (CMA)
      • intolerance or allergy to cow's milk is more complex and less well understood
      • Cow's milk protein allergy/cows' milk allergy
        • defined as adverse reactions to cow's milk that can be reproduced and are immune-mediated
          • most common immune responses are immunoglobulin E (IgE)-mediated, cell-mediated (non-IgE), or the combination of the two
      • Cow's milk protein intolerance/cow's milk intolerance
        • not immune-mediated
          • said to be undefined because an immune component is not clearly identifiable (1,2,3)
      • definition of CMPI/CMI does not include the symptoms of lactose intolerance or the presence of incidental isolated GI tract infections
      • children with CMA or CMI can present with a variety of clinical features that are cutaneous, GI, or respiratory in origin
        • most common cutaneous reactions include:
          • urticaria, atopic dermatitis, angioedema, and contact rashes
        • infants with GI reactions can present with various clinical features including
          • nausea, vomiting (including hematemesis), colic, diarrhoea, (including occult and frank blood), enterocolitis, colitis, constipation, and transient enteropathies
        • respiratory reactions include:
          • rhinoconjuctivitis, asthma, wheezing, laryngeal edema, otitis media, and anaphylaxis


  • 1. Host A., Clinical course of cow's milk protein allergy and intolerance. Pediatr Allergy Immunol 1998; 9 (Suppl 11):48-52
  • 2. Host A. Cow's milk protein allergy and intolerance in infancy. Pediatr Allergy Immunol 1994;5:5-36.
  • 3. Wilson J. Milk Intolerance: Lactose Intolerance and Cow's Milk Protein Allergy. Newborn and Infant Nursing Reviews 2005; 5 (4): 203-207.

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