Milk-Related Symptoms and Immunoglobulin E Reactivity in Swedish Children from Early Life to Adolescence.

Jennifer Protudjer,Erik Melén,Inger Kull,Marianne Van Hage,Anna Bergström,Magnus Wickman,Mirja Vetander,Ola Olén

doi:10.3390/nu10050651

Abstract

Cow’s milk often causes symptoms in infants. Whereas, some continue to experience symptoms through childhood, others become tolerant. Yet, the ages at which persistence and tolerance occur are less clear. Thus, we examined the age of onset and persistence of milk-related symptoms from early life to adolescence, and Immunoglobulin E (IgE) milk reactivity, focusing on gender differences in a large, population-based birth cohort. Overall, 20.0% (537/2985) of children, with a comparable gender distribution, had early life milk-related symptoms. At 16y, approximately 2% (62/2985) children had persistent symptoms and high milk IgE levels (e.g., median at 4 years: 1.5 kUA/L) that were beginning in early life. In contrast, 94% had transient symptoms and low median IgE levels (early life: 0.63 kUA/L, 8y: 0.72 kUA/L; 16 years: 1.1 kUA/L). Also, at 16 years, approximately 6% of females and 3% of males without any previously reported symptoms reported adolescent-onset of symptoms (p < 0.001). Such symptoms were almost exclusively gastrointestinal symptoms and were not associated with detectable IgE. In conclusion, early life milk-related symptoms are common, although most cases are transient by 16 years. Twice as many females vs. males report adolescent-onset symptoms, and particularly gastrointestinal symptoms. Children with persistent symptoms have both a higher prevalence and higher milk IgE levels, as compared to other phenotypes.

Highlights

Consumption of cow’s milk is common in many parts of the world
We aimed to examine the age of onset and the persistence of cow’s milk-related symptoms from early life to adolescence, as well as Immunoglobulin E (IgE) reactivity to milk, focusing on gender differences in the Swedish population-based birth cohort, named BAMSE
Milk-related symptoms are common in early life, most children achieve tolerance by age 16 years

Summary

Introduction

Consumption of cow’s milk is common in many parts of the world. Milk is a common cause of food-associated symptoms in infancy [1,2]. But not all, cases of milk-related symptoms in infancy are Immunoglobulin E (IgE) mediated [1,2,3]. Nutrients 2018, 10, 651 reported for both immunologically mediated and non-immunological phenotypes. Affected children and their families report worse health-related quality of life [7,8] and increased household costs [9] than those who are tolerant to milk. Tolerance, which was defined as an absence of symptoms upon milk consumption, commonly occurs by school age [3]. Some evidence suggests that tolerance occurs as late as adolescence [4], and/or to heated or baked milk, but not to milk as a beverage [3]

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Conclusion