Whole Cow's Milk but Not Lactose Can Induce Symptoms in Patients with Self-Reported Milk Intolerance: Evidence of Cow's Milk Sensitivity in Adults.

Antonio Carroccio,Ada Florena,Beatrice Mantia,Alberto D’Alcamo,Francesca Fayer,Francesco La Blasca,Pasquale Mansueto,Chiara Tinè,Aurelio Seidita,Chiara Garlisi,Maurizio Soresi

doi:10.3390/nu13113833

Abstract

Background: Lactose intolerance is the most frequent food intolerance, but many subjects with self-reported milk intolerance (SRMI) are asymptomatic at lactose hydrogen breath test (LHBT). The aim of this study was to evaluate the frequency of lactose intolerance in SRMI patients and their clinical characteristics. Methods: In a retrospective study, the clinical records of 314 SRMI patients (259 females, mean age: 39.1 ± 13.5 years) were reviewed; 102 patients with irritable bowel syndrome (IBS) served as controls. In a prospective study, 42 SRMI patients, negatives at the LHBT, underwent a double-blind, placebo-controlled (DBPC) whole cow’s milk challenge. Results: In the retrospective study, only 178 patients (56%) were lactose maldigesters and intolerant at LHBT; 68% of the subjects with SRMI were suffering from IBS; 74% reported dyspepsia (p = 0.0001 vs. IBS controls); and weight loss was recorded in 62 SRMI patients (20%) (p = 0.01 vs. IBS controls). Duodenal histology showed intra-epithelial lymphocytosis in about 60% of cases. In the prospective study, 36 patients (86%) experienced symptoms during the DBPC cow’s milk challenge, and only 4 patients (9%) reacted to placebo (p = 0.0001). Conclusions: A percentage of SRMI patients were not suffering from lactose intolerance. DBPC revealed that SRMI patients had clinical reactions when exposed to whole cow’s milk.

Highlights

It should be underlined that many patients who self-report symptoms after milk ingestion and avoid milk consumption are found to be asymptomatic at the hydrogen breath test for lactose (LHBT), which is currently considered the “gold standard” to diagnose lactose
The aims of the present study were to evaluate: (a) the frequency of lactose intolerance at lactose hydrogen breath test (LHBT) in self-reported milk intolerance (SRMI) patients; (b) the clinical characteristics of patients with SRMI, compared with patients suffering from irritable bowel syndrome (IBS) unrelated to food intolerance; and (c) the clinical reaction to a double-blind, placebo-controlled (DBPC) challenge with whole cow’s milk or placebo in patients with SRMI and negative LHBT
We should recall that the female sex is largely prevalent in patients suffering from non-celiac wheat sensitivity (NCWS), a condition which we consider very similar to that which we described in this study for a percentage of the SRMI patients included

Summary

Introduction

It should be underlined that many patients who self-report symptoms after milk ingestion and avoid milk consumption are found to be asymptomatic at the hydrogen breath test for lactose (LHBT), which is currently considered the “gold standard” to diagnose lactose “maldigestion” and lactose “intolerance” [3,4]. In these subjects, many other differential diagnoses should be considered [3,5].

Objectives

Methods

Results

Discussion

Conclusion