Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited
Lactose is the main carbohydrate in human and mammalian milk. Lactose requires enzymatic hydrolysis by lactase into D-glucose and D-galactose before it can be absorbed. Term infants express sufficient lactase to digest about one liter of breast milk daily. Physiological lactose malabsorption in infa...
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doaj-d4ea644539a84acfa1c60509a77ad1ee2020-11-25T02:25:44ZengElsevierWorld Allergy Organization Journal1939-45512017-01-01101Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisitedRalf G. Heine0Fawaz AlRefaee1Prashant Bachina2Julie C. De Leon3Lanlan Geng4Sitang Gong5José Armando Madrazo6Jarungchit Ngamphaiboon7Christina Ong8Jossie M. Rogacion9Murdoch Childrens Research Institute, Melbourne, Australia; Correspondence:Al Adan Hospital, Ministry of Health, Kuwait City, KuwaitRainbow Children’s Hospital, Banjara Hills, Hyderabad, IndiaPhilippine Society of Allergy, Asthma & Immunology, Philippine Medical Association, Quezon City, PhilippinesGuangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, ChinaGuangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, ChinaUniversidad National Autonoma de México, Hospital Infantil Privado Star Médica, Polanco, Mexico City, MexicoChualalongkorn University, Bangkok, ThailandKK Women’s and Children’s Hospital and Yong Loo Lin School of Medicine and Duke-NUS Medical School, Singapore, SingaporeUniversity of the Philippines, Philippine General Hospital, Manila, PhilippinesLactose is the main carbohydrate in human and mammalian milk. Lactose requires enzymatic hydrolysis by lactase into D-glucose and D-galactose before it can be absorbed. Term infants express sufficient lactase to digest about one liter of breast milk daily. Physiological lactose malabsorption in infancy confers beneficial prebiotic effects, including the establishment of Bifidobacterium-rich fecal microbiota. In many populations, lactase levels decline after weaning (lactase non-persistence; LNP). LNP affects about 70% of the world’s population and is the physiological basis for primary lactose intolerance (LI). Persistence of lactase beyond infancy is linked to several single nucleotide polymorphisms in the lactase gene promoter region on chromosome 2. Primary LI generally does not manifest clinically before 5 years of age. LI in young children is typically caused by underlying gut conditions, such as viral gastroenteritis, giardiasis, cow’s milk enteropathy, celiac disease or Crohn’s disease. Therefore, LI in childhood is mostly transient and improves with resolution of the underlying pathology. There is ongoing confusion between LI and cow’s milk allergy (CMA) which still leads to misdiagnosis and inappropriate dietary management. In addition, perceived LI may cause unnecessary milk restriction and adverse nutritional outcomes. The treatment of LI involves the reduction, but not complete elimination, of lactose-containing foods. By contrast, breastfed infants with suspected CMA should undergo a trial of a strict cow’s milk protein-free maternal elimination diet. If the infant is not breastfed, an extensively hydrolyzed or amino acid-based formula and strict cow’s milk avoidance are the standard treatment for CMA. The majority of infants with CMA can tolerate lactose, except when an enteropathy with secondary lactase deficiency is present. Keywords: Malabsorption, Carbohydrate, Enteropathy, Cow’s milk allergy, Celiac disease, Gastroenteritishttp://www.sciencedirect.com/science/article/pii/S1939455119300407 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ralf G. Heine Fawaz AlRefaee Prashant Bachina Julie C. De Leon Lanlan Geng Sitang Gong José Armando Madrazo Jarungchit Ngamphaiboon Christina Ong Jossie M. Rogacion |
spellingShingle |
Ralf G. Heine Fawaz AlRefaee Prashant Bachina Julie C. De Leon Lanlan Geng Sitang Gong José Armando Madrazo Jarungchit Ngamphaiboon Christina Ong Jossie M. Rogacion Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited World Allergy Organization Journal |
author_facet |
Ralf G. Heine Fawaz AlRefaee Prashant Bachina Julie C. De Leon Lanlan Geng Sitang Gong José Armando Madrazo Jarungchit Ngamphaiboon Christina Ong Jossie M. Rogacion |
author_sort |
Ralf G. Heine |
title |
Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited |
title_short |
Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited |
title_full |
Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited |
title_fullStr |
Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited |
title_full_unstemmed |
Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited |
title_sort |
lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited |
publisher |
Elsevier |
series |
World Allergy Organization Journal |
issn |
1939-4551 |
publishDate |
2017-01-01 |
description |
Lactose is the main carbohydrate in human and mammalian milk. Lactose requires enzymatic hydrolysis by lactase into D-glucose and D-galactose before it can be absorbed. Term infants express sufficient lactase to digest about one liter of breast milk daily. Physiological lactose malabsorption in infancy confers beneficial prebiotic effects, including the establishment of Bifidobacterium-rich fecal microbiota. In many populations, lactase levels decline after weaning (lactase non-persistence; LNP). LNP affects about 70% of the world’s population and is the physiological basis for primary lactose intolerance (LI). Persistence of lactase beyond infancy is linked to several single nucleotide polymorphisms in the lactase gene promoter region on chromosome 2. Primary LI generally does not manifest clinically before 5 years of age. LI in young children is typically caused by underlying gut conditions, such as viral gastroenteritis, giardiasis, cow’s milk enteropathy, celiac disease or Crohn’s disease. Therefore, LI in childhood is mostly transient and improves with resolution of the underlying pathology. There is ongoing confusion between LI and cow’s milk allergy (CMA) which still leads to misdiagnosis and inappropriate dietary management. In addition, perceived LI may cause unnecessary milk restriction and adverse nutritional outcomes. The treatment of LI involves the reduction, but not complete elimination, of lactose-containing foods. By contrast, breastfed infants with suspected CMA should undergo a trial of a strict cow’s milk protein-free maternal elimination diet. If the infant is not breastfed, an extensively hydrolyzed or amino acid-based formula and strict cow’s milk avoidance are the standard treatment for CMA. The majority of infants with CMA can tolerate lactose, except when an enteropathy with secondary lactase deficiency is present. Keywords: Malabsorption, Carbohydrate, Enteropathy, Cow’s milk allergy, Celiac disease, Gastroenteritis |
url |
http://www.sciencedirect.com/science/article/pii/S1939455119300407 |
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