Please use this identifier to cite or link to this item: https://doi.org/10.1186/s40413-017-0173-0
Title: Lactose intolerance and gastrointestinal cow's milk allergy in infants and children - Common misconceptions revisited
Authors: Heine, R.G
Alrefaee, F
Bachina, P
De Leon, J.C
Geng, L
Gong, S
Madrazo, J.A
Ngamphaiboon, J
Ong, C 
Rogacion, J.M
Keywords: galactose
glucose
lactase
lactose
prebiotic agent
artificial milk
Bifidobacterium
breast milk
celiac disease
child
chromosome 2
Crohn disease
diagnostic error
diet restriction
diet supplementation
diet therapy
differential diagnosis
digestion
enteropathy
feces analysis
feces microflora
food composition
genetic analysis
giardiasis
human
hydrogen breath test
hydrolysis
infant
lactose intolerance
milk allergy
nutritional status
priority journal
promoter region
protein expression
Review
single nucleotide polymorphism
viral gastroenteritis
weaning
Issue Date: 2017
Citation: Heine, R.G, Alrefaee, F, Bachina, P, De Leon, J.C, Geng, L, Gong, S, Madrazo, J.A, Ngamphaiboon, J, Ong, C, Rogacion, J.M (2017). Lactose intolerance and gastrointestinal cow's milk allergy in infants and children - Common misconceptions revisited. World Allergy Organization Journal 10 (1) : 41. ScholarBank@NUS Repository. https://doi.org/10.1186/s40413-017-0173-0
Rights: Attribution 4.0 International
Abstract: 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. © 2017 The Author(s).
Source Title: World Allergy Organization Journal
URI: https://scholarbank.nus.edu.sg/handle/10635/178127
ISSN: 19394551
DOI: 10.1186/s40413-017-0173-0
Rights: Attribution 4.0 International
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