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Table 2 Lactose restriction in cow’s milk allergic infants

From: Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited

Type of cow’s milk allergy (CMA) Need for lactose restriction
IgE-mediated CMA / anaphylaxis NO a
Cow’s milk protein-induced enteropathy YES b
Cow’s milk protein-induced enterocolitis syndrome (FPIES) NO
Cow’s milk protein-induced proctocolitis NO
CMA-associated gastro-esophageal reflux disease NO
CMA-associated constipation NO
CMA-associated eczema NO
  1. a For formula-fed infants with non-anaphylactic IgE-mediated CMA, a lactose-containing extensively hydrolyzed formula is suitable [60]. In infants with a history of anaphylaxis to cow’s milk protein, an amino acid-based formula is recommended. No lactose-containing amino acid-based formula is currently available
  2. b For formula-fed infants with cow’s milk protein-induced enteropathy, a lactose-free extensively hydrolyzed formula or amino acid-based formula are considered the first line treatment, depending on clinical features and severity [60]. Lactose may be tolerated later in the treatment course after intestinal mucosal repair has been achieved on a cow’s milk protein-free diet