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

Table 2 Lactose restriction in cow’s milk allergic infants

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

^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
^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

ISSN: 1939-4551