Dairy allergy – myths and facts

Today I’m inspired by a patient who was reacting to dairy, and went to her doctor.  He did not do a single test, to see what element of dairy she was reacting to.  Instead, he yelled at her “you’re lactose intolerant, here–take these!!” and slapped down some samples of lactaid enzymes in front of her.  She decided never to see him again, but did try the lactaid – but the milk still made her feel sick.

We tested her later and it turned out she is actually allergic to the milk protein casein, not lactose, and there is pretty much no way to deal with that except to avoid dairy, though you can break down a small amount with certain types of enzymes.

This all brought back a memory of being in the hospital with my Dad when he was dying.  He was allergic to dairy.  He hadn’t wanted to give up his milk, but tried it because I asked him to.  Then he ate an ice cream bar and had a giant reaction that nearly choked him–not hives, not swollen lips which are caused by a histamine response,  just huge choking amounts of phlegm and generalized swelling, which are caused by a different type of allergic response (I’ll explain more about that later.)

Dietary department

After that he wanted no part of dairy, and asked me to call down to the dietary department and tell them he was to have no dairy products.  I did that, and was glad I was still in his room when they delivered a tray with not one but two glasses of milk!  I called them and asked if they had not understood me.  ”Oh no,” the woman said, that’s not dairy, that’s lactaid milk.  I said “I didn’t say he was lactose intolerant, I said he was allergic to all dairy, and lactaid is still milk, so please come and take the tray.”   The next day, they delivered a dietary “shake” type supplement called Boost, which has dairy protein-casein–as its main protein.  So, I called again.  I guess they must have gotten the message because that’s the last dairy we saw in his room.

Confusion in a hospital dietary department

So how does this kind of confusion go on? Even in a hospital dietary department?  In the first place, most people now say that they are “lactose intolerant” rather than dairy allergic.  Where do they get this?  Unfortunately, mostly from their doctors.  For some reason, doctors assume that the main reason people react to dairy is because of lactose–the milk sugar–and if they take an enzyme to break it down, they will be fine.  I have been testing people for food allergies since the early 1980’s and have found that when it comes to dairy, most people are reacting to the protein–casein,  not the sugar–lactose.

And most people who do react to dairy do not show it on allergy skin tests. Why is this?  Because skin tests measure things that cause what is known as an “immediate type” allergic response, which involves an immune globulin called IgE, and causes a histamine response–hives, lips swelling, throat closing–the kind that most people with peanut allergies have.  So the first thing that may happen to you if you think you are reacting to dairy is that you go get a skin test and are told firmly, “No, you are not allergic to dairy.”

But the more correct response would be “No you don’t have an immediate-type allergy to dairy but you should be tested for a delayed-type allergy.  However, it is currently the fashion among many doctors to dismiss delayed type allergies as “just sensitivities, not real allergies,” and to fail to test for them.  I always tell them “if you look in your Harrison’s Textbook of Medicine, you will see that it does define delayed type allergies as real!

Delayed type allergy

And actually, the delayed type allergy to dairy is the type that most people have!  It involves immune globulins known as IgG or IgM, and the body actually attacks the dairy protein with antibodies.  This creates very inflammatory particles called “antigen-antibody complexes” that can cause inflammation in everything from the sinuses to the intestines, and even in the brain.   I have seen delayed type allergies be the source of a wide variety of illnesses–chronic sinusitis, migraines, “irritable bowel syndrome” (abdominal pain, gas, bloating) “gastroesophageal reflux disease”, ADD, asthma, and many other illnesses.

One of the types of testing that is available for delayed-type allergies to foods is called ELISA testing, which tests your antibody level to different foods.  If you think you are reacting to dairy, gluten or an other common allergenic food wheat (gluten) dairy (casein),corn, soy, egg, yeast, or sugar, don’t accept a scratch test or some lactaid pills as your “final answer.”  Be sure to see a practitioner who knows about and tests for delayed type allergies.

Dr Martha Howard