Although they are often used to refer to the same symptoms, lactose intolerance and Cow's Milk Protein Allergy are not the same. It is very important that they get to know each other and know how to approach each other, especially when the affected person is a child.

To begin with, CMA is an allergic manifestation (as its name suggests) that occurs with so-called immediate reactions, including vomiting (propulsive), skin reactions, diarrhea that starts suddenly, cough, hives, swelling of the lips…, what happens is that histamine and serotonin are released, due to the appearance of IgE antibodies that act against casein (one of the main proteins in milk).

In a food allergy (and CMPA is) the immune system overreacts to one or more proteins present in cow's milk, and What is the most effective way to avoid it? then reject the intake of such protein. It is the entire immune system that is at stake, and sometimes the life of the allergic person may be at stake if they suffer a anaphylactic shock.

Babies with an allergy to cow's milk protein

I take this opportunity to remember that the best food for an infant under 6 months is breast milk, which can continue to be offered along with complementary feeding (ideally up to 2 years). In cases where the mother's milk (naturally formulated for human calves) is discontinued, they opt for so-called artificial milks, made from cow's milk.

These formulas are generally well accepted, but small percentages of babies develop CMA during the first year of life, and after being diagnosed. they should drink milk with a special formula. It is worth mentioning that on some occasions, breastfed babies may also have an allergic reaction if the mother drinks cow's milk or derivatives, but the solution to this problem is simple, since it consists of eliminating certain foods from the mother's diet.

Lactose intolerance is not an allergy

Now we go with lactose intolerance: the body cannot digest lactose and it affects the digestive system (without it being an allergic reaction); it is also known as a non-IgE-mediated allergy. Malabsorption can lead to diarrhea, pain in the abdomen, bloating, diarrhea. Lactose is a sugar present in milk, and in intolerant people the absence of the lactase enzyme that allows its absorption, is what causes the manifestations.

Therefore, it is not necessary to exclude milk and derivatives from the diet, since they can be substituted by 'lactose-free' products (nowadays common in large stores); and it should always be taken into account that in case of dispensing with milk, yogurts, cheeses, it is important to ensure the presence of calcium in the diet of children. Regarding vegetable smoothies (rice, oatmeal, almond, soy, walnut, quinoa ...) I recommend reviewing this entry by Jesús Garrido in My Online Pediatrician.

The process of a girl or a boy diagnosed with a food allergy (CMPA or others) must be strictly reviewed by a doctor)This is not to say that parents cannot seek other sources of information, ensuring that they are reliable.

Here are the main differences:

• An allergy is caused by a protein, an intolerance to a sugar (lactose).
• Allergy affects the immune system, intolerance only the digestive system.
• The allergy causes sudden reactions that are triggered quickly, and even violently; the manifestation of an intolerance can appear days after having ingested the food.
• An allergic person should not take any food that contains milk protein (dairy or processed); a person with intolerance can consume 'lactose-free' dairy.
• Exposure to milk protein can trigger anaphylactic shock; an intolerant person avoids dairy with lactose, but if exposed, his life is not at risk.

How to distinguish milk protein on labels?

Allergy sufferers, and parents of children with CMA, avoid milk, butter, cheese, yogurt, custard, cream, curd, smoothies, flan and any food that contains them. You should also do without cookies and pastries made with milk or derivatives, and nougat. Lactalbumin, animal whey solids, whey, lactalbumin phosphate, and others are prohibited.

Also you have to be very careful with the labels, avoiding buying those foods whose labeling specifies artificial butter or butter flavor, hydrolyzed protein, butter oil, ... unless the source is clearly specified, and it is not an animal protein. Obviously, choosing a diet based on basic ingredients cooked at home is the safest; and a very close coordination with the school dining room is necessary, as well as giving precise instructions to friends or family to help us take care of children. When eating out, it is advisable to consult with the restaurant staff for the ingredients of the dishes.

And how to detect lactose in non-dairy foods?

It is clear that the intolerant person can take any of the 'lactose-free' dairy foods that are already common in supermarkets and commercial surfaces (not allergic because they would be exposed to casein), but what about those foods non-dairy products made with lactose? The label 'contains lactose' gives us a clear clue, but it is not always so easy. If on the label they appear: milk sugar, whey, lactose monohydrate, 'sugars' (it should be noted), powdered milk, milk cream, etc. is that we should avoid such products.

Finally, mention that the allergy to cow's milk protein (CMPA) ranks third among food allergies. And (this is important) goat and cow's milk should also be avoided.