1. Cow milk is not responsible for most gastrointestinal immune-like syndromes--evidence from a population-based study
- Author
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Paajanen, Laura, Korpela, Riitta, Tuure, Tuula, Honkanen, Jarno, Jarvela, Irma, Ilonen, Jorma, Knip, Mikael, Vaarala, Outi, and Kokkonen, Jorma
- Subjects
Milk -- Nutritional aspects ,Milk -- Health aspects ,Food allergy -- Risk factors ,Gastrointestinal system -- Endoscopic surgery ,Gastrointestinal system -- Patient outcomes ,Food/cooking/nutrition ,Health - Abstract
Background: Gastrointestinal hypersensitivity to cow milk (CM) may be more common among school-aged children and young adults than previously thought. Objective: The objective was to study various gastrointestinal complaints and the immunologic mechanisms associated with food-related, especially CM-related, gastrointestinal disorders in young adults. Design: Of 827 subjects aged 16-21 y who completed a questionnaire on food-related gastrointestinal symptoms, 49 symptomatic subjects agreed to a clinical examination, including an interview, blood tests, a lactose-maldigestion test, a blinded CM challenge and, in severely symptomatic subjects (n = 12), an endoscopic examination. Twenty-nine subjects served as controls. Results: Approximately 10% of the subjects reported having major gastrointestinal symptoms, mainly food-related (n = 70 of 86), during the preceding year. Specific organic disease was found in 2 symptomatic subjects: 1 case of celiac disease and 1 of colitis. The result of the lactose-maldigestion test was positive in 16 of the remaining 47 symptomatic subjects, but only 4 carried the C/[C.sub.-13910] genotype for adult-type hypolactasia. The symptomatic subjects had restricted their consumption of certain foods, particularly CM. However, in a blinded challenge, CM-induced symptoms were rare. The symptomatic subjects had higher plasma soluble intercellular adhesion molecule 1 (P = 0.007) and lower granzyme A (P = 0.001) concentrations than did the control subjects. Duodenal biopsy sampies tended to have higher intraepithelial CD[3.sup.+] cell counts (P = 0.065) and a higher expression of transforming growth factor [beta] (P = 0.073) and interleukin 12p35 messenger RNA (P = 0.075) than did the control subjects. Conclusions: In an unselected cohort of young adults, 8% reported food-related gastrointestinal symptoms. The finding of immunologic activity implied the existence of a food-related gastrointestinal syndrome but not one induced by CM. KEY WORDS: Cow milk hypersensitivity, cytokines, endoscopy, gastrointestinal symptoms
- Published
- 2005