Can milk-allergic patients achieve adequate bone health from nondairy sources?

Published Online: August 1, 2014

Study of the role of dairy intake on bone health has been historically handicapped by the reliance on a dietary history that would ideally span from infancy to young adulthood. IgE-mediated cow's milk allergic (IgE-CMA) patients, by definition, are unable to consume even minor amounts of dairy foods, since infancy, due to the risk for anaphylaxis. These patients, therefore, provide a valuable model for studying the relationship between dairy intake and bone mineral density (BMD).  

In a prospective observational study recently published in The Journal of Allergy and Clinical Immunology (JACI), Nachshon and Goldberg et al., determined the effects of dairy restriction on BMD in young adult IgE-CMA patients. Since their diagnosis in infancy, all had strictly avoided dairy products, including those containing baked milk. Densitometric measurements of postpubertal patients diagnosed with IgE-CMA, were compared to volunteers matched for age and gender without IgE-CMA. Furthermore, IgE-CMA patients and controls were compared to a third group of IgE-CMA patients who reversed their dietary deficiency after desensitization through milk oral immunotherapy.

The authors demonstrated that densitometric measurements of the hip, femoral neck, and lumbar spine of milk-allergic patients were significantly lower than those in the control group.  Furthermore, already by age 30, the maximal age of inclusion into this study, 27% of IgE-CMA patients had BMD measurements in the osteoporotic range. This places IgE-CMA patients as a population at high risk for early osteoporotic fractures. Nutritional evaluation revealed that the calcium intake of milk-allergic patients was severely reduced, despite the supplementation and directed consumption of calcium-rich foods compared to controls. In contrast, milk-allergic patients who underwent milk oral immunotherapy and restarted dairy intake for a period of one-three years, had normal BMD measurements similar to the control group and significantly greater than their IgE-CMA counterparts who continued to avoid dairy products.  

This study highlights an often overlooked problem for milk-allergic patients. In summary, the author's note that milk-allergic patients have a significant risk for early osteoporosis that appears to be reversible upon milk desensitization. This is an often overlooked problem for milk-allergic patients due to their natural preoccupation with the threat of anaphylaxis. The authors emphasize that awareness of this problem by pediatricians, allergists, and other care-givers is necessary in order to initiate early preventative nutritional strategies.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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