Milk allergy or lactose intolerance?

Dear Alice,

This may sound like a dumb question... But I really am unsure. What is the difference between a milk allergy and lactose intolerance? Or are they one in the same? I was in an accident when I was 14. I had emergency surgery on my liver and spleen. After about the age of 20, I have developed severe mad dashes to the restroom after eating anything dairy.

But I have a lot of sinus allergies... that seem to flare up after eating milk products. Although generally milk products do cause thickening of the mucus... I was wondering if severe congestion also goes with it? I no longer eat milk products, of course. But I recently read about a child with a milk allergy who could not breathe through his nose afterward... accompanied by severe coughing. I am now 40 and learned my lesson well... But still curious and always looking for additional info and answers!!


Dear Kathy,

Your question doesn't seem dumb. Many people confuse allergies with intolerances, or mistakenly use the terms interchangeably. So, what's the difference?

Intolerance is a physical reaction to a substance that usually does not involve the immune system. For example, lactose intolerance occurs when a person has a deficiency in lactase — the enzyme that breaks down lactose, the carbohydrate found in cow's milk. So, this milk sugar is not digested adequately, producing abdominal discomfort, gas, and diarrhea. Lactase enzyme supplements and reduced lactose dairy products can help people tolerate foods containing lactose.

An allergy is an immune response — when the body senses that a harmful substance has entered it, and releases specific chemicals to combat the perceived threat. For example, when you are having an allergic reaction, your body releases chemicals called histamines. These cause allergic symptoms that may affect your gastrointestinal tract, skin, respiratory system, and/or cardiovascular system. The effects on one's respiratory system could include a runny nose, cough, swelling of the larynx, and asthma. In the case of foods, studies show that food allergies rarely cause nasal symptoms or wheezing without also causing skin or gastrointestinal symptoms.

Since you are experiencing this set of symptoms, it seems possible that you have a milk allergy. It's a good idea to get the diagnosis from an allergist, so that the appropriate treatment can be identified. Other substances found in milk also can trigger allergic reactions in some people, including antibiotics given to cows, or the proteins of ragweed, linseed, peanut, or wheat that make their way into milk. People with a milk allergy may need to cut milk out of their diet entirely.

Diagnosing food allergies is complex. And having symptoms that seem like a milk allergy doesn’t necessarily rule out the possibility of also having an intolerance to lactose. You have found that cutting milk products out of your diet works well for you, which is a great step. It may make sense to see your health care provider or an allergist to learn more about your own specific situation.

Good luck!

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