CMPA vs Lactose intolerance

How to Tell
Them Apart.

CMPA is an immune-mediated response to proteins in milk or dairy, mediated through IgE or non-IgE-mechanisms.

Lactose intolerance is a non-immune mediated condition and is due to the absence (or insufficiency) of the enzyme lactase.

Lactose is the dominant carbohydrate (or sugar) found in human and other mammalian milks and requires enzymatic hydrolysis by the enzyme lactase in the gut in order to be absorbed (Heinie et al 2017). 

The symptoms of LI might include bloating, excess wind, abdominal discomfort and diarrhea due to the passage of undigested lactose into the large bowel where it is fermented. Hence the symptoms of lactose intolerance can be confused with CMPA due to similar presentation.

There are 2 types of lactose intolerance (LI), primary and secondary. Importantly, primary LI does not usually manifest clinically before 5 years of age (Heine et al 2017). About 70% of the world’s population, more commonly adults, suffer from primary LI which is genetically predisposed, leading to a gradual decline in lactase expression over time (Heine et al., 2017; Harvey et al., 1998).

Secondary LI can occur at any age, when there is villus damage, for example gut enteropathy, which can occur in some infants with CMPA (Heine et al., 2017).  Secondary LI is transitory and once the cause, commonly viral gastroenteritis (or gut enteropathy in CMPA), has been treated it resolves quickly (Heyman et al 2006). 

Lactose is important for the infant with CMPA. It is the dominant carbohydrate in human breastmilk and the largest solid component, representing around 70g/Litre (Zivkovic et al. 2013). It also forms the backbone to almost all Human Milk Oligosaccharides (HMO), the 3rd largest solid component of human milk (Zivkovic et al. 2013).