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Can't drink milk/protein shakes but can eat ice cream, cheese, and other dairy?
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An_190951 posted:
Hi, I have a milk allergy (at least that's why the doctor said a while ago), but I discovered that I can eat ice cream, cheeses, and basically all kinds of dairy with no real notable problems. But I CANNOT drink milk or protein shakes. Right when I try, my throat gets itchy and my stomach is upset a little while later. I have been trying to research and I think I may be allergic to whey protein? I kind of want to know exactly what it is I am allergic to so I can work around it. Also, the doc said I was allergic to eggs and I haven't had pure eggs since but I have eaten french toast and stuff so I dunno about that one either...
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DUKE MEDICINE
Michael H Land, MD responded:
Dear Anon_179058,

Your symptoms are a little bit tricky and I would consider a few possibilities for your diagnosis. There are a few individuals with milk allergy who can tolerate the foods if they are prepared a certain way (highly heated, or baked). A subset of milk allergic patients cannot tolerate milk, but they can have another dairy product if it has been baked in a dessert or food (i.e. lasagna with cheese or cakes). It is not clear to me why you can have ice cream but not milk without the same symptoms. Can you have yogurt or pudding? Another possibility is that you might have a lactose intolerance, which is not an "allergy" by definition, but a GI problem where you lack an enzyme to help digest lactose. This could explain your stomach upset that occurs later. Another possibility is that you are developing a milk allergy or it is going away. I have had adult patients who were fine drinking milk as children and young adults and began having symptoms more often intermittently with milk or pizza, and over a period of a few years, discovered that they would have symptoms more frequently until it was every time. This is pretty rare, but it could occur.

Regarding the egg, you might also be in a small subset of patients who can tolerated highly heated (baked) goods containing egg but not able to tolerate low-heated versions. I have several pediatric patients who are egg allergic (if they eat a scrambled egg), but they can eat cakes, brownies and cookies that contain egg that has been baked.

What happens at high heat is the temperature may denature (or change the shape) of proteins, which changes how it appears to your immune system.

Since your case is challenging, I would encourage you to bring up your questions with a well qualified Food Allergy specialist to further define if you actually have the food allergy, if it is to certain forms of the food, or if it is an intolerance. You could talk to them about considering a blood test for ovomucoid IgE, which can also help define the egg allergy.

Good Luck, and let us know what happens.
 
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KimberlyKK replied to Michael H Land, MD's response:
I tested positive to a Cow's Milk allergy (and a lot of other things) after assumming I had a lactose intolerance problem. I thought it was a lactose problem because many diary items such as hard cheese and butter don't seem to bother me at all while milk, yogurt, and processed cheeses do give me gastrointestinal issues and sinus issues. I've searched the web repeatedly to try to answer why hard cheeses and other dairy products don't seem to bother me with a verified milk allergy. I just finished an elimination diet, without dairy for a full 2 months because it was my worst allergy at a 5 with a skin prick test. After trying to re-introduce some milk items it seems again hard cheeses, even cream cheese, and butter are not bothering me, while processed cheeses do still bother me. I'm not finding much on the web to help me understand why and are hoping you can give an opinion? Thank you.
 
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Michael H Land, MD replied to KimberlyKK's response:
Dear KimberlyKK,

For further reading, I addressed the issue of "testing for food allergies" in an entry about 9 months ago in the link HERE

In this forum (above), I basically say that these tests to detect food specific IgE levels in the blood and skin tests do NOT make a diagnosis of food allergy alone. They Must be carefully interpreted in the right context of clinical symptoms that fit an immune system mediated reaction to be applicable. This is an issue I am very passionate about in my clinic, if you can't tell already. Patients often come to me saying that they "tested positive for XYZ food" but they eat that food just fine or develop other symptoms that are not allergy symptoms.

If you drank coffee and then within 30 minutes, felt sweaty, jittery, and your heart was racing, would you believe you had an allergy to coffee? What if you had a "positive test" to coffee? We all know that these symptoms are a side effect of caffeine. It would not matter what the test showed, because the mechanism behind the symptoms is not an allergic reaction.

What the blood tests look for are antibodies (IgE) that your immune system has made against a food or substance. The significance of this antibody is to initiate an allergic reaction. We may make these antibodies to many substances (and it would be detectable on a test), but they don't cause us to have reactions. This could be misinterpreted as a positive test when in reality it has no clinical significance.

For example, if you "tested positive for prunes" but you were able to eat prunes a few times a day and intermittently developed diarrhea after eating the prunes, then the results of the test are meaningless. I would make a diagnosis of a normal food adverse effect, not a food allergy. However, if you had the same exact test result, but said that you developed lip swelling, hives, vomited, and had wheezing a few minutes after you ate the food each time, the same exact result would be very important and likely to confirm a food allergy.

Far too often, I am seeing food allergies over-diagnosed based on improper interpretation of test results. I would encourage you to discuss this carefully with a board certified allergist to come up with a plan to objectively assess your symptoms and come up with a solid diagnosis, which is what you deserve.

What you describe above sounds like it could be a food intolerance (i.e. lactose intolerance). I hope this helps.
Good luck,
ML
 
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KimberlyKK replied to Michael H Land, MD's response:
Thank you Dr. Land; I appreciate your time. I read the other post and the articles you referenced and have printed them out to re-read often (until it sinks in). It's a lot of good information and hit home in the sense that I was shocked to hear I had all these 'allergies' to foods without any noticable reactions. After enjoying dairy for 40 years, I had finally pinpointed that dairy was the only thing I knew to be giving me issues the last few years and of course that specific skin prick test (cow's milk) did come back higher than any other foods. My internist conducted the skin prick tests and did tell me that not all of these things were real/fixed allergies and that I should be able to add some foods back in sucessfully once I got my system calmed down. I will be researching more and also plan to see an actual allergist in the near future as well.
 
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joy0joy replied to Michael H Land, MD's response:
My 20-year-old daughter has been violently allergic to milk all her life, and it was recently confirmed when she became ill after eating a dish that had butter in it. But a couple of accidental exposures to cheese showed that she can indeed eat cheese with no reaction whatsoever. She is so thrilled to FINALLY be able to enjoy pizza with real cheese, and grilled-cheese sandwiches. As you mentioned above, we suspect that the high-temperature processing of cheese (plus the removal of the whey) alters the protein somehow. So far, she has tried colby, cheddar, mozzarella and provolone cheeses. She is still imbibing with caution, but we are thrilled that she doesn't have to request "special" food preparation with regards to cheese, and don't have to buy the expensive soy alternatives any more.
 
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FtLaudJeff replied to Michael H Land, MD's response:
I am a 41-year old male. Within the last 2 - 3 months I have noticed that after I eat ice cream, drink milk or drink coffee with creamer in it I begin coughing within less than 5 minutes of ingestion.

I have never had this type of reaction previously with any dairy products. I am okay when eating cheese.

Could I have possibly developed an allergy to milk late in life?

Thanks,
Jeff in Fort Lauderdale
 
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kedwards2011 replied to Michael H Land, MD's response:
Hi doctor. Today has been a horrible day because I had a bowl of cereal. I havent been able to tolerate milk for a few years now but I can tolerate all other dairy products. I troed switching to rice milk, goat milk, soy milk, and all I get sick with. It seems to be anything with a milky texture. I have no issues with yogurt, pudding or ice cream, but once I drink milk, its almost instantaneous diarrhea, and vomiting. Can you possibly give me some insight as to what the heck! Is going on?
 
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atti_editor replied to kedwards2011's response:
Hi kedwards2011,

Dr. Michael H Land is no longer an expert in this community unfortunately. It definitely sounds like you are having some sort of an allergic reaction. Have you mentioned this to your doctor? I would suggest you make an appointment to discuss your symptoms with your doctor or an allergist -- a medical professional will be able to run tests to see what exactly you are allergic to and then can go from there. Please check back in here and let us know what you find!

Best wishes,
Atti


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