title: Cow milk is not responsible for most gastrointestinal immune-like syndromes--evidence from a population-based study.
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.
  
  
  METHODS
  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(-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 samples tended to have higher intraepithelial CD3(+) 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.
authors.affiliation: Foundation for Nutrition Research, Helsinki, Finland. laura.paajanen@helsinki
authors.forename: Laura
authors.initials: L
authors.lastname: Paajanen
authors.forename: Riitta
authors.initials: R
authors.lastname: Korpela
authors.forename: Tuula
authors.initials: T
authors.lastname: Tuure
authors.forename: Jarno
authors.initials: J
authors.lastname: Honkanen
authors.forename: Irma
authors.initials: I
authors.lastname: Järvelä
authors.forename: Jorma
authors.initials: J
authors.lastname: Ilonen
authors.forename: Mikael
authors.initials: M
authors.lastname: Knip
authors.forename: Outi
authors.initials: O
authors.lastname: Vaarala
authors.forename: Jorma
authors.initials: J
authors.lastname: Kokkonen
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000818:Animals; D016022:Case-Control Studies; D002417:Cattle; D015331:Cohort Studies; D020776:Endoscopes, Gastrointestinal; D005260:Female; D005387:Finland / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006306:Health Surveys; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007787:Lactose Intolerance / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D016269:Milk Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D008894:Milk Proteins / Q000009:adverse effects*; D011795:Surveys and Questionnaires
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D008894:Milk Proteins