title: Cow's milk protein intolerance in adolescents and young adults with chronic fatigue syndrome.
abstract: OBJECTIVE
  To examine the prevalence, clinical features and influence on illness severity of cow's milk protein intolerance in young people with chronic fatigue syndrome.
  
  
  METHODS
  In a two-year prospective study of 55 adolescents and young adults with chronic fatigue syndrome, we defined intolerance to milk protein if subjects reported (i) no evidence of immediate or anaphylactic reactions to milk, (ii) at least 2 of the following 3 chronic symptoms: gastroesophageal reflux, early satiety and epigastric/abdominal pain, (iii) improvement in upper gastrointestinal symptoms on a milk protein elimination diet and (iv) at least 2 recurrences of upper gastrointestinal symptoms >two hours following open re-exposure to milk protein. Subjects completed three quality of life surveys at baseline and at six months.
  
  
  RESULTS
  The mean (SD) age of the 55 participants was 16.5 (2.1) years. Seventeen (31%; 95% CI, 19-43%) met study criteria for cow's milk protein intolerance. Compared to milk-tolerant subjects, milk-sensitive participants had significantly worse health-related quality of life at baseline but not at six months (after institution of the milk-free diet).
  
  
  CONCLUSIONS
  Cow's milk protein intolerance is a common problem in young people with chronic fatigue syndrome and is a treatable contributor to their symptoms.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rowe
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Marden
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Jasion
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Erica M
authors.initials: EM
authors.lastname: Cranston
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Marissa A K
authors.initials: MA
authors.lastname: Flaherty
authors.affiliation: Pediatric Specialty Care, Willow Grove, PA, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D015142:Baltimore / Q000453:epidemiology; D015673:Fatigue Syndrome, Chronic / Q000150:complications*; D005260:Female; D006801:Humans; D016269:Milk Hypersensitivity / Q000150:complications* / Q000178:diet therapy / Q000453:epidemiology; D008894:Milk Proteins / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D055815:Young Adult
chemical_list: D008894:Milk Proteins
keywords: Aphthous ulcers; Chronic fatigue syndrome; Cow's milk protein intolerance; Joint hypermobility; Milk protein allergy