Diagnostic algorithm – interactive

Adverse Milk Reaction
Assessment Tool for Adults

The exclusion diet and challenge protocol is an assessment tool to identify A1 beta-casein and lactose intolerance following milk intake. It should be undertaken with the support and supervision of a medical practitioner and/or dietitian.

Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a healthcare practitioner.

Medically confirmed cows’ milk protein allergy

Immune system mediated¹
Types:
IgE mediated
Non-IgE mediated
Mixed IgE and non-IgE mediated
Cell mediated

Yes

Strict dietary elimination

Strictly avoid all milk and dairy products.
Use appropriate non-dairy food substitutes and/or calcium supplements if dietary intake of calcium is inadequate.

Consider non-immune mediated milk intolerance

Milk intolerance

Non-immune mediated intolerance
Symptoms following milk intake:
Bloating
Abdominal pain
Difficulty voiding

Yes

CONSIDERATION 1
Intolerance symptoms may be due to A1 beta-casein protein or lactose², in many cases.

Dairy A1 protein and lactose elimination

Duration: 2 weeks
Eliminate: All foods and ingredients containing animal milk proteins e.g. malted milk biscuits, digestives, yoghurt, cheese, chocolate, ice cream, all animal milk, etc. Consider calcium supplements (e.g. calcium carbonate).

CHALLENGE 1: Lactose in A1 protein-free milk

a2 Milk™ is A1 beta-casein protein-free (but contains lactose). Challenge with 500 mL/day (i.e. 2 cups) for 7 days or until symptoms appear (best to consume all at once). Do not include other dairy. Record symptoms in a diary.

As a2 Milk™ is A1 protein-free, challenging with a2 Milk™ will indicate whether a patient is symptomatic following milk intake due to lactose, while eliminating any confounding A1 protein gastrointestinal response. Alternatively, a hydrogen breath test will assess lactose absorptive capacity, but will not indicate whether an individual will be symptomatic following intake of lactose-containing milk.³

Symptoms persist?

Yes

Lactose intolerance indicated:
Dairy elimination until symptoms have resolved.

CHALLENGE 2: Lactose reduced or lactose-free milk

Challenge with 500 mL a2 Milk™ with lactase enzyme supplement (best to consume all at once). Record symptoms in a diary.

Note: there is no lactose-free a2 Milk™, so lactase enzyme is required. Lactase enzymes (e.g. Lacto-free®) are available from a pharmacy.

A1 beta-casein intolerance

Continue on a2 Milk™. As symptoms resolved following a dairy A1 protein and lactose elimination, and did not reappear with the lactose in a2 Milk™ challenge which is also an A1 protein-free trial, previous milk intolerance symptoms are likely due to A1 protein and not lactose.

Symptoms persist?

Yes

Symptoms not mediated by low lactose intake

CONSIDERATION 2
Avoid animal dairy products and consider challenging with calcium enriched, plant-based milk drink alternatives (e.g. soy and rice milk drinks). Consider calcium supplementation, as required.

Confirmed lactose intolerance

Stay on lactose-free or low lactose foods and milk, including a2 Milk™ with lactase enzyme supplements.

The European Food Safety Authority’s report on lactose thresholds notes that most individuals with lactose intolerance can tolerate small amounts of lactose⁴ (as would be consumed with a2 Milk™ with lactase supplements).

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Adverse Milk Reaction
Assessment Tool for Adults

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Adverse Milk Reaction Assessment Tool for Adults

Important note:

Welcome to milkdigestion.com

Terms of use

Adverse Milk Reaction
Assessment Tool for Adults