In this video Dr. A addresses common questions about dairy-related adverse reactions, distinguishing true IgE‑mediated cow‑milk allergy from other forms of dairy intolerance and sensitivity. The speaker explains that a type‑1 (IgE) allergy to cow milk affects roughly 3‑7 % of the U.S. population and is diagnosed via skin prick or serum IgE testing. He describes the phenomenon of baked‑milk tolerance, noting that about 70 % of allergic individuals can tolerate milk that has been heated, while the remaining 30 % react to both raw and baked forms. The talk then explores why reactions can vary across dairy products—liquid milk, butter, yogurt, and different cheeses—because processing changes protein conformations. Dr. A contrasts allergic reactions (potentially anaphylaxis) with lactose intolerance, whose prevalence ranges from ~95 % in some Asian, African, Hispanic, and Native American groups to ~15‑20 % in Northern Europeans, emphasizing the genetic basis of lactase deficiency. He also mentions other non‑allergic sensitivities that can cause digestive, joint, or skin symptoms. Practical guidance is offered: for severe IgE‑mediated reactions, prioritize safety and obtain emergency medication; for milder intolerance or sensitivity, implement a systematic elimination diet followed by stepwise re‑introduction of individual dairy items (typically after 10 days‑2 weeks of avoidance) to pinpoint the offending product. The overall message is to correctly categorize the type of dairy reaction, use appropriate diagnostic tools, and adopt a structured dietary approach to improve health and avoid unnecessary restriction.
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Today, what I want to get into is some questions we got about allergies, specifically to dairy products. So the first thing is there are different types of allergic response and allergic phenomenon. So if we're talking about a, what we would call a type 1 allergy, there is a response that is based on an immunoglobulin, immunoglobulin E, like Edward. And if that is high against cow milk, Then you will have an IgE or a type one type reaction. Now that could be something very significant, such as an anaphylactic reaction where you have an overwhelming allergy. You can go into shock and die and all of those sorts of things. Or it could be another type of an IgE response where maybe you get extremely sick in your GI tract or in other areas. So the way that that one would be diagnosed would be to looking at either a surface. Test, like a scratch type of an allergy test or a blood test to IgE that would show a high amount of IgE against the protein in question. In this case, let's say milk, for example, cow milk allergy. In the United States, true cow milk allergy is considered to be somewhere between 3% and 5% to 7% of the population. Now, when we talk about cow milk allergy, we're talking about that particular type of a reaction where You have an elevation in the IgE response and you have a type 1, kind of a classic allergic reaction. Now, there's a subset of those people where if they take the cow milk and then it is, say, baked. So for example, it's in a recipe and you bake it into a baked good, et cetera. Some people will not react to the cow milk proteins anymore because it was baked and that changes the protein. But about 30% of people who react to cow milk allergy will also react to the baked good as well. So this is another layer of confusion and consternation that comes up with patients in that they're saying, well, how could it be that if I drink it, I might have this very bad reaction, but I could eat it in a baked good and I don't get that bad reaction? It's because the act of baking it changes the proteins enough that for, like we say, about 70% of people, they don't have that particular reaction when it's in a baked product. Now, what is another level of confusion? And the thing with dairy products is there's a lot of levels of reaction, but also of sort of subtlety that can become problematic when you're having a discussion about milk allergy or dairy allergy. If we take a step back under dairy, then we may have other different types of reactions to different subcategories of dairy products. So for example, you can have somebody where they have an allergic reaction to cow's milk, but they may not They may not react to something like yogurt or certain cheeses or butter, or they may react to all of it. And there again, you say, well, how can one allergy be so dissimilar amongst people? And what it has to do with is the level of sensitivity to the milk proteins that the allergy response is created against, and whether or not those change enough when we go from one form, such as liquid milk, to something like butter, which is a very different conformation of the different subparts of milk. So often when people are challenged with allergy, especially of the higher orders, they will report, well, if you'd say a child or an adult, you know, drank cow milk and they got a respiratory response or a full-blown allergic reaction, et cetera, why didn't they have that when they had butter, for example? Well, it's because they are not the same thing, even though they're all made out of dairy products in the beginning. The same happens with cheese. There are Some people who will not react to cow milk and will react to certain types of cheese. So often what we have to do in sort of the detective work around dairy allergy is to figure out, is it everything that you're reacting to, or is it just one or two types of that dairy product that you're reacting to? And then, as I said, about 30% of people, it doesn't matter what way or what you do to the cow milk protein, they're going to react whether it's baked or not baked, and they might react across the board to anything with cow milk protein. The next thing is that not all reactions are allergic reactions. And this becomes also a little confusing to people because people will say, well, I'm allergic to dairy products. And they might actually be sensitive or intolerant of parts of dairy products. They're not really allergic to them, at least under the standard categorization of a type 1 allergy. So what could happen there? Well, the much larger portion, if we look worldwide, Of responses to dairy would be things like lactose intolerance. So lactose is going to be one particular subtype of dairy, and that's going to vary based on your genetics and your heritability. So you can have up to 95% lactose intolerance in people of Asian and African, Hispanic and Native American heritage, and then you can have all the way down to 15 to 20% or a little bit more response. In, say, Northern Europeans. And a lot of that has to do with the heritability of certain types of enzymes to help break the lactose down, et cetera. So again, you'll react, you may feel very sick, you may get certain signs and symptoms when you have lactose, but it's not the same as the reaction you get to, say, a true dairy allergy, a type 1 IgE dairy allergy. The next thing is you can have other variations of a sensitivity that goes on that again is not an allergy. So we have cow milk allergy based on usually the protein type 1 reaction. We have lactose intolerance where we don't make enzymes to break lactose down, and so it becomes sort of an internal poison really. And then there's other intolerances that again are not allergy, but they still make you feel sick. So if you have lactose intolerance, you're still going to feel sick if you have dairy products that have lactose in them. You may not react at the same level or in the same way as somebody with a true cow milk allergy, but it still makes you sick. Then if you have some other type of reactivity or sensitivity, again, it's not really an allergy, but it still makes you feel bad. It could be digestive signs and symptoms that may or may not be related to lactose intolerance. You could have joint swelling and pain. You could have itchiness. You could have all sorts of things that go on with sensitivity reactions. And normally what the allergy community tells you to do with that would be to do elimination Testing. So okay, we know it's somewhere in the dairy product category. The first thing is, is it at a high level where it's dangerous? So first do no harm. If you're having true allergic reaction and/or you might become allergic anaphylactic, you need to make sure that you and your doctor know about that, and they can get you the appropriate medications to take care of that if you have a high-level reaction. What if it's not that, and you're having either lactose intolerance or a sensitivity reaction? Well, then the recommendation is to try. So you would remove all. Things dairy from your diet and take them out and then reintroduce them one at a time after your body's had a chance to calm down, usually 10 days to 2 weeks with no dairy products. But you don't just do all, have a dairy festival one day. You take the dairy out and then you try one thing at a time. And so remember, we go back to sometimes there's a difference between say butter or yogurt. Then there's different types of cheese reactions and cheeses or cow milk. So usually we'll have people try one thing at a time. So the first thing might be butter. And you try it and you don't notice a reaction. So you always try it the next day just to make sure. And then if there's no reaction after 2 tries, you can kind of move on to testing the next thing. So the next thing might be yogurt or might be cow's milk or might be hard cheeses or might be soft cheeses or something of that nature. Then you try them one at a time. Now, there's also subreactions that don't have anything to do with the fact that it's dairy proper, but could be, as I said, a reaction to a particular component of something like cheese where you have fermentation involved. Et cetera. So what you can see here is that there's this stratification of allergy and then intolerance and reactivity and sensitivity. None of them make you feel good. None of them overall are good for you. Some are much more immediately dangerous to you, but none are good for you overall. And so first thing that we want to be careful with is calling it all allergy because you're not really allergic in the sensitivity realm. You might be intolerant, might have a sensitivity to something else, but also we want to know because even sensitivities can make make us feel unwell. We need to identify if I don't have a true allergy to milk proteins, or I don't maybe have a hardcore lactose intolerance, but dairy makes me sick. Try and narrow down which dairy product or products it is that you react to. And you may never find out why you react to it. There's literally 100 reasons it could happen, but the ones that do cause symptoms for you, take them out of your diet and you will probably be less symptomatic over time. All right. Well, what I was trying to do there is to narrow down and categorize for you why dairy can be so problematic to figure out in the diet and why an allergy is one part of the problem and that intolerances and sensitivities are sort of a different part biochemically of the problem. And ultimately the idea is to have you feel well, to have you not consume foods that give you reactions, but to get— consume foods that are fine and to know the difference between the two. All right, I'm Dr. A. Thank you everyone in the community. Thanks for liking, sharing, subscribing, and I'll see you guys on the next video.
