Compendium of the most significant studies with reference to properties, intake, effects.

D'Auria E, Salvatore S, Pozzi E, Mantegazza C, Sartorio MUA, Pensabene L, Baldassarre ME, Agosti M, Vandenplas Y, Zuccotti G. Cow's Milk Allergy: Immunomodulation by Dietary Intervention. Nutrients. 2019 Jun 21;11(6):1399. doi: 10.3390/nu11061399.

Abstract. Cow's milk proteins cause allergic symptoms in 2% to 3% of all infants. In these individuals, the physiological mechanism of tolerance is broken with subsequent possible sensitization to antigens, which can lead eventually to allergic responses. The present review aims to provide an overview of different aspects of immune modulation by dietary intervention in cow's milk allergy (CMA). It focuses on pathogenetic mechanisms of different CMA related disorders, e.g., gastroesophageal reflux and eosinophilic esophagitis, highlighting the role of dietary management on innate and adaptive immune systems. The traditional dietary management of CMA has greatly changed in the last years, moving from a passive approach, consisting of an elimination diet to relieve symptoms, to a "proactive" one, meaning the possibility to actively modulate the immune system. Thus, new insights into the role of hydrolysates and baked milk in immunomodulation are addressed here. Additionally, nutritional components, such as pre- and probiotics, may target the immune system via microbiota, offering a possible road map for new CMA prevention and treatment strategies.

Inuo C, Tanaka K, Suzuki S, Nakajima Y, Yamawaki K, Tsuge I, Urisu A, Kondo Y. Oral Immunotherapy Using Partially Hydrolyzed Formula for Cow's Milk Protein Allergy: A Randomized, Controlled Trial. Int Arch Allergy Immunol. 2018;177(3):259-268. doi: 10.1159/000490804.

Abstract. Background: Partially hydrolyzed cow's milk protein-based formula (pHF) possesses low allergenicity. Here, we investigate the safety and efficacy of oral immunotherapy using pHF for children with cow's milk protein allergy (CMPA). Objectives: A randomized, double-blind, controlled single-center trial was conducted to evaluate the efficacy and safety of pHF oral immunotherapy in children with CMPA....Conclusions: The results of this trial suggest that, in children with CMPA, tolerance to cow's milk might be safely enhanced by intake of pHF, relative to that of eHF. © 2018 S. Karger AG, Basel.

Qamer S, Deshmukh M, Patole S. Probiotics for cow's milk protein allergy: a systematic review of randomized controlled trials. Eur J Pediatr. 2019 Aug;178(8):1139-1149. doi: 10.1007/s00431-019-03397-6. 

Abstract. Cow's milk protein allergy (CMPA) is the commonest food allergy in infancy and is associated with significant health burden. Given their immune modulatory properties, probiotics have been proposed as a strategy for management of CMPA. We aimed to systematically review efficacy and safety of probiotics in the management of CMPA. Databases PubMed, EMBASE, CINAHL, Cochrane Central Library, and Google scholar were searched in August 2018 for randomized controlled trials (RCT) of probiotic supplementation as an adjunct in the management of infants with suspected/proven CMPA. Primary outcomes were resolution of hematochezia and acquisition of tolerance to CMP at 6, 12, 24, and 36 months. Secondary outcomes included effect on allergic symptoms (SCORAD index), growth, gut microbiota, and adverse effects. A total of 10 RCTs (n = 845; probiotics, 422; control, 423) with low to unclear risk of bias were included. Meta-analysis showed probiotic supplementation was not associated with earlier resolution of hematochezia (n = 87; RR: 1.45 (95% CI: 0.96-2.18), p = 0.08; level of evidence (LOE), very low), in presumed CMPA. In confirmed CMPA, probiotics were associated with higher rate of acquisition of tolerance to CMP at the end of 3 years compared with placebo (N = 493; RR, 1.47; 95% CI, (1.17-1.84); p = 0.0009; LOE, low]. Meta-analysis was not possible for other outcomes. There were no probiotic related adverse effects. Conclusion: Limited low-quality evidence indicates that probiotic supplementation may be associated with earlier acquisition of tolerance to CMP in children with CMPA. Large well-designed trials are essential to confirm these findings. What is Known: • Cow's milk protein allergy (CMPA) is one of the commonest food allergies in children. CMPA is associated with significant socioeconomic burden. • Elimination diet and extensively hydrolyzed formula is the mainstay of the management of CMPA. What is New: • This first systematic review of randomized controlled trials shows that probiotics as an adjuvant can lead to earlier acquisition of tolerance to CMP in children at 36 months of age. However, the evidence is low quality and influenced by data from one large study. • Probiotic supplementation was not associated with earlier resolution of hematochezia.

Çelik MN, Köksal E. Nutritional Targets in Cow's Milk Protein Allergy: A Comprehensive Review. Curr Nutr Rep. 2022 Jun;11(2):329-336. doi: 10.1007/s13668-022-00408-1.

Abstract. Purpose of review: Cow's milk protein allergy (CMPA) is known as the most common food allergy in the first year of life. For this purpose, in our review, the regulation of maternal and infant nutrition, and the risks and the issues to be considered in terms of nutrition are discussed from the perspective of a dietitian. Recent findings: Therefore, understanding the epidemiology, symptoms, diagnostic criteria, and appropriate treatment of cow's milk protein allergy is crucial for the multidisciplinary team of physicians, dietitians, and nurses working in the clinic. It has been reported that tolerance develops in approximately 50% of infants affected by cow's milk protein in the first year of life. Although CMPA is generally thought to clear up between 1 and 2 years of age, there is insufficient evidence to determine an optimal time to reintroduce cow's milk protein to the diet. Because the elimination diet recommended in the treatment of children with CMPA, adequate protein and calcium intake of the mother and/or baby in the diet should be evaluated. Studies focusing on metabolic bone turnover in children with food allergies are limited. In general, low calcium intake is associated with reduced bone formation in children with CMPA. Therefore, bone health should be focused on and appropriate strategies should be developed in children with CMPA. Unnecessary elimination of milk and its products, which are an important part of nutrition, should be prevented and nutrient deficiencies and growth status should be monitored by dietitians especially working in the field of pediatric nutrition. © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Host A, Halken S. Cow's milk allergy: where have we come from and where are we going? Endocr Metab Immune Disord Drug Targets. 2014 Mar;14(1):2-8. doi: 10.2174/1871530314666140121142900. 

Abstract. Since the 1930's the scientific literature on cow's milk protein allergy (CMPA) has accumulated. Over the last decade new diagnostic tools and treatment approaches have been developed. The diagnosis of reproducible adverse reactions to cow's milk proteins (CMP), i.e. CMPA, still has to be confirmed by controlled elimination and challenge procedures. Advanced diagnostic testing using epitope and microarray technology may in the future improve the diagnostic accuracy of CMPA by determination of specific IgE against specific allergen components of cow's milk protein. The incidence of CMPA in early childhood is approximately 2-3% in developed countries. Symptoms suggestive of CMPA may be encountered in 5-15% of infants emphasizing the importance of controlled elimination/milk challenge procedures. Reproducible clinical reactions to CMP in human milk have been reported in 0.5% of breastfed infants. Most infants with CMPA develop symptoms before 1 month of age, often within 1 week after inter introduction of CMP-based formula. The majority has two or more symptoms from two or more organ systems. Approximately 50-70% have cutaneous symptoms, 50-60% gastrointestinal symptoms and 20-30% respiratory symptoms. Symptoms may occur within 1 hour after milk intake (immediate reactions) or after 1 hour (late reactions). The prognosis of CMPA is good with a remission rate of approximately 45 to 50% at 1 year, 60 to 75% at 2 years and 85 to 90% at 3 years. Associated adverse reactions to other foods develop in up to 50% and allergy against inhalants in 50 to 80%. The basic treatment of CMPA is avoidance of CMP. In early childhood a milk substitute is needed. Documented extensively hydrolysed formulas are recommended, whereas partially hydrolysed formulas should not be used because of a high degree of antigenicity and allergenicity associated with adverse reactions. In case of intolerance to extensively hydrolysed formulas and multiple food allergies a formula based on aminoacids is recommended. Alternative milk substitutes such as sheep's and goat's milk should not be used because of a high degree of cross reactivity with CMP. Milk from other mammals such as mare and donkey may be tolerated by some children with CMPA. Soy protein is as allergenic as CMP and soy formula is not recommended for young children with CMPA because of a great risk of development of allergy to soy, whereas soymilk is normally tolerated in older children with CMPA. Recent treatment modalities are oral immunotherapy (OIT) involving the ingestion of increasing amounts of milk allergen on a regular basis to desensitize and potentially permanently tolerize patients to CMP. OIT can increase the reaction thresholds to CMP, but questions about safety and long-term efficacy remain. Anti-IgE therapy with Omalizumab may improve the safety and efficacy of OIT and may provide benefit in monotherapy.

Flom JD, Sicherer SH. Epidemiology of Cow's Milk Allergy. Nutrients. 2019 May 10;11(5):1051. doi: 10.3390/nu11051051.

Abstract. Immunoglobulin E (IgE)-mediated cow's milk allergy (CMA) is one of the most common food allergies in infants and young children. CMA can result in anaphylactic reactions, and has long term implications on growth and nutrition. There are several studies in diverse populations assessing the epidemiology of CMA. However, assessment is complicated by the presence of other immune-mediated reactions to cow's milk. These include non-IgE and mixed (IgE and non-IgE) reactions and common non-immune mediated reactions, such as lactose intolerance. Estimates of prevalence and population-level patterns are further complicated by the natural history of CMA (given its relatively high rate of resolution) and variation in phenotype (with a large proportion of patients able to tolerate baked cow's milk). Prevalence, natural history, demographic patterns, and long-term outcomes of CMA have been explored in several disparate populations over the past 30 to 40 years, with differences seen based on the method of outcome assessment, study population, time period, and geographic region. The primary aim of this review is to describe the epidemiology of CMA. The review also briefly discusses topics related to prevalence studies and specific implications of CMA, including severity, natural course, nutritional impact, and risk factors.

Zepeda-Ortega B, Goh A, Xepapadaki P, Sprikkelman A, Nicolaou N, Hernandez REH, Latiff AHA, Yat MT, Diab M, Hussaini BA, Setiabudiawan B, Kudla U, van Neerven RJJ, Muhardi L, Warner JO. Strategies and Future Opportunities for the Prevention, Diagnosis, and Management of Cow Milk Allergy. Front Immunol. 2021 Jun 10;12:608372. doi: 10.3389/fimmu.2021.608372.

Abstract. The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended. Copyright © 2021 Zepeda-Ortega, Goh, Xepapadaki, Sprikkelman, Nicolaou, Hernandez, Latiff, Yat, Diab, Hussaini, Setiabudiawan, Kudla, van Neerven, Muhardi and Warner.

Santoro A, Andreozzi L, Ricci G, Mastrorilli C, Caffarelli C. Allergic reactions to cow's milk proteins in medications in childhood. Acta Biomed. 2019 Jan 29;90(3-S):91-93. doi: 10.23750/abm.v90i3-S.8169. 

Abstract. Introduction: Cow's milk is a frequent trigger of allergic reactions in childhood. Cow's milk proteins can be present in pharmaceutical excipients. Methods: We have analyzed paediatric literature on allergic reactions to cow's milk proteins in medication, focusing on the different routes of administration (inhaled, parental and oral). Results: Dry-powder inhalers may contain lactose as excipient. Lactose can be rarely contaminated with milk proteins and it may induce allergic reactions in patients with cow's milk allergy. Case reports have described immediate hypersensitivity reactions to methylprednisolone sodium succinate 40 mg injection, a formulation that contains lactose as excipient. Some cases of anaphylaxis after receiving diphteria-tetanus-pertussis vaccine injection in children allergic to milk have been reported. Cow's milk proteins can be detected also in oral polio vaccine, certain probiotics and lactulose syrup.

Abbring S, Xiong L, Diks MAP, Baars T, Garssen J, Hettinga K, van Esch BCAM. Loss of allergy-protective capacity of raw cow's milk after heat treatment coincides with loss of immunologically active whey proteins. Food Funct. 2020 Jun 24;11(6):4982-4993. doi: 10.1039/d0fo01175d.

Abstract. The allergy-protective capacity of raw cow's milk was demonstrated to be abolished after heat treatment. The heat-sensitive whey protein fraction of raw milk is often implied to be the source of this allergy-protective effect, but a direct link between these proteins and the protection against allergic diseases is missing. This study therefore aimed at investigating the mechanistic relation between heat damage to whey proteins and allergy development. Raw cow's milk was heated for 30 min at 50, 60, 65, 70, 75, or 80 °C and the native whey protein profile of these differentially heated milk samples was determined using LC-MS/MS-based proteomics. Changes in the native protein profile were subsequently related to the capacity of these milk samples to prevent the development of ovalbumin-induced food allergy in a murine animal model. A substantial loss of native whey proteins, as well as extensive protein aggregation, was observed from 75 °C. However, whey proteins with immune-related functionalities already started to denature from 65 °C, which coincided with the temperature at which a loss of allergy protection was observed in the murine model. Complement C7, monocyte differentiation antigen CD14, and polymeric immunoglobulin receptor concentrations decreased significantly at this temperature, although several other immunologically active whey proteins also showed a decrease around 65 °C. The current study demonstrates that immunologically active whey proteins that denature around 65 °C are of importance for the allergy-protective capacity of raw cow's milk and thereby provides key knowledge for the development of microbiologically safe alternatives to raw cow's milk.

ensabene L, Salvatore S, D'Auria E, Parisi F, Concolino D, Borrelli O, Thapar N, Staiano A, Vandenplas Y, Saps M. Cow's Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children? Nutrients. 2018 Nov 9;10(11):1716. doi: 10.3390/nu10111716. 

Abstract. The role and prevalence of cow's milk protein allergy (CMA) in functional gastrointestinal disorders remains unclear. The aim of this review is to update knowledge on the relationship between CMA and functional abdominal pain disorders (FAPDs) in children. Cochrane Database and Pubmed were searched from inception using general and specific terms for CMA and functional gastrointestinal disorders. CMA is reported as a predisposing or coexisting factor in a wide range of functional gastrointestinal disorders in infants and children. Pathogenesis of both conditions is complex and multiple mechanisms including dysmotility and hypersensitivity might contribute to the clinical manifestations. Data supporting the possible role of food allergies in the pathogenesis of FAPDs are limited. CMA may predispose to early life inflammation and visceral hypersensitivity, which in turn might manifest as FAPDs. The diagnosis of either CMA or FAPDs and distinction between them is challenging because of nonspecific and overlapping symptoms. Lack of accurate allergy tests in non-IgE (immunoglobulin E) mediated cases is also problematic. Oral food challenge, following an elimination diet, should be performed to diagnose a suspected non-IgE CMA allergy in children with FAPDs. In the management of FAPDs, an elimination diet should be considered for a limited period to verify if the symptoms improve or resolve.

Compendium of the most significant studies with reference to properties, intake, effects.

Marangoni F, Pellegrino L, Verduci E, Ghiselli A, Bernabei R, Calvani R, Cetin I, Giampietro M, Perticone F, Piretta L, Giacco R, La Vecchia C, Brandi ML, Ballardini D, Banderali G, Bellentani S, Canzone G, Cricelli C, Faggiano P, Ferrara N, Flachi E, Gonnelli S, Macca C, Magni P, Marelli G, Marrocco W, Miniello VL, Origo C, Pietrantonio F, Silvestri P, Stella R, Strazzullo P, Troiano E, Poli A. Cow's Milk Consumption and Health: A Health Professional's Guide. J Am Coll Nutr. 2019 Mar-Apr;38(3):197-208. doi: 10.1080/07315724.2018.1491016.

Abstract. The most recent scientific evidence supports the consumption of cow's milk and dairy products as part of a balanced diet. However, these days, the public and practicing physicans are exposed to a stream of inconsistent (and often misleading) information regarding the relationship between cow's milk intake and health in the lay press and in the media. The purpose of this article, in this context, is to facilitate doctor-patient communication on this topic, providing physicians with a series of structured answers to frequently asked patient questions. The answers range from milk and milk-derived products' nutritional function across the life span, to their relationship with diseases such as osteoporosis and cancer, to lactose intolerance and milk allergy, and have been prepared by a panel of experts from the Italian medical and nutritional scientific community. When consumed according to appropriate national guidelines, milk and its derivatives contribute essential micro- and macronutrients to the diet, especially in infancy and childhood where bone mass growth is in a critical phase. Furthermore, preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes, and cardiovascular disease, while no clear data suggest a significant association between milk intake and cancer. Overall, current scientific literature suggests that an appropriate consumption of milk and its derivatives, according to available nutritional guidelines, may be beneficial across all age groups, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy. Key teaching points: Milk and its derivatives contribute essential micro and macronutrients to the diet, when consumed according to appropriate national guidelines, especially in infancy and childhood where bone mass growth is in a critical phase. Preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes and cardiovascular disease No clear data are available about the association between milk intake and cancer. Current scientific literature suggests that an appropriate consumption of milk and its derivatives may be beneficial at all ages, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy.

Alcantara JMA, Sanchez-Delgado G, Martinez-Tellez B, Labayen I, Ruiz JR. Impact of cow's milk intake on exercise performance and recovery of muscle function: a systematic review. J Int Soc Sports Nutr. 2019 May 6;16(1):22. doi: 10.1186/s12970-019-0288-5.

Abstract. Dairy products are thought to improve recovery after both resistance and endurance exercises due to their nutritional proprieties. We systematically reviewed the effects of dairy product intake on exercise performance and recovery of muscle function in humans. A literature search was conducted in the MEDLINE (via PubMed) and Web of Science databases from their inception to 15th April 2018. The initial search retrieved 7708 articles, and a total of 11 studies were finally included after applying inclusion and exclusion criteria. All the selected studies were conducted with cow's milk. Whereas some studies found significant positive effect of cow's milk on exercise performance and recovery of muscle function, others did not find any effect. These controversies could be due to the heterogeneity of cow's milk ingestion (e.g., amount of cow's milk, timing of consuming the cow's milk), to the type of intervention, and to the large heterogeneity of outcomes measured. Limited studies exist examining the effects of cow's milk consumption and its influence on exercise performance and recovery of muscle function, therefore further studies are needed to draw more definitive conclusions.

Foroutan A, Guo AC, Vazquez-Fresno R, Lipfert M, Zhang L, Zheng J, Badran H, Budinski Z, Mandal R, Ametaj BN, Wishart DS. Chemical Composition of Commercial Cow's Milk. J Agric Food Chem. 2019 May 1;67(17):4897-4914. doi: 10.1021/acs.jafc.9b00204. 

Abstract. Bovine milk is a nutritionally rich, chemically complex biofluid consisting of hundreds of different components. While the chemical composition of cow's milk has been studied for decades, much of this information is fragmentary and very dated. In an effort to consolidate and update this information, we have applied modern, quantitative metabolomics techniques along with computer-aided literature mining to obtain the most comprehensive and up-to-date characterization of the chemical constituents in commercial cow's milk. Using nuclear magnetic resonance (NMR) spectroscopy, liquid chromatography-mass spectrometry (LC-MS), and inductively coupled plasma-mass spectrometry (ICP-MS), we were able to identify and quantify 296 bovine milk metabolites or metabolite species (corresponding to 1447 unique structures) from a variety of commercial milk samples. Through our literature analysis, we also found another 676 metabolites or metabolite species (corresponding to 908 unique structures). Detailed information regarding all 2355 of the identified chemicals in bovine milk have been made freely available through a Web-accessible database called the Milk Composition Database or MCDB ( http://www.mcdb.ca/ ).

Corazzin M, Romanzin A, Sepulcri A, Pinosa M, Piasentier E, Bovolenta S. Fatty Acid Profiles of Cow's Milk and Cheese as Affected by Mountain Pasture Type and Concentrate Supplementation. Animals (Basel). 2019 Feb 22;9(2):68. doi: 10.3390/ani9020068.

Abstract. The aim of this trial was to assess the effect of pasture type and concentrate supplementation on the fatty acids (FA) composition of milk and cheese obtained during summer grazing on mountain pasture. Seventy-two Italian Simmental dairy cows were assigned to two groups that differed by the amount of concentrate supplementation: 3.0 kg/head/d (HIGH) vs. 1.5 kg/head/d (LOW). The dairy cows grazed on a Poion alpinae alliance pasture (PAST1), and subsequently they grazed on a Seslerion caeruleae alliance pasture (PAST2) for 10 d each. In the last three days of each experimental period, milk samples were collected immediately before each cheese-making event. Cheese samples were collected from each cheese loaf after 60 d of ripening. LOW showed higher isoFA, FA intermediates of the ruminal biohydrogenation, C18:3 c9,c12,c15, and total polyunsaturated fatty acid (PUFA) levels than HIGH. The pasture type had a more limited effect on FA composition of milk than concentrate level and was mainly related to monounsaturated fatty acids (MUFA), which were higher in PAST1 than PAST2 (p < 0.05). In cheeses, these differences were reduced. The phytanic acid and phytanic isomer ratio (SRR/RRR) in milk were not affected either by supplement level (p > 0.05) or by type of pasture (p > 0.05). Increasing the concentrate offered to dairy cows from 1.5 to 3.0 kg/d did not markedly influence the level of PUFA in cheeses produced during summer grazing on high mountain pasture.

Thorning TK, Raben A, Tholstrup T, Soedamah-Muthu SS, Givens I, Astrup A. Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence. Food Nutr Res. 2016 Nov 22;60:32527. doi: 10.3402/fnr.v60.32527.

Abstract. Background: There is scepticism about health effects of dairy products in the public, which is reflected in an increasing intake of plant-based drinks, for example, from soy, rice, almond, or oat. Objective: This review aimed to assess the scientific evidence mainly from meta-analyses of observational studies and randomised controlled trials, on dairy intake and risk of obesity, type 2 diabetes, cardiovascular disease, osteoporosis, cancer, and all-cause mortality. Results: The most recent evidence suggested that intake of milk and dairy products was associated with reduced risk of childhood obesity. In adults, intake of dairy products was shown to improve body composition and facilitate weight loss during energy restriction. In addition, intake of milk and dairy products was associated with a neutral or reduced risk of type 2 diabetes and a reduced risk of cardiovascular disease, particularly stroke. Furthermore, the evidence suggested a beneficial effect of milk and dairy intake on bone mineral density but no association with risk of bone fracture. Among cancers, milk and dairy intake was inversely associated with colorectal cancer, bladder cancer, gastric cancer, and breast cancer, and not associated with risk of pancreatic cancer, ovarian cancer, or lung cancer, while the evidence for prostate cancer risk was inconsistent. Finally, consumption of milk and dairy products was not associated with all-cause mortality. Calcium-fortified plant-based drinks have been included as an alternative to dairy products in the nutrition recommendations in several countries. However, nutritionally, cow's milk and plant-based drinks are completely different foods, and an evidence-based conclusion on the health value of the plant-based drinks requires more studies in humans. Conclusion: The totality of available scientific evidence supports that intake of milk and dairy products contribute to meet nutrient recommendations, and may protect against the most prevalent chronic diseases, whereas very few adverse effects have been reported.

Konstantynowicz J, Nguyen TV, Kaczmarski M, Jamiolkowski J, Piotrowska-Jastrzebska J, Seeman E. Fractures during growth: potential role of a milk-free diet. Osteoporos Int. 2007 Dec;18(12):1601-7. doi: 10.1007/s00198-007-0397-x. 

Abstract. Dietary calcium deficiency may increase fracture risk. In girls, 29.4% of fracture cases and 11.8% of controls without fracture had a history of milk-free diet. The odds ratio (OR) for fracture with a milk-free diet in girls was 4.6, p < 0.01. In boys, 23% of cases and 19% of controls had a history of a milk-free diet; OR = 1.3, NS). A milk-free diet due to cow's milk allergy is associated with increased fracture risk in girls. Introduction: An intake of calcium below the reference daily intake (RDI) of 800-1200 mg/day during growth is thought to increase fracture risk even though convincing evidence for this view is scarce. The paucity of evidence may be partly due to many trial participants being calcium replete. Children and adolescents with cow's milk allergy (CMA) avoid milk and have a calcium intake below the RDI. The aim of this study was to examine the association between consumption of a milk-free diet and fracture risk....Conclusions: Cow's milk allergy is associated with increased fracture risk in girls. Whether this association is due to the illness, calcium deficit or a deficit in other milk nutrients is uncertain. These data suggest that the contribution of milk-free diet to fracture liability among children and adolescents is modest.

Fresh pasteurised whole milk is a food product obtained by an industrial pasteurisation process.

Pasteurization is an industrial process that subjects milk to a rapid rise in temperature: it heats milk for about 20/30 seconds at a temperature of between 72 and 75 degrees.

In this way, any toxic microorganisms that are harmful to human health are eliminated.

Cow's milk is used in many applications:

• uman nutrition
• animal nutrition
• food industry
• cosmetics
• medicine

With regard to  human nutrition, cow's milk is treated industrially with the pasteurization process to destroy pathogenic bacteria that can cause risks to human health.

We find it on the market as:

• Fresh whole milk 67 kcal/100g

pasteurized within 48 hours of milking

• Fresh pasteurized whole milk 67 kcal/100g

pasteurized several times after 48 hours of milking

• Skim milk 38 kcal/100g

degreased

• Partially skimmed milk 48 kcal/100g

Partially degreased

• ESL milk

microfiltered

• UHT milk

homogenized and preheated to 135 degrees

The industry uses cow’s milk mainly in these forms:

• Milk powder

dehydrated

• Whole milk powder

dehydrated

• Skim milk powder

dehydrated

• Dehydrated skim milk

dehydrated

• Rehydrated skim milk

dehydrated and subsequently rehydrated

The most natural form of cow's milk is raw milk, directly harvested after milking, which must be immediately stored in the refrigerator and drunk only after boiling to eliminate microbiological risks.

The advantages (for those who are not allergic) of cow's milk are manifold as cow's milk is a source of carbohydrates, calcium, proteins and other interesting nutrients that can lead to an increase in the concentration of amino acids resulting in improved muscle function (1).

Consumption of 500 mL milk attenuated losses in muscle function following repeated sprinting and jumping and thus may be a valuable recovery intervention for female team-sport athletes following this type of exercise (2).

Milk consumption on bone and fracture incidence: studies on the effects of milk or whey extracts show positive effects on bone health or risk of hip fracture. Nevertheless a few contradictory epidemiological studies showed an increased risk of hip fractures in subjects drinking higher quantities of milk (3).

Rural life is considered a promising system against asthma and allergies. Although this associative mechanism has not been fully clarified, this study presents an up-to-date under standing of the protective effect of raw milk on allergies and asthma (4).

For more:

Cow's milk studies

Cow's milk allergy studies

References_____________________________________________________________________

(1) Rankin P, Lawlor MJ, Hills FA, Bell PG, Stevenson EJ, Cockburn E. The effect of milk on recovery from repeat-sprint cycling in female team-sport athletes. Appl Physiol Nutr Metab. 2018 Feb;43(2):113-122. doi: 10.1139/apnm-2017-0275. 

(2) Gao R, Rapin N, Elnajmi AM, Gordon J, Zello GA, Chilibeck PD. Skim milk as a recovery beverage after exercise is superior to a sports drink for reducing next-day postprandial blood glucose and increasing postprandial fat oxidation. Nutr Res. 2020 Oct;82:58-66. doi: 10.1016/j.nutres.2020.08.007.

(3) Fardellone P. The effect of milk consumption on bone and fracture incidence, an update. Aging Clin Exp Res. 2019 Jun;31(6):759-764. doi: 10.1007/s40520-019-01192-9. 

(4) Mayerhofer H, Zednik K, Pali-Schöll I. The extended farm effect: The milk protein β-lactoglobulin in stable dust protects against allergies. Allergol Select. 2022 Mar 29;6:111-117. doi: 10.5414/ALX02246E. 

(5) Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, Bozzola M, Bradsher J, Compalati E, Ebisawa M, Guzman MA, Li H, Heine RG, Keith P, Lack G, Landi M, Martelli A, Rancé F, Sampson H, Stein A, Terracciano L, Vieths S. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. World Allergy Organ J. 2010 Apr;3(4):57-161. doi: 10.1097/WOX.0b013e3181defeb9.