“My 6 month old boy Alex has been very fuzzy and irritable for the past 2 weeks since we switched him from breast milk to cow’s milk formula. Does he have a cow’s milk allergy, lactose intolerance or something else?” After a thorough interview and evaluation, we found that Alex also has blood in his stool. We diagnosed him with cow’s milk protein allergic colitis. We explained to his parents that this type of cow’s milk allergy does not have a risk of anaphylaxis and Alex will most likely outgrow it by the age of 2. We did a baked milk* oral challenge in our office and Alex was able to consume it without any issues, liberating his diet quite a bit. His parents also met with our dietitian and were prescribed a comprehensive dietary plan to prevent nutritional deficiency. * Baked goods with milk as an ingredient, extensively heated at 325F for 10-15 minutes.”

“My doctor told me I do not have celiac disease but I feel less bloated when I avoid gluten. Do I have gluten sensitivity? Have I been misdiagnosed?” We confirmed Sarah does not have celiac disease by negative HLA typing (a blood test) and diagnosed her with fructan intolerance (a condition in which the patient has difficulty digesting and absorbing fructan – similar to patients with lactose intolerance who cannot digest and absorb lactose). Fructan is a complex sugar found in wheat. By avoiding gluten, Sarah has been avoiding wheat and thus reducing consumption of fructan. It is therefore of no surprise she has symptom relief as a result. We told Sarah that while patients with either celiac disease or fructan intolerance can achieve symptoms improvement by avoiding wheat, only patients with celiac disease need to completely eliminate gluten (the protein component of wheat, barley and rye) because even a very small amount of cross-contamination can cause gut injury. On the other hand, consumption of fructan in patients with fructan intolerance does not cause any damage to the gut and there is no need to completely avoid fructan. She met with our dietitian and reviewed other dietary source of fructan, and how to effectively minimize its intake to reduce symptoms. By minimizing other source of fructan (garlic, onion and banana), her bloating has further improved. More importantly, she no longer has to worry about gluten cross-contamination once she learns the key differences between celiac disease and fructan intolerance.”