Lactose intolerance in common language milk allergy is very common in Indian population. It is as common as one-third of the population is suffering from lactose intolerance. This incidence is reported to be even higher in southern population. The child most commonly develops lactose intolerance after some illness affecting intestines like infection or malabsorptive syndromes which cause mucosal damage to intestines. Congenital lactose intolerance since birth is very uncommon. A child with milk allergy present with a history of longstanding diarrhea and pain abdomen. The undiagnosed child may present with poor weight and height gain resulting in underweight child and short stature. Milk intolerance is usually a clinical diagnosis, supported by improvement in symptoms after stopping milk in the diet. This can be confirmed by breath test and biopsy documenting enzyme deficiency in the intestinal mucosa. Treatment of milk intolerance is the exclusion of milk from the diet, a child may be able to digest curd or hard cheese.
Gluten intolerance or Celiac disease is a condition of gluten allergy where the child is not able to digest gluten containing products. Wheat is the major portion of our diet, so it is commonly called as wheat allergy. This is always present from early childhood. It usually presents with poor growth after 6 months of age when the cereal based diet is introduced along with milk. The child may present with a history of pain abdomen, long standing diarrhea, and bloated tummy. Child occasionally may have constipation. The child may also have extra intestinal features like anemia, joint pain, rash, mouth ulcers and teeth problems. Its diagnosis is confirmed endoscopy followed by an intestinal biopsy. Treatment of gluten intolerance is 100% exclusion of gluten from diet i.e wheat, barley and rye products. This is very important not only to treat present symptoms in a child but also to prevent long term complications of celiac disease especially cancer.