Talk:Milk allergy/Archive 1

Archive 1

Expert

I am not 100% on this article, I am just curious what an expert opinion would state about this article. Yanksox ^(talk) 17:04, 15 June 2006 (UTC)

I was thinking that the Milk allergy page needed some work when you added the expert tag. I have a severe anaphylactic allergy to milk and a lot of information from FAAN (Food Allergy and Anaphylaxis Network) about milk allergies. I was also thinking of adding a section with differences between lactose intolerance and milk allergy. I also noticed that food intolerance redirects to food allergy, so I was going to write a food intolerance article. Since they are very different conditions, I thought it was a bit misleading for it to redirect to food allergy. I'd appreciate if you replyed with your thoughts. jf 17:22, 15 June 2006 (UTC)

I'm a little confused. I wasn't proposing a redirect. I just cleaned it up and added an expert tag. Yanksox ^(talk) 17:25, 15 June 2006 (UTC)

Oh yes, but whenever you added the tag, I became excited and thought of more things that needed fixing. Just curious what you thought. jf 17:29, 15 June 2006 (UTC)

I don't know too much about the subject, and I tried my best to clean it up. It does seem a little messy and confusing. It does need some revamping, I say go for the gold as long as you can prove it. Yanksox ^(talk) 17:30, 15 June 2006 (UTC)

I'm a scientific copywriter on the Act Against Allergy project, an interactive communication program about child food allergies. All information in the website is supported by official references (scientific literature and clinical studies) and you can access detailed content in the Act Against Allergy website. Allergies of all kinds are increasingly becoming common in industrialized countries, so it's important to increase the awareness and knowledge about this problem in the community we live in. For the same reason I've introduced a paragraph on “Cow milk allergy” into the article on "Milk" because we know there is a significant difference between an intolerance and an allergy, and I'm going to introduce a similar content in "Cow Milk Allergy" article (I'd like to restore it as Cow Milk Allergy, to differentiate from other milks, like goat milk etc.) --Angelopas 10:55, 16 June 2006 (UTC)

I'm not sure that we should restore "Cow milk allergy" and create "Goat milk allergy" and however many other types of milk there are. Goat's milk and cow's milk both redirect to milk, and it seems that if you made multiple articles, the information would be largely redundant. I suggest keeping the article at milk allergy and maybe adding a paragraph about the different types of milk. I think what we should mainly focus on is adding to the article and bringing it up to standard. cøøkiə Ξ _(talk) 14:48, 16 June 2006 (UTC)

Organic milk?

Went ahead and deleted this: "It should noted that there are different types of milk, and most of the information in this page relates to the consumption of conventional milk from grain fed confined cattle. Milk from organic grass-fed pasturing cattle actually reduces allergies and promotes good health." If milk proteins are the allergen the cow's food shouldn't change anything.--Fisher4.wemo (talk) 03:07, 10 January 2008 (UTC)

Oral Immunotherapy Trials for Milk Allergy

I think the current clinical trials for oral immunotherapy at Johns Hopkins University (and I believe, Duke University) should be mentioned in this article under treatment. —Preceding unsigned comment added by 71.246.79.102 (talk) 01:20, 3 May 2008 (UTC)

Raw milk info spamming

I'm trying to centralize the discussion for now at Talk:Raw_milk#Moved_to_talk_for_discussion --Ronz (talk) 03:05, 19 May 2009 (UTC)

A standardized definition of the term in the article title is needed.....

because the content in the earlier version of the article has been mopped off, which is related to the topic--222.64.219.44 (talk) 00:39, 29 May 2009 (UTC):

The link is
http://en.wikipedia.org/w/index.php?title=Milk_allergy&diff=259486592&oldid=259485597 --222.64.219.44 (talk) 00:58, 29 May 2009 (UTC)

---

It has been reported that children who suffer from Otitis media are also associated with the consumption of dairy products, such as cow's milk and the illness can be avoided for the infant who has had a breastfeeding^, . Some scientists consider the allergy from infants is partly due to the exposure to organochlorines which are pesticides and could contaminate food or feeds .

The other reported diseases that are associated with the consumption of dairy products include

• Diabetes mellitus type 1 ^, and the disease by children ^,
• Ischaemic heart disease ^,
• Ischemic stroke ^,

Relevant literature

--222.64.219.44 (talk) 00:43, 29 May 2009 (UTC)

In addition to that, the claim in the content is supported by the following
http://scholar.google.com/scholar?as_q=organochlorine+pesticides+milk&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en&lr=&newwindow=1 --222.64.219.44 (talk) 00:54, 29 May 2009 (UTC)

I don't think the title needs any clarification. What you are describing is some pathology, not food allergy, which is an immune system reaction to a food protein. kd 9/2009

Please elaborate your opinion further then--222.67.218.127 (talk) 03:12, 19 January 2010 (UTC)

Red links maybe associated with the following...

• http://scholar.google.com/scholar?hl=en&q=allintitle%3A+infant+constipation&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0
• http://scholar.google.com/scholar?as_q=infant+diarrhea&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

--222.67.218.127 (talk) 03:34, 19 January 2010 (UTC)

It looks like that the disease of Infant diarrhea is more common than the one of Infant constipation, according to the search results from Google scholar...Food chain problem or others....???--222.67.218.127 (talk) 03:39, 19 January 2010 (UTC)

• http://scholar.google.com/scholar?as_q=Infant+autism&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

--222.67.218.127 (talk) 03:43, 19 January 2010 (UTC)

• http://scholar.google.com/scholar?as_q=infant+diarrhea+milk&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

--222.67.218.127 (talk) 03:57, 19 January 2010 (UTC)

• Infant eczema -- http://scholar.google.com/scholar?hl=en&q=allintitle%3A+infant+eczema&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--222.67.218.127 (talk) 04:05, 19 January 2010 (UTC)

• • http://scholar.google.com/scholar?as_q=breastfeeding+eczema&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

--222.67.218.127 (talk) 04:31, 19 January 2010 (UTC)

• • http://scholar.google.com/scholar?hl=en&newwindow=1&resnum=0&q=milk%20feeding%20eczema&um=1&ie=UTF-8&sa=N&tab=ws

--222.67.218.127 (talk) 04:37, 19 January 2010 (UTC)

• Infant dermatitis -- http://scholar.google.com/scholar?as_q=infant+dermatitis&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

--222.67.218.127 (talk) 04:16, 19 January 2010 (UTC)

• • http://scholar.google.com/scholar?hl=en&q=allintitle%3A+infant+seborrhoeic+dermatitis&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--222.67.218.127 (talk) 04:23, 19 January 2010 (UTC)

• • http://scholar.google.com/scholar?as_q=infant+atopic+dermatitis&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

--222.67.218.127 (talk) 04:25, 19 January 2010 (UTC)

More non infant milk allery....

• http://scholar.google.com/scholar?as_q=milk+allergy+eczema&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

--222.67.218.127 (talk) 04:46, 19 January 2010 (UTC)

• http://scholar.google.com/scholar?hl=en&q=allintitle%3A+milk+eczema&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--222.67.218.127 (talk) 04:47, 19 January 2010 (UTC)

Maternal diet and infant leukemia....

• http://scholar.google.com/scholar?hl=en&q=allintitle%3A+maternal+diet+infant+leukemia&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--222.67.218.80 (talk) 05:22, 19 January 2010 (UTC)

• http://scholar.google.com/scholar?hl=en&q=allintitle%3A+infant+leukemia&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--222.67.218.80 (talk) 05:23, 19 January 2010 (UTC)

Controversy results

• http://scholar.google.com/scholar?hl=en&q=allintitle%3A+infant+leukemia+dietary&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--222.67.218.80 (talk) 05:34, 19 January 2010 (UTC)

The latest research

• http://scholar.google.com/scholar?as_q=infant+leukemia&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=2008&as_yhi=2009&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

--222.67.218.80 (talk) 05:26, 19 January 2010 (UTC)

See the following for further infos

• Talk:Leukemia#leukemia and diet ....FYI...

--222.67.218.80 (talk) 06:11, 19 January 2010 (UTC)

Lactic Acid

As a parent of a milk allergic child, I think the "lactic acid" mention is wrong. Lactic acid is not usually a dairy product, and quick googling seems to confirm this. I will edit when I get a chance to find some harder scientific info.

http://ourworld.compuserve.com/homepages/stevecarper/experts.htm —Preceding unsigned comment added by 65.118.24.3 (talk) 09:09, 2 July 2008 (UTC)

• The lactic acid in food is invariably derived from milk, so it invariably comes with traces of milk protein and, thus, can cause an allergic reaction for people with allergies triggered by trace amounts (such as myself). —Preceding unsigned comment added by 123.243.177.36 (talk) 05:36, 2 March 2010 (UTC)

Rate of hospitaliztion....

• http://scholar.google.com.hk/scholar?as_q=milk+allergy+rate&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en
• http://scholar.google.com.hk/scholar?hl=en&q=allintitle%3A+milk+allergy+rates&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--222.67.206.22 (talk) 08:12, 30 April 2010 (UTC)

Dairy allergy

Should we rename this page 'dairy allergy'? And have a redirect from 'milk allergy'? Asbruckman 20:58, 11 September 2007 (UTC)

Both names are fairly ambiguous. Generally milk allergy is understood to mean dairy products, but the best name would be "Cow milk allergy". Fickce4 (talk) 13:20, 9 August 2010 (UTC)

My allergist advised avoiding all animal-derived milk, not just goat. This article could be helped by expanding on this.Rachaella (talk) 22:21, 13 August 2010 (UTC)

Quality of citations

I know citations are everything to wikipedians, but the citations to a chiropracter's website and content by an "NMD" need to be replaced by citations to actual scientific or medical review content. (I'm not saying the facts the citations support are wrong, just that they need reliable sources as citations). — Preceding unsigned comment added by 24.3.23.126 (talk) 10:13, 19 December 2011 (UTC)

Good catch! I've removed it and the one from the product site. --Ronz (talk) 17:24, 19 December 2011 (UTC)

caption

The caption on the images says the milk is pasturised. Can you please state your source or change it to just say "a glass of milk"? — Preceding unsigned comment added by 188.220.95.51 (talk) 22:34, 16 March 2012 (UTC)

Glaring inconsistency...

To quote the article: "The most common one is alpha S1-casein.[1] Alpha S1-caseins differ between species."

Well is there ONE [ie., alpha S1-casein protein]? Or more than one?

The first sentence above suggests that alpha S1-casein is ONE protein. The very next sentence suggests there are multiple types of alpha S1-caseins.

If the latter is correct, then it should read something like this:

"A person with milk allergy can be reactive to any of dozens of the proteins within milk. The most common [allergen proteins] are alpha S1-caseins.[1] Alpha S1-caseins differ between species." 109.149.158.177 (talk) 19:05, 12 April 2012 (UTC)

Isn't this sentence HIGHLY controversial?

To quote the article: "On an avoidance diet, it may be possible to reduce the longer-term risk of calcium deficiency and osteoporosis..."

My question: Isn't this VERY HIGHLY controversial?

I've heard or read that calcium is (cow's) milk either is not absorbed or is, at best, poorly absorbed?? (Don't know if this is true.)

Furthermore, has it actually been established that avoiding dairy/milk risks calcium deficiency and osteoporosis? Or is this just one of those simplistic assumptions that society has taken as the truth: E.g., "There's calcium in milk, therefore milk provides us with calcium [assumption?], and therefore if we don't drink milk, we'll have calcium deficiency [assumption?], and if we have calcium deficiency, then our bones will fall apart [assumption?]...", even though I've been led to understand that osteoporosis may very well be caused by such things as imbalances in our mineral supplies (e.g., imbalances in our mineral ratios such as the magnesium:calcium ratio in our diets) or by other deficiencies (eg., vitamins).

So the above sentence in the article just sounds like a scare-mongering, "of course everyone knows this", type of thing that someone from the dairy industry might throw in.

Do epidemiological studies (despite their limitations) show that people who do NOT drink (much) milk demonstrate greater "longer-term risk of calcium deficiency and osteoporosis"? (Somehow I doubt it.) 109.149.158.177 (talk) 19:36, 12 April 2012 (UTC)

Connection with beef allergy

So, is beef allergy more common in milk allergy sufferers than in the general population? The current text suggests it but does not say so explicitly. Zargulon 19:40, 26 August 2007 (UTC)

Yes, much more so--see the cited reference for more info. Asbruckman 20:58, 11 September 2007 (UTC)

The info provided on beef allergy is not only controversial, it's clearly a falsification. NO case of beef allergy has been reported and tested, but there are assumptions on such a thing existing as a reaction to tick bites from a very specialized form of tick, isolated to a few US states. No connection between milk and beef allergy has ever been proven. http://allergicliving.com/index.php/2010/07/02/food-allergy-beef-emerges-as-issue/ 62.16.147.126 (talk) 22:50, 15 April 2013 (UTC)

Treatment section restored

Hi there, I restored the Treatment header and first few sentences that had been cut in 2010 with no explanation (vandalism?).

I don't know if the information is still current, especially the part starting with "Currently the only treatment is" but it's better than the previous state of the article. The absence of the Treatment header made it look like everything after "Milk protein intolerance is also referred to as milk soy protein intolerance (MSPI)" was still referring to MSPI, including the "Milk Avoidance and Replacement For Infants" and "Milk Substitution for Children and Adults" subsections, making this basically an article on MSPI and not milk allergy. 207.45.249.143 (talk) 10:39, 15 January 2014 (UTC)

Possible addition/notation needed?

In http://en.wikipedia.org/wiki/Food_allergy, it notes quote "Milk, from cows, goats or sheep, is another common food allergen, and many sufferers are also unable to tolerate dairy products such as cheese." However, on this page it makes no mention that those suffering from a milk allergy might still be able to consume/tolerate other dairy products like cheese, butter, and yogurt. Would it hurt the overall article to include a notation or addition stating that there are varying degrees of the allergy, with some people with it being able to eat milk based foods, while others are unable to have any milk based foods in their diet? I know I have the allergy myself, and while I'm unable to drink milk, or products such as bottled coffees with milk; I am still able to eat yogurt, cheese, and butter. Kitsunedawn (talk 4:54, 9, March 2015 (UTC)

I think it would be irresponsible to suggest that those with a true milk *allergy* attempt to consume any milk products. Those who can consume some milk products but not others are more likely to be lactose intolerant, not allergic. Those who have an allergy may be able, possibly, to consume some milk products safely, in small amounts, at the moment, but their allergy could easily escalate without notice, leading to a potentially life-threatening reaction. --Beth Kevles, maintainer "Eating without Casein" web site — Preceding unsigned comment added by 74.104.156.84 (talk) 20:41, 5 October 2016 (UTC)

Probiotics research

Interesting research area, but the three cited reviews conclude not yet ready to be accepted as a standard treatment. Zhang's review suggested that providing probiotics during pregnancy may be more effective than to the infant/child after birth. Health information websites present the probiotics anti-allergy theory in a more favorable slant than the actual researchers. David notMD (talk) 15:47, 16 October 2017 (UTC)

Initial impressions of rewrite

Thanks for all the good work on this article. The GA nom caught my eye, so I thought I'd give the article a quick look. What stands out most to me is the use of Wikipedia's voice (especially in the Treatment section, where there are WP:NOTHOWTO problems as well), some awkward wording and repetition, and the lede section being rather long and straying from the main subject. Also, the image of a glass of milk lends little and seems overly large. --Ronz (talk) 02:30, 12 December 2017 (UTC)

To the last, all I can say is that the milk image was in place when I first saw the article, and equally large as the egg image at Egg allergy, hazelnut at Tree nut allergy....David notMD (talk) 02:56, 12 December 2017 (UTC)

Everything else, willing to address once a reviewer steps in. Personally, I am a big fan of shorter and also stay on topic. David notMD (talk) 03:21, 12 December 2017 (UTC)

Major rewrite

Conducting major rewrite and re-referencing of the entire article, with intent to nominate for Good Article. Started at 10,000 bytes. Some of the content is copied from Egg allergy, where I created it. Some of the content modified text from the Allergy or Food allergy articles. Those changes are attributed to the source. No conflict of interest. David notMD (talk) 12:46, 11 November 2017 (UTC)

Done with what I intended to review/revise. Consider ready for GA evaluation. David notMD (talk) 16:31, 15 December 2017 (UTC)

Not just food protein-induced enterocolitis syndrome

The gastrointestinal symptoms include chronic diarrhea, blood in the stools, gastroesophageal reflux disease (GERD), constipation, chronic vomiting and colic. If not diagnosed, continued infant feeding with milk protein formula can lead to iron deficiency anemia, protein-losing enteropathy with hypoalbuminemia and poor growth. Collectively, the gastrointestinal symptoms are described as food protein-induced enterocolitis syndrome (FPIES). Common trigger foods are cow's milk, soy, rice and oats.

As in the case of soy allergy, this paragraph must be adjusted. I have little time now, so I moved it to the discussion. This reference makes a very clear explanation. PMID 25316115 (Full text).

There are at least three gastrointestinal clinical conditions caused by non-IgE-mediated food allergy: the food protein-induced enterocolitis syndrome, the food protein-induced proctocolitis, and the food protein-induced enteropathies. In the pediatric population, non-IgE-mediated food allergy is mainly due to cow’s milk protein hypersensitivity (CMPH) but also soya (most common triggers). --BallenaBlanca 🐳 ♂ (Talk) 11:56, 31 December 2017 (UTC)

I will review the text and references - including your recommended PMID 25316115 - before returning any content to the article spaces at Milk allergy and Soy allergy. I agree that what I wrote lumped all non-IgE symptoms into FPIES, whereas your note points out that non-IgE may be better described as encompassing FPIES, proctocolitis and enteropathies. If you fix the articles before I can get to them, I would be happy with that. David notMD (talk) 12:15, 31 December 2017 (UTC)

A more recent ref, of 2017 PMID 29138990 Non-IgE-mediated Adverse Food Reactions. Is not free-access but I can send you the paper if you want it. Best regards. --BallenaBlanca 🐳 ♂ (Talk) 12:27, 31 December 2017 (UTC)

This one PMID 27637372 is free and appears to explain the distinctions among FPIES, FPIAP and FPE. David notMD (talk) 14:54, 31 December 2017 (UTC)

Revised text, distinguishing among FPIAP, FPE and FPIES, added to Signs and symptoms, using Caubet 2017 and Nowak-Wegrzyn 2017 as references. Both available as free PDFs. Decided to not use the other refs (Leonard 2017, another Nowak-Wegrzyn 2017 ref, Michelet 2017). David notMD (talk) 17:02, 3 January 2018 (UTC)

One additional area which needs some attention is the A1/A2 casein story I think. See PMID 28916574 (but also the older PMID 15867940). Jrfw51 (talk) 20:04, 3 January 2018 (UTC)

My reading of the A1 versus A2 beta-casein debate is a combination of too soon and/or not true. Ten years ago there were hypotheses put forward that cow's milk with A1 beta-casein increased risk of type 2 diabetes and perhaps other diseases. This thinking appeared to fade away. The new idea that A1 is more likely to cause gastrointestinal illness (the Brooke-Taylor 2017 article) mentions scant human trial literature, and all that in adults. Most of the literature concerning milk allergy is about infants and young children, and the treatment algorithms call for extensively hydrolyzed milk protein or a rice-derived formula, not substituting one whole milk formula over another. David notMD (talk) 00:40, 4 January 2018 (UTC)

I have reviewed and edited a bit. Please, check if you want to continue expanding or correcting. I still do not have enough time and I have not looked deeply. There were some inaccuracies and content that did not correspond to the citation given, specifically the paragraph referenced with PMID 26135565 (I removed this source). Was it an error?

I added the Leonard 2017 reference PMID 29138990. I like this table, I think it's very explanatory (I do not know if it could be included on the page or there would be a copyright conflict):

Table 1. Comparison of Non-IgE-mediated food allergies

	Food protein-induced enterocolitis syndrome (FPIES)	Food protein-induced allergic proctocolitis (FPIAP)	Food protein-induced enteropathy (FPE)
Main feature	Delayed, repetitive emesis	Blood in stool	Chronic diarrhea
Typical age of onset	1 day–1 year	1 day–6 months	Up to 2 years
Main foods	Milk, soy, rice	Milk, soy	Milk, soy, wheat, egg
Multiple sensitivities	> 50% milk/soy in some populations; up to 35% ≥ 1 food	40% milk/soy	Rare
Feeding at onset	Formula	>50% exclusively breastfed in some studies	Formula
Typical age at resolution	> 3 years	1–2 years	1–3 years

--BallenaBlanca 🐳 ♂ (Talk) 02:26, 4 January 2018 (UTC)

Adding Leonard fine with me. I did not do it because I don't have the PDF. I am leery about adding the table possibly because of the copyright issue (is this in Leonard as a table?), and also I feel the non-IgE content may be getting too long. My thinking is that the article should be accessible to parents of children diagnosed with milk allergy; too long may be off-putting. I had added that ref you questioned, so will have to look again for why. (I may have gotten too far away from milk allergy.) Speaking of away from milk allergy, I am leaning toward adding content on cross-reactivity between milk and soy - putting it in the Research section. I do see that Leonard touches on the topic (as did Caubet). What I am finding is thinking that infants that manifest one allergy - milk - may be at higher risk for another - soy - but at least one publication proposes cross-reactivity of milk and soy proteins. David notMD (talk) 03:13, 4 January 2018 (UTC)

Yes, this is in Leonard as a table. --BallenaBlanca 🐳 ♂ (Talk) 12:52, 4 January 2018 (UTC)

OK on the deletion of PMID 26135565. And fixed ref #27. David notMD (talk) 13:50, 4 January 2018 (UTC)

References

GA Review

This review is transcluded from Talk:Milk allergy/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: AmericanAir88 (talk · contribs) 00:27, 3 January 2018 (UTC)

@David notMD: The flu is finally gone! Is the article still going under extensive changes before I should review it or is now a good time? AmericanAir88 (talk) 14:26, 20 January 2018 (UTC)

Please start the process. I believe the article is stable enough that the review will not trigger massive additions or subtractions. David notMD (talk) 15:34, 20 January 2018 (UTC)

Issues

@David notMD: Starting! I sincerely apologize for the delay. I am finally back to work and my schedule is normal again. Thank you for your patience. AmericanAir88 (talk) 16:31, 3 February 2018 (UTC)

OK. I have no travel/away plans, so will be able to respond in timely fashion. David notMD (talk) 18:02, 3 February 2018 (UTC)

• Try your hardest to fill more of the info-box out.

Classifications moved from External links to info-box. This matches system seen at Egg allergy, Peanut allergy and Nut allergy. David notMD (talk) 11:51, 8 February 2018 (UTC)

• The first sentences of the intro are awkward as it gives only one sentence of definition before it impulsively moves to symptoms. The opening sentences need to be more definition and background. Take a look at some of the sentence starters. "Presentations may include" doesn't seem like the best choice.

Revised first paragraph, with more lead-in before getting to symptoms. David notMD (talk) 22:27, 9 February 2018 (UTC)

Revised lead-in again. Doc James reverted what I did because he wants the lead to start with the words Milk allergy I retained that, but added sentences between the first sentence and the beginnings of the symptoms text. David notMD (talk) 17:15, 10 February 2018 (UTC)

• The second paragraph of the intro needs to be reworked majorly. It is full of sentences that go nowhere and grammar mistakes.

You are so right. What happened here is that other editors changed text after I revised the lead, but it was still my responsibility to review it before proposing a Good Article nomination. Split second paragraph into two. David notMD (talk) 22:27, 9 February 2018 (UTC)

• The third paragraph limits your audience as it is mostly talking about babies. Make it more universal.

Moved one sentence out of Lead, to prognosis, and tried to add more on adult allergy. David notMD (talk) 22:27, 9 February 2018 (UTC)

• "Immediate reactions are usually IgE-mediated, whereas delayed reactions may also involve non–IgE-mediated immune mechanisms." Elaborate more.

Covered in what is now first paragraph of the Signs and symptoms section. David notMD (talk) 04:09, 11 February 2018 (UTC)

• Define IgE and Non IgE more; Some sections make it confusing without definition. I know it is defined in "Mechanisms" but you mention it several times in the above section

Added more text to explain the difference.

• "Why some proteins trigger allergic reactions while others do is not entirely clear, although in part thought to be due to resistance to digestion. Because of this, intact or largely intact proteins reach the small intestine, which has a large presence of white blood cells involved in immune reactions." Awkward Sentence

Two sentences, actually, at 49 words, but now two sentences shortened to 38 words. David notMD (talk) 02:19, 10 February 2018 (UTC)

• "Prevention" needs a better start.

Rewrote start of prevention. I concur that the existing first sentence had looped around on itself. Shortened that, and added a new first sentence to define what is meant by 'prevention.'

• Third paragraph of "Prevention" is very confusing as it goes off-topic.

Revised/shortened, but may need more work David notMD (talk) 11:28, 8 February 2018 (UTC)

• "Desensitization via oral immunotherapy holds some promise but is still being actively researched (see Research)." Rework to make it sound more encyclopedic

First paragraph of Treatment revised, and one citation added. David notMD (talk) 22:59, 11 February 2018 (UTC)

• "Beyond the obvious (anything with milk, cheese, cream, butter, or yogurt in the name)" Could be worded better.

Revised first paragraph of Avoiding dairy and added a list of non-obvious foods. David notMD (talk) 04:09, 11 February 2018 (UTC)

Another editor has removed the table. Pros and cons on the value of such a table have been a topic of an earlier debate. See extensive comments below the check-off table. I will try to resolve this after addressing your other initial set of comments. David notMD (talk) 11:44, 11 February 2018 (UTC)

• "Cross-reactivity with Soy" Talks about "Various Websites". That is not encyclopedic. Elaborate on this.

Revised text. David notMD (talk) 11:28, 8 February 2018 (UTC)

• The entire first paragraph of "Cross-reactivity with soy" needs a rewrite as it contains sentences such as ""There is at least one U.S. state government website that presents the same concept."

Revised text. David notMD (talk) 11:28, 8 February 2018 (UTC)

• "To meet FALCPA labeling requirements, when an ingredient is derived from a major food allergen, its “food source name” must necessarily appear just once in the list of ingredients. For example, “casein (milk)”." Rework.

Revised this next-to-last sentence in the first paragraph of Regulations David notMD (talk) 15:01, 11 February 2018 (UTC)

• Second paragraph of "Regulation of labeling" becomes bias.

Revised second paragraph to attribute the discussion to the citations. David notMD (talk) 15:41, 11 February 2018 (UTC)

• "As of 2014" Try and update if you can.

No citations available to update this content. Added Popping 2018, which states that the EU intends to regulate PAL. David notMD (talk) 12:23, 8 February 2018 (UTC)

• The first sentence of "Prognosis" needs to be reworked.

What is wrong with "Milk allergy typically presents in the first year of life."

• "This is not the same beef allergy that is seen primarily in the southeastern United States, triggered by being bitten by a Lone Star tick". How does this relate to Milk Allergies?

Deleted. David notMD (talk) 11:28, 8 February 2018 (UTC)

• "Milk allergies are usually observed in infants and young children, and often disappear with age (see Prognosis)" Rework to make it sound more encyclopedic (Remove the "see Prognosis")

"(see Prognosis)" deleted and all of Epidemiology text revised to read more clearly. David notMD (talk) 21:19, 11 February 2018 (UTC)

• Need better sentence starts for "Society and culture"

Changed. Does it need more change? David notMD (talk) 18:08, 8 February 2018 (UTC)

• "The evidence was not consistent." Elaborate more on using the sources or else it becomes bias.

Deleted the sentence. The citations remain, as are used elsewhere in the article.David notMD (talk) 18:08, 8 February 2018 (UTC)

All issues all fixed

Comment: added three images.David notMD (talk) 16:33, 13 February 2018 (UTC)

Review Table

Rate	Attribute	Review Comment
1. Well-written:
	1a. the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct.	Check
	1b. it complies with the Manual of Style guidelines for lead sections, layout, words to watch, fiction, and list incorporation.	Check
2. Verifiable with no original research:
	2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline.	Check
	2b. reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose).	Check
	2c. it contains no original research.	Check
	2d. it contains no copyright violations or plagiarism.	Check
3. Broad in its coverage:
	3a. it addresses the main aspects of the topic.	Check
	3b. it stays focused on the topic without going into unnecessary detail (see summary style).	Check
	4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each.	Check
	5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute.	Edit war solved
6. Illustrated, if possible, by media such as images, video, or audio:
	6a. media are tagged with their copyright statuses, and valid non-free use rationales are provided for non-free content.	Check
	6b. media are relevant to the topic, and have suitable captions.	Check
	7. Overall assessment.	Pass

Closing Comments

Congratulations on passing. Your dedication and hard work was fantastic. I hope we can work together in the near future. Have a fantastic day. If you need any help on anything just ask. If you want me to take a look at any other articles you have for review, I will be more than happy to. Thank you. AmericanAir88 (talk) 03:12, 15 February 2018 (UTC)

Trace amounts

Trace amounts are an important concern for allergic people, especially with IgE-mediated reactions, but they are not mandatory in the labeling:

FDA. "Food Allergen “Advisory” Labeling FALCPA’s labeling requirements do not apply to the potential or unintentional presence of major food allergens in foods resulting from “cross-contact” situations during manufacturing, e.g., because of shared equipment or processing lines. In the context of food allergens, “cross-contact” occurs when a residue or trace amount of an allergenic food becomes incorporated into another food not intended to contain it. FDA guidance for the food industry states that food allergen advisory statements, e.g., “may contain (allergen)” or “produced in a facility that also uses (allergen)” should not be used as a substitute for adhering to current good manufacturing practices and must be truthful and not misleading. FDA is considering ways to best manage the use of these types of statements by manufacturers to better inform consumers."

FSA. "Advisory labelling. Manufacturers often use phrases such as 'may contain' to show that there could be small amounts of an allergen for example milk, egg, nuts etc. in a food product because it has entered the product accidentally during the production process. It's not a legal requirement to say on the label that a food might accidently contain small amounts of an allergen, but many manufacturers label their products in this way to warn their customers of this risk."

However, the content of the page is currently misleading:

The U.S. Food Allergen Labeling and Consumer Protection Act of 2004 requires that the label of a food that contains an ingredient that is or contains protein from these eight major food allergens declare the presence of the allergen on the label.(3) Dairy foods are also on the mandatory labeling list in Japan(4) and the European Union.(5)

We have to work on this too. --BallenaBlanca 🐳 ♂ (Talk) 13:54, 4 January 2018 (UTC)

I agree. In looking at article with a fresh eye, the Lead mentions government labeling regulations, with a few references, but there is no follow-up content under either Prevention or Treatment to elaborate on compliance and whether food allergen labeling laws actually reduce inadvertent consumption the listed foods. The Food allergy article has a subsection Regulation of labeling under the Society and Culture section. Does this article need the same?

Yes, IMO off course it does. All pages related to food allergies should talk about the issue of the trace amounts, and their labeling. This paper, which is free access, contains a good summary of the situation PMID 24791183. --BallenaBlanca 🐳 ♂ (Talk) 00:56, 7 January 2018 (UTC)

Regulation of labeling sub-section added. David notMD (talk) 03:14, 12 January 2018 (UTC)

Conflicting recommendations

Prevention ends with a recommendation that for infants manifesting an allergy to cow's milk, to not switch to formula containing hydrolyzed dairy proteins, and instead consider soy formula. The section of cross-reactivity with soy ends with a recommendation that for infants manifesting an allergy to cow's milk, to not switch to soy formula, and instead use a hydrolyzed dairy protein formula. This conflict should be resolved before the Good Article review is completed. David notMD (talk) 12:10, 11 February 2018 (UTC)

Avoiding dairy - table or not

The table was there when I started working on the article. I revised the table, but prior to the start of the GA review, it was deleted as part of a complete revision of the Avoiding dairy section. My opinion is that the truncation is a disservice to people who are learning about milk allergy. Secondly, a sentence was added "Many medicines contain dairy ingredients or lactose. Lactose (a sugar found in milk) does not normally contain proteins but could possibly be contaminated with them, and can cause allergic reactions in very sensitive people." The reference for this is weak (a hospital publication) and does not provide any referenced support for the claim that medical products with lactose may by contaminated with milk proteins and thus trigger allergic reactions. David notMD (talk) 11:28, 13 January 2018 (UTC)

My intention when removing the table is to review it. I think it is good to incorporate a table, but if it is well adjusted. We can not mix ingredients with elaborated products, it gives rise to error (all elaborate products must be reviewed). I do not know if I'm explaining well.

On contaminated lactose, other sources can be searched. If you want we can remove it in the meantime. --BallenaBlanca 🐳 ♂ (Talk) 12:17, 13 January 2018 (UTC)

About contaminated lactose, we have for example this on a source already present TaylorHefle2006 PMID 16670512:

Extended content

Other ingredients are made from commonly allergenic sources and contain low levels of residual protein although not as low as the edible oils. Examples include wheat starch, lactose, and soybean lecithin. Clinical challenge studies have not been done to clearly establish the allergenicity of these ingredients. Some patients avoid these ingredients while others do not. These ingredients are evidently safe for some individuals with allergies to the ingredient source but their safety for the entire population of such individuals has not been established. Of course, the level of use is again important and variable for these ingredients. ........ Table 1 contains a partial list of ingredients derived from commonly allergenic sources along with our assessment of their relative allergenicity (admittedly sometimes based on limited evidence). While the allergenicity of casein, whey, semolina, and soy protein isolate is well established, the level of allergenic proteins in other ingredients (for example, wheat starch, soy lecithin, and lactose) is much lower. Few allergic reactions have been documented from the use of these ingredients in foods [17–19] and most milk-allergic infants have been documented to tolerate lactose ingestion [20]

About inhaled medicines with contaminated lactose, which can be swallowed, we have these two free-access reviews:

PMID 27551328 The use of inhaled corticosteroids in pediatric asthma: update

"Few cases have been reported with possible hypersensitivity reactions in children with asthma and cow’s milk allergy due to milk protein traces in inhaled corticosteroids (203–205)."

PMID 27092299 Asthma and Food Allergy in Children: Is There a Connection or Interaction?:

"It should be noted that dry powder inhalers may contain lactose whose cow’s milk protein contamination usually does not induce allergic reactions (63). However, caution should be exercised in asthmatic children with severe cow’s milk allergy because chest tightness, decline in FEV1, and blood pressure drop have been described after inhalation from some lots of fluticasone/salmeterol dry powder containing lactose (64). Most of lactose in the powder is swallowed rather than inhaled."

I do not have more time now, I'll be happy if you adjust the page. Best. --BallenaBlanca 🐳 ♂ (Talk) 12:59, 13 January 2018 (UTC)

David notMD In response to your comments on my talk page: "Allergy events triggered by airborne allergens is real (hayfever!), but I do wonder how common it is for food allergy proteins in general and milk proteins in particular, other than in the context of food manufacturing facilities where they can be a lot of particulate exposure. ..... However, other than one mention of inhalation exposure in a dairy worker PMID 29016916 I did not find support for allergy by inhalation for dairy. I added text and citations on the inhalation topic to Food allergy article. Suggesting not the milk allergy." I think this subject is important enough to be mentioned on the milk allergy page. There are more than one case documented and not only in the context of food manufacturing facilities. In fact, this is an increasingly recognized problem in children, but underdiagnosed. Let's see this review of 2014 PMID 24992548 "Allergic reactions to foods by inhalation in children":

Extended content

This article focuses on hypersensitivity reactions after inhalation of food particles as primary cause for food allergy. This is an increasingly recognized problem in children. ... There are sparse epidemiological data on the frequency of reaction to food particle inhalation in children with food allergy. ..... A cohort of 512 children with milk/egg allergy were prospectively followed for a median of 36 months. A total of 1171 reactions to any food were reported; 14(1.2%) reactions were precipitated by inhalation of the food proteins.5 In a 6-year-old school milk–allergic child, casein contained in chalk caused asthma and rhinoconjunctivitis at school.23 It has also been reported that in adults with occupational asthma, inhalation of food allergens might be considered a relevant route of primary sensitization.29 At the workplace, inhalation of airborne food molecules from wheat,30 cow’s milk,31–33 hen’s eggs,34 soybeans, 24 seafood,35 and enzymes used in the cheese industry,36 as well as many vegetables, fruits, spices, mushrooms, additives, and contaminants,16 trigger allergic reactions. ..... Table 1 List of foods eliciting clinical reaction by inhalation in childhood Food Patient No. Food Patient No. Bean60,68 2 Peanut19,22,39,50,54 _500 (the exact no. is not available) Buckwheat8,73,74 10 Poppy seed83 1 Chickpea8,56 33 Potato82 1 Cow’s milk31,33,78 3 adolescents and 13 children Rice70 1 Fish7,8,28 53 Sesame84 1 Lentil56–61 51 Lupine69 1 290 July–August 2014, Vol. 35, No. 4 FOODS All foods may potentially induce clinical symptoms when they are inhaled. There are no epidemiological studies on the relative frequency of foods eliciting hypersensitivity by inhalation. .... The more commonly reported inhaled food allergens in children are seafood, legumes, peanut, tree nut, and cow’s milk (Table 1). Cow’s Milk Severe reactions to aerosolized milk protein have been reported.23 A 18-year- old girl suffering from asthma and cow’s milk allergy from infancy had fatal anaphylaxis when she entered a dairy shop.78 Some formulations of inhaled medications contain lactose that generally does not induce reaction.79 However, an 8-year-old boy with milk allergy and persistent asthma had anaphylactic reactions to milk protein contaminating lactose contained in fluticasone/salmeterol drypowder inhaler. Variability of contamination from lotto- lot is unpredictable. Therefore, lactose-containing dry-powder inhalers should be prudently used in patients with severe milk allergy.80 There is a need for studies on the tolerance of cow’s milk substitutes81 in children who reacted to cow’s milk inhalation.

--BallenaBlanca 🐳 ♂ (Talk) 19:02, 13 January 2018 (UTC)

I made thi edit [1]. Opinions? --BallenaBlanca 🐳 ♂ (Talk) 18:48, 14 January 2018 (UTC)

@David notMD: Why did you re add the table on this edit?

The reasons you give are not convincing and do not take into account the previous comments in this thread.

I repeat: practically any processed product may contain dairy products or trace amounts of dairy products. Always, all labels have to be checked. If you only list one part of food, it seems that the rest is safe. This is worse than saying nothing. And also this table are mixing ingredients with processed foods.

See an example of what a correct table would look like (in this case it is for gluten, in Spanish): Clasificación de los alimentos por su contenido en gluten. All kind of foods must be listed and specified which ones are always considered free, which ones may contain the allergen according to the brands and which ones always contain the allergen.

Best. --BallenaBlanca 🐳 ♂ (Talk) 11:02, 11 February 2018 (UTC)

I restored the table because the GA reviewer made a request that what was in the article could be worded better. What is in the table is not intended to be comprehensive, only to provide examples of foods that might be presumed to not contain diary (hotdogs!) but on reading of the ingredient label will be found to contain dairy-sourced ingredients. The ingredients are there because it may not be obvious to people looking at the label that casein (and the others) as ingredients are dairy. I will comment further in this Talk section before attempting any changes in the article itself. David notMD (talk) 11:39, 11 February 2018 (UTC)

GA reviewer asked for a table. As now described, clear that this is not intended to be comprehensive, nor an indication that foods not on this list will not contain dairy ingredients. David notMD (talk) 03:12, 13 February 2018 (UTC)

@David notMD: you are doing a good job, but remember that you said "I will comment further in this Talk section before attempting any changes in the article itself", but you re-added the table again, without commenting here. Also, you wrote in this edit "Protein ingredients include casein, caseinates, whey and lactalbumin." But this is inaccurate and again leads to the error of thinking that they are the only ingredients that contain milk protein.

I'm not seeing where this particular table is being requested, just the need of improving the explanation.

I still disagree with adding this partial table, for the reasons I explained above.

Let's see the opinions of other editors and reach a consensus.

As a datum, note how the FDA information talks about allways reading all the labels and does not provide any partial list. --BallenaBlanca 🐳 ♂ (Talk) 18:11, 13 February 2018 (UTC)

I had prefaced the list with mention that it is intended only as examples, and that food purchasers need to read labels, even from brands they have purchased in the past. At this point I am bringing it to the attention of the GA reviewer. David notMD (talk) 19:08, 13 February 2018 (UTC)

@David notMD:@BallenaBlanca: In order to pass section "5" of the review; No edit wars have to be present. This is a major edit war between two good faith editors. BallenaBlana, as the reviewer I personally agree that the table/list provides necessary information for the article. Ballena, Take this as your warning to stop removing the table/list. If you truly are against it, keep it to chat only. I am on Davids side This article will not pass until this argument is taken care of according to the rules of GA. AmericanAir88 (talk) 03:07, 14 February 2018 (UTC)

List restored. BallenBlanca and I are in agreement on the text of the four paragraphs. And on which citations to use. The disagreement remains on whether to provide a list of examples of foods that may not be expected to contain dairy-sourced ingredients. I still feel this is of benefit to viewers of the article. The list is clearly described as examples. The text advises food purchasers/consumers to read the label of every food. David notMD (talk) 11:52, 14 February 2018 (UTC)

When I started the process of raising this C-class article to GA status on 30 September 2017 the length was 10,000 bytes and the article had only 10 citations. The article is now at 60,000 bytes and 87 citations. I will be disappointed if it cannot reach GA status because of this minor dispute. David notMD (talk) 11:46, 14 February 2018 (UTC)

I do not think a table is unreasonable. I would remove the brandname products though, which I think Simplesse is the only one. Doc James (talk · contribs · email) 12:22, 14 February 2018 (UTC)

I agree on removing brand name examples. As Nutella (another brandname) was also removed, I took out "hazelnut/cocoa spread", as that can only be Nutella. David notMD (talk) 13:56, 14 February 2018 (UTC)

It is not my intention to enter an edit war, but I did not understand why David did not comment here before editing again, because as we all know is the right procedure in Wikipedia when there are differences of opinion.

I am not opposed to a list being made. What I am saying is that a more complete list should be made. My experience shows me that partial lists disorient and lead to errors (we have to write for all kinds of people, from all cultural levels). It is preferable for people to know that they should always look at the labels of all products. Milk or milk traces may be present in practically any processed food, at least here in Europe.

Even if I do not agree, I will accept the opinion of the majority. At least, the current list has been improved by not mixing ingredients with food. --BallenaBlanca 🐳 ♂ (Talk) 21:37, 14 February 2018 (UTC)

Few additional thoughts

• Refs should be consistently formatted with the "cite" templates
• Medlineplus by ADAM is not a very good source.
• Would be nice to have a lead image with a better background.

Article is coming along nicely though. Doc James (talk · contribs · email) 12:35, 14 February 2018 (UTC)

Replaced glass of milk image David notMD (talk) 22:37, 14 February 2018 (UTC)

Thanks agree the new one looks much better. Doc James (talk · contribs · email) 07:48, 15 February 2018 (UTC)

BallenaBlanca added some valuable information about classes of foods that in the U.S. are exempt from FDA regulation. The bottle of Irish Cream momentarily on my desk does have "Cream" in the name, but does not have an ingredient list, nor call out that it contains milk is separate wording on the label. David notMD (talk) 22:33, 16 February 2018 (UTC)

Prognosis

In the referenced section is this passage: "In a U.S. government diet and health surveys conducted in 2007-2010, 6,189 children ages 2-17 years were assessed. For those classified as cow's milk allergic at the time of the survey, mean weight, height and body-mass index were significantly lower than their non-allergic peers. This was not true for children with other food allergies. Diet assessment showed a significant 23% reduction of calcium intake and near-significant trends for lower vitamin D and total calorie intake.[74]" In the USA, lower weight and body-mass index are both positive results. The average child here is overweight or obese. Likewise, I question mentioning "trends" that are non-significant, because that means "We didn't actually find a trend." IAmNitpicking (talk) 13:49, 14 March 2018 (UTC)

As written in the article, does not say whether the differences are good or bad, just that they are. Note that height was also less in children classified as cow's milk allergic. The P-values for vitamin D and total calorie intake were 0.053 and 0.054, respectively. Given that <0.05 is typically used as indication of statistical significance, describing these as "near-significant trends" felt appropriate. David notMD (talk) 19:35, 14 March 2018 (UTC)

Not disagreeing with you per se, but the trend in medical research these days is to use P < 0.01. IAmNitpicking (talk) 14:43, 15 March 2018 (UTC)

Not in the literature I am seeing. And if true, would reverse majority of what is consider "true" in past-published medical research. Can you provide editorials, position papers, etc. in support of P<0.01? David notMD (talk) 14:44, 16 March 2018 (UTC)