The practical diagnosis of allergy to cow's milk in the majority of cases is, in our opinion, best carried out by eliminating milk from the diet followed by a planned, carefully observed challenge and then a second elimination diet. When the patient is first seen while symptomatic and ingesting cow's milk, he is undergoing his first dietary challenge. When cow's milk is eliminated from his diet, this is both his first diagnostic test and his first therapeutic trial. If this presumptive test is positive, the diagnosis is confirmed by the planned challenge plus the subsequent clearing when milk is once again removed from the diet. Evidence of an unusual immunological response to cow's milk protein is a prerequisite to making a firm diagnosis of allergy. Laboratory measurements of observable phenomena permit the diagnosis to be made with much greater certainty than do subjective evaluations of symptoms. Lactose intolerance is subdivided into 3 major categories: congenital lactose intolerance, late onset lactose intolerance and secondary lactose deficiency. The clinical and diagnostic criteria of each category are outlined. Treatment of allergy to cow's milk and lactose intolerance is dicussed.
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