Do dairy products induce bronchoconstriction in adults with asthma?

doi:10.1016/S0091-6749(98)70192-7

Journal of Allergy and Clinical Immunology

Volume 101, Issue 1, January 1998, Pages 45-50

https://doi.org/10.1016/S0091-6749(98)70192-7 Get rights and content

Abstract

Background: Dairy products have often been implicated as a cause of exacerbation of asthma, but there is little scientific evidence to support this hypothesis. Objective: We sought to determine whether dairy products induce bronchoconstriction in a group of adults with asthma. Methods: Twenty subjects with asthma (13 women and 7 men) were recruited from respondents who had previously completed a food and asthma questionnaire. Ten subjects perceived that their asthma became worse with ingestion of dairy products (positive perceivers), whereas ten were negative perceivers. None of the subjects had positive skin prick test results with cow's milk. The study was a randomized, cross-over, double-blind, placebo-controlled trial. Subjects complied with a dairy-free diet throughout the study. The active challenge was a single-dose drink equivalent to 300 ml of cow's milk. A positive reaction was defined as a 15% reduction in both FEV₁ and peak expiratory flow (PEF) on the active challenge day compared with results obtained at the same time on the placebo day. Results: For both FEV₁ and PEF there were no statistically significantly differences in group means between active challenge and placebo challenge, between sequence of administration, or between perceptions. Nine subjects showed FEV₁ or PEF changes that were greater than 15% of baseline values: four patients showed changes after both active and placebo treatment; two after treatment with placebo only; and three after active treatment alone. Of the latter group, two subjects showed changes only in PEF, and when one of these subjects underwent a further detailed study, no asthmatic reaction could be demonstrated. Conclusion: It is unlikely that dairy products have a specific bronchoconstrictor effect in most patients with asthma, regardless of their perception. (J Allergy Clin Immunol 1998;101:45-50.)

Section snippets

Subjects

Twenty-two subjects with asthma who met the American Thoracic Society definition of asthma¹¹ were recruited, with 20 subjects successfully completing the study. One subject withdrew from the study at visit 3 (second challenge day) because of perceived inability to tolerate the second challenge drink. The other subject's dietary compliance was inadequate and the results were therefore not included. All subjects had previously completed a food and asthma questionnaire, the details of which have

Subject characteristics

The mean age of the subjects was 35.4 years (SD = 15.4 years). All subjects except one (subject 4) were atopic to at least one of seven common aeroallergens. None had a positive skin prick test response to either cow's milk or soybean. The mean body mass index (BMI) was 25.7 kg/m² (SD = 4.4 kg/m²), a value considered to be in the overweight category. Of the 20 subjects, 11 were currently employed outside the home, 4 were students, 2 were retired/pensioners, 2 were involved with home-duties, and

DISCUSSION

The present study was unable to demonstrate that dairy products induce bronchoconstriction or changes in asthma symptoms in this group of adults with asthma. This is the first report of a double-blind study that assesses the effect of dairy products on asthma control in adults.

Because all subjects gave negative skin prick test responses to cow's milk, it is difficult to generalize these findings to patients with asthma who do have skin reactivity to cow's milk. However, the aim of the study was

Acknowledgements

The authors wish to acknowledge gratefully the assistance of Mrs. Joan Raven, RN, who prepared the challenge drinks and Ms. Thoa Nguyen, Monash University Statistical Consulting Service, for statistical assistance.

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Clinicians are faced with evaluating real and alleged reactions to foods that may be allergic or nonallergic. Pathogenesis, diagnosis, and treatment of various non–IgE-mediated diseases are discussed in this review. These food-related conditions range from mild to severe. Referral for an allergy workup may be pursued despite the lack of IgE-mediated symptoms. Diagnostic testing is available for defined non–IgE-mediated food diseases that are either immunologic or nonimmunologic. These include celiac disease and related disorders, carbohydrate maldigestion, pancreatic insufficiency, and histamine intolerance. In contrast, there is a paucity of definitive studies to prove food intolerance diseases. There are no definitive diagnostic criteria or testing for nonceliac gluten sensitivity. Functional gastrointestinal disorders, such as irritable bowel syndrome, are better stratified diagnostically but still lack reliable testing. Both nonceliac gluten sensitivity and irritable bowel syndrome are linked to dietary triggers including fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Therefore, dietary alteration alone may be diagnostic and therapeutic when all other conditions are ruled out. These conditions are important considerations when evaluating a patient with history of a food reaction. There is little evidence that foods are causative in other ailments such as acne, migraines, and nasal congestion and hypersecretion.
Calcium and vitamin D intake in allergic versus non-allergic children and corresponding parental attitudes towards dairy products
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Citation Excerpt :
Studies have been conducted in subsets of adult populations exploring perceptions towards dairy products. Such a study of 20 subjects with asthma revealed that 10 of them perceived that their asthma was exacerbated by ingestion of dairy products despite negative skin-prick tests to cow's milk and no evidence of bronchoconstriction on spirometry after its consumption.19 Additionally, one study found a potential link between vegetarian lifestyle and negative perceptions towards milk and dairy products.20
It is hypothesized that parents of children with allergic conditions believe dairy products are potentially harmful to their child.
This study compares the calcium and vitamin D intake of allergic versus non-allergic children and parental beliefs about milk and dairy products.
A survey and food-frequency-questionnaire were administered to parents of children between 3 and 13 years, 110 with allergic disease (allergic rhinitis, asthma, food allergy, and/or atopic dermatitis) versus 110 without allergic disease. Calcium and vitamin D intake was calculated from the food-frequency-questionnaire and compared to National Institutes of Health recommendations. Associations between atopy, calcium and vitamin D intake, and beliefs were investigated using Chi-square test (α = 0.05). Distribution across subjects was investigated using Mann-Whitney-U test (α = 0.05).
Fewer allergic (51.8%) versus non-allergic children (77.3%) met the recommended calcium intake (p < 0.001). Both had similar rates of insufficient vitamin D intake: 12.7% allergic and 17.3% non-allergic (p = 0.345). 81.7% of parents of allergic versus 94.0% of non-allergic children believe intake of dairy is important (p = 0.009). 23.7% of parents of allergic versus 8.0% of non-allergic children believe dairy negatively impacts their child (p = 0.003). 19.1% of parents of allergic children (excluding 3 with documented milk allergy) versus 2.0% of non-allergic believe their child is allergic or intolerant to dairy (p < 0.001).
Children are at risk of insufficient calcium and vitamin D intake. Atopic children may be at increased risk for insufficient intake, due in part to parent's negative beliefs regarding dairy products. Physicians should counsel on the importance of micronutrient intake and how allergic conditions do or do not entail dietary restrictions.
Survey-Defined Patient Experiences With Aspirin-Exacerbated Respiratory Disease
2015, Journal of Allergy and Clinical Immunology: In Practice
Citation Excerpt :
It is possible that spice, mint (ie, mint toothpaste), and alcohol acting through thermoreceptor transient receptor potential ion channels activate mast cells, which harbor various receptors for these triggers.31-36 Dairy products have been implicated as a cause of asthma exacerbation but with little scientific evidence to support this hypothesis.37,38 Despite the lack of evidence, a brief Internet keyword search will demonstrate that the nonscientific community feels strongly that a connection between sinus health and dairy ingestion exists.
Aspirin-exacerbated respiratory disease (AERD) is a chronic illness of progressive recurrent sinus disease with nasal polyps and asthma. No population-based comprehensive surveys of patients with AERD have been carried out to assess specific quality-of-life impact or perceptions of treatment benefit.
This survey analyzed perceptions and quality of life in those living with AERD and queried patient observations of treatment effectiveness. The survey assessed whether dietary and nutritional support was used to manage AERD, and if so, whether there was a perceived benefit.
This survey was publicized through clinics that treat patients with AERD, Web sites, and online blogs.
Results are reported for 190 patients. Most subjects reported an adverse effect of AERD on quality of life. Chronic nasal symptoms followed by decreased sense of smell were reported to have the greatest impact on quality of life—in 81 (43%) and 74 (39%), respectively. Those who lost their ability to smell (n = 65; 34%) reported that they missed the enjoyment of food and eating the most. A minority indicated that a combination of medications (aspirin, leukotriene receptor antagonist, zileuton, or omalizumab) was more effective than 1 alone. Of those surveyed, 120 (63%) respondents felt that components of their diet contributed to their disease and 147 (77%) respondents reported having reactions after alcohol consumption.
Patients with AERD live with frustration and report a poor quality of life in spite of several pharmacologic treatments including aspirin desensitization followed by daily aspirin. Despite ongoing medical therapy, the burden of disease in AERD remains high.
Does milk increase mucus production?
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Excessive milk consumption has a long association with increased respiratory tract mucus production and asthma. Such an association cannot be explained using a conventional allergic paradigm and there is limited medical evidence showing causality. In the human colon, β-casomorphin-7 (β-CM-7), an exorphin derived from the breakdown of A1 milk, stimulates mucus production from gut MUC5AC glands. In the presence of inflammation similar mucus overproduction from respiratory tract MUC5AC glands characterises many respiratory tract diseases. β-CM-7 from the blood stream could stimulate the production and secretion of mucus production from these respiratory glands. Such a hypothesis could be tested in vitro using quantitative RT-PCR to show that the addition of β-CM-7 into an incubation medium of respiratory goblet cells elicits an increase in MUC5AC mRNA and by identifying β-CM-7 in the blood of asthmatic patients. This association may not necessarily be simply cause and effect as the person has to be consuming A1 milk, β-CM-7 must pass into the systemic circulation and the tissues have to be actively inflamed. These prerequisites could explain why only a subgroup of the population, who have increased respiratory tract mucus production, find that many of their symptoms, including asthma, improve on a dairy elimination diet.
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2005, Immunology and Allergy Clinics of North America
Dairy intake in association with asthma symptoms among a large sample of children and adolescents: a cross-sectional study
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^☆: From the Departments of ^aRespiratory Medicine, ^bMedicine, ^cEpidemiology and Preventive Medicine, and ^dAllergy and Clinical Immunology, Monash Medical School and Alfred Hospital, Melbourne.

^☆☆: Funded in part by The Alfred Hospital Foundation. R.K.W. is the recepient of an Australian Postgraduate Award.

^★: Reprint requests: Rosalie Woods MPH, APD, Department of Respiratory Medicine, Alfred Hospital, Commercial Rd, Prahran, Victoria, 3181, Australia.

^★★: 1/1/85503

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Do dairy products induce bronchoconstriction in adults with asthma?☆,☆☆,★,★★

Abstract

Section snippets

Subjects

Subject characteristics

DISCUSSION

Acknowledgements

J Allergy Clin Immunol

J Allergy Clin Immunol

A feast for Aesculapius: historical diets for asthma and sexual pleasure

Ann Rev Nutr

Relationship between milk intake and mucus production in adult volunteers challenged with Rhinovirus-2

Am Rev Respir Dis

Effect of milk ingestion on pulmonary function in healthy and asthmatic subjects

J Asthma

Patients' perceptions of food-induced asthma

Aust NZ J Med

Childhood asthma: what do parents add or avoid in their children's diets?

NZ Med J

Australia's Food and Nutrition

Calcium-deficiency rickets in a four-year-old boy with milk allergy

J Pediatr

Eczema, rickets and food allergy

J Allergy Clin Immunol

Nutritional hazards of elimination diets in children with atopic eczema

Arch Dis Child

Guidelines for the evaluation of impairment/disability in patients with asthma

Am Rev Respir Dis