Asthma, Migraine Headaches and Milk Allergy in Lactase-Deficient Patients
In this study from the Emergency Department and Neurology Unit of the Central Emek Hospital, Afula, Israel 48 patients suffering from nonseasonal asthma and migraines participated involving a trial of a cow’s milk protein-free diet.
22 nonseasonal asthmatic patients agreed to dietary therapy for their condition. All 22 were poorly controlled on medications, requiring an average of one or more emergency visits each month. The group included 9 men and 13 women, ranging in age from 13 to 77 years. There were 11 Ashkenazic Jews, 9 Sephardic Jews and 2 Arabs. The average duration of their asthma was 14 years. 14 patients also had a family history of allergy, asthma or migraine.
26 patients with classic migraine syndrome also agreed to dietary therapy. All 26 had classic migraine attacks necessitating medication and bed rest at least every 2 weeks. They included 19 women and 7 men, ranging in age from 24 to 68 years. 19 were Ashkenazic Jews and 7 were Sephardic. 19 of the 26 had a family history of allergy, asthma or migraine. All 26 were taking commonly used drugs without effect, and 3 had been treated by acupuncture without results.
The patients were instructed to follow a strict milk-free diet, taking into account foods containing milk powder. Unlabeled foods were forbidden. Neither the asthmatics or migraine sufferers were told to change their medication or alter their usual practices of self-medication during periods of symptomatic distress. All patients were reevaluated after 6 months of dietary, milk protein-free therapy.
15 of the 22 asthmatics (68%) improved on the milk protein-free diet, as measured by the absence of hospital admissions or emergency-room visits for asthma for at least 6 months, and by a 50% or greater reduction in daily medication requirements. Improvement was apparent 2 to 3 weeks after the start of the diet but reached maximum benefit only after 2 or 3 months. 8 of the 15 that improved showed improvement to the extent that they required only occasional inhalant (salbutamol) therapy. Another patient, after 5 years of prednisone therapy, was able to reduce his daily dose from between 30 and 40 milligram to 10 milligram and had not had an acute asthmatic attack for 14 months after milk elimination.
The condition of 18 of 26 migraine patients (69%) improved on the diet, as measured by an absence of classic migraine attacks for at least 6 months. Improvement occurred after an average of 10 days and peaked after 1 month. Those 18 patients who reported improvement also reported occasional headaches, which were now relieved by simple aspirin.
5 asthmatic patients and 9 migrainous patients who improved on the milk protein-free diet agreed to a milk challenge diet. All 5 asthmatics had severe attacks approximately 1 week after the start of the dairy diet. One patient was hospitalized for status asthmaticus that necessitated parenteral steroids, and subsequently improved with the reintroduction of a milk-free diet.
The 9 migraine headache sufferers agreed to two dietary challenges–one containing 4% or more lactose sugar and negligible tyramine (milk and ice cream) and the other challenge containing a minimum of 0.1% lactose but considerable tyramine (hard Israeli cheese)-separated by a one-month interval of dairy-free diet. All 9 suffered classic migraine attacks 2 to 3 days after starting each diet, one patient requiring sedation and hospitalization to correct dehydration.
Lactose deficiency was proven in 34 of the 48 patients in the study (71%). These included all 15 asthmatics and 18 migrainous patients who improved on the milk protein-free diet. Lactase deficiency was also identified in one migrainous patient who did not respond to the diet. 9 of the lactase deficient patients had previously suffered from flatulence, heartburn, occasional diarrhea or anal irritation, but none sought medical aid for these GI symptoms prior to the study. All these GI symptoms improved on the milk-free diet. The 14 lactose tolerant patients included 7 asthmatics and 7 migrainous patients who did not improve on the milk protein-free diet.
The authors conclude: “All patients whose condition improved had laboratory evidence of lactase deficiency, whereas the condition of the lactose-tolerant patients did not improve… it leads us to believe that non-compliance may be the reason for the single failure of dietary therapy.” “An association between asthma and migraine in certain families has been noted and patients with food-sensitive migraine have been reported. Among the 48 patients, 32 (67%) had a family history of allergy, asthma or migraine. 71% of our patients were lactase deficient, whereas the rate of 55% has been reported elsewhere in asymptomatic patients; lactase deficiency ranges from approximately 20% in northern Europeans to 90% in some African tribes.2-4
Ratner D, Shoshani E and Dubnov B. Milk protein-free diet for nonseasonal asthma and migraine in lactase-deficient patients. Israel Journal of Medical Sciences, volume 19, pages 806-809, 1983.
- Wechsler IS (1963). “Clinical neurology,” 9th edition. WB Saunders, Co, Philadelphia, page 592
- Rozen P and Shfrir E (1968). Behaviour of serum free fatty acids and glucose during lactose tolerance tests. Israel Journal of Medical Sciences, Volume 4: pages 100-109.
- Kretchmer N (1971). Lactose and lactase, a historical perspective. Gastroenterology, Volume 61: pages 805-813
- Spiro Hm (1977). “Clinical gastroenterology,” 2nd edition. Macmillan Company, New York, pages 495-496.