milk-freeApproximately 2.5 percent of children under age three are allergic to milk, making it one of the most common allergies in children. It is most common in infants who are fed formula from cow’s milk than in those who are breastfed or give hypoallergenic hydrolyzed formula. Although the allergy is usually related to cow’s milk, milk from sheep, goats, and other animals are not safe alternatives since the milk proteins are very similar. Most children who are allergic to milk developed the allergy during the first year of life. Thankfully, most will outgrow the allergy by age three.

Symptoms

Symptoms often occur within minutes of consuming the food and may include:

  • Hives
  • Vomiting
  • Wheezing

Other symptoms take several hours to develop and may include:

  • Runny nose and watery eyes
  • Cramping, loose stools or diarrhea
  • Skin rash, often around the mouth
  • Colic (in babies)

On rare occasions, allergic reactions may result in anaphylaxis, which requires immediate attention and symptoms include:

  • Constriction of airways
  • Shock and a severe drop in blood pressure
  • Rapid pulse
  • Dizziness or loss of consciousness

Diagnosis

If you or your child experiences any of these symptoms near the time you have eaten milk or products that contain milk proteins, contact your doctor about allergy testing. Your doctor may recommend the following tests:

  • Skin test – A skin prick test is used to expose small amounts of the protein to your body. A food allergy is confirmed by the presence of a raised bump or hive at the prick location.
  • Blood test – A blood test, also referred to as an IgE test, measures your immune system’s response to the proteins found in milk by counting the number of specific antibodies in your blood.
  • Elimination diet – The offending food is eliminated from the diet and then added back in to see if it causes an allergic reaction.

*It’s important to differentiate between a milk allergy and milk or lactose intolerance since the cause, symptoms and treatment are different. Milk or lactose intolerance occurs in people who are missing the enzyme lactase, which breaks down lactase, a sugar found in milk. Without this enzyme, these individuals are unable to digest milk and dairy products and thus experience digestive problems, like gas or diarrhea. A milk allergy involves an immune system reaction triggered by two types of proteins present in milk, casein and whey. A person may be allergic to only one or both casein and whey.

Survival Skills

The only way to prevent a reaction is to avoid milk and foods that contain milk proteins, which can be difficult since milk is present in so many processed foods. Therefore, it important to read labels carefully. In general, avoid:

  • Milk
  • Butter
  • Cheese
  • Cream
  • Custard
  • Curds
  • Yogurt
  • Ice cream
  • Puddings
  • Chocolate, nougat and caramel candies

See shopping tips below for “code words” to look for on an ingredients listing. Food Handling: An allergic reaction typically only occurs from ingesting milk; a reaction from contact with milk is unlikely. However, precautions must be taken when preparing food to avoid cross-contamination such as using separate cooking utensils (cutting boards, serving spoons, pots and pans, etc.) for milk-containing products and by washing their hands in between handling of these foods. Shopping: Since many foods contain milk, you must read labels carefully while shopping. The FDA mandates the labeling of foods that contain the eight major food allergens, which includes milk. Before purchasing a product, look to see if a product is labeled as milk-free. However, products that are labeled as milk-free or dairy-free may still contain small amounts of milk proteins. When in doubt, contact the manufacturer or ask a Weis Markets dietitian to be sure a product does not contain eggs. Milk in Disguise:

  • Whey, whey protein, or milk protein
  • Casein or caseinates (sometimes used in meats as a binder)
  • Rennet or rennet casein
  • Words starting with “lact” such as lactose or lactate
  • Hydrosolate
  • Ghee
  • Protein powders
  • Artificial butter or cheese flavors
  • Fat-replacement products
  • Recaldent™ (Used in tooth-whitening gums)
  • Lactic acid starter (may contain milk; lactic acid does not)

*When purchasing deli meats, make sure that slicer has not also been used to cut cheese. Some ingredients sound like they contain milk proteins but they actually do not. These include:

  • Cocoa butter
  • Coconut milk
  • Cream of tartar
  • Calcium lactate
  • Calcium stearoyl lactylate
  • Sodium stearoyl lactylate
  • Oleoresein
  • Lactic acid

Eating Out: When dining out, ask detailed questions about ingredients and how the food was prepared – your health and safety are at stake! There’s a high risk for cross-contamination in the kitchen so be sure to clearly express your food allergy to the server or cook. Ask if your food was prepared with butter, dipped or mixed with milk, etc. Request to look at the food package or recipe if necessary.

Don’t Go it Alone

A new diagnosis can be scary. Be sure to build a support system of family, friends and healthcare professionals to help you manage your milk allergy. Talk to a doctor or registered dietitian when eliminating foods from your diet about possible nutrient deficiencies like protein, calcium, vitamin D and vitamin B12. They may recommend an adjustment in your meal plan or a supplement to replace nutrients lost by eliminating the offending food and food ingredients. Also talk to your doctor about how to prepare for a reaction. You may treat a mild reaction with oral antihistamines to reduce signs and symptoms and relieve discomfort. If you are at risk for severe reactions or anaphylaxis, your doctor may advise you to wear a medical alert bracelet and/or prescribe an injectable epinephrine (EpiPen) to carry with you at all times.

Additional Resources

American College of Allergy, Asthma and Immunology http://www.acaai.org
American Academy of Allergy, Asthma and Immunology http://www.aaaai.org
Asthma and Allergy Foundation of America http://www.aafa.org
The Food Allergy & Anaphylaxis Network http://www.foodallergy.org
The Food Allergy Initiative http://www.faiusa.org