Cows’ milk is one of the eight foods responsible for most food allergies in children. It’s also a common ingredient in many foods. Dr. Cindy Gellner gives tips on how to help your child manage the allergy. She also talks about the effects of a milk allergy and how to treat a reaction if it happens.
Dr. Gellner: Like all food allergies, milk allergy can be difficult to manage in a child. How can you help your child when milk is a common ingredient in so many foods? I’m Dr. Cindy Gellner with some tips for this tricky food allergy on today’s Scope.
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Dr. Gellner: A milk allergy is not the same as lactose intolerance. Lactose intolerance only affects the digestive tract and it cause symptoms such as bloating, gas, and diarrhea. A milk allergy is a reaction by your child’s immune system to the protein in milk. Our immune systems normally respond to bacteria or viruses that attack the body, but sometimes the body’s immune system mistakenly believes that a harmless substance such as the proteins found in milk are harmful.
In order to protect the body, the immune system goes on attack with antibodies against that food. And the next time you eat that food, your immune system releases huge amounts of histamine to protect the body against the evil food proteins. That is what causes the symptoms that make us so miserable.
Casein is the main protein found in milk. It is found in the solid part of milk called curd when the milk goes sour. Whey, which is the liquid that remains once the curd is removed, contains the rest of the proteins. Your child can be allergic to the proteins in the curd, the whey, or both.
In very young children, cow’s milk is the leading cause for allergic reactions. Milk is one of the eight foods that are responsible for food allergies in children. The other foods include eggs, soy, peanuts, tree nuts, wheat, fish, and shellfish. The good news is that most kids outgrow milk allergy by two or three years of age.
If you think your child is allergic to milk, dairy products, or any other food, it is important to get a diagnosis from your pediatrician or an allergist. Usually the history of the reaction is all we need to determine the allergy. But there are blood tests to confirm for some of these foods.
Milk allergies are typically discovered very early in formula and breast-fed babies. If a mother drinks cow’s milk, the milk protein also comes out in her breast milk. The symptoms seen in milk allergy depend on whether or not the child has a slow or rapid reaction to milk.
The slower reaction is more common and the symptoms develop over time. Symptoms that occur slowly over several hours or sometimes days include diarrhea, often with streaks of blood, wheezing, rashes like eczema flares, and failure to grow very well. Symptoms that occur rapidly within seconds to hours may include severe wheezing, vomiting and hives.
If a mom is nursing, the pediatrician will most likely recommend avoiding milk products to the mom and taking calcium and vitamin D supplements instead. If your baby is formula fed, sometimes pediatricians will recommend a soy-based formula. These formulas contain soybean proteins, vitamins and minerals. The switch to soy formula helps for about half of the baby’s allergic to milk. For those babies who still have reactions to milk proteins, pediatricians recommend hypoallergenic formulas. There are two types.
Hydrolyzed formulas contains proteins that have been broken down so they are easily digested and less likely to cause a reaction. These include Nutramigen, Alimentum and Pregestimil. Elemental formulas have proteins in their simplest form and are used when hydrolyzed formulas continue to cause symptoms. These include Neocate and EleCare.
The only treatment for a child with a milk allergy is to completely avoid milk and foods that contain milk products. Many processed food and restaurant foods contains milk or processed milk products. And you will need to change the way you shop and prepare foods.
The first step is to learn how to read labels and become familiar with ingredients that contains milk or dairy products. Always ask about ingredients if you are not sure. Foods and ingredients that contain milk include milk from other animals such as a goat, as well as yogurt, cheese, cottage cheese, cream, anything with casein or whey, butter and sadly chocolate. And also be careful of any ingredients that begin with “lac” such as lactose, lactate, lactalbumin, and lactic acid, and also fat replacers such as Simplese.
Reading labels to avoid allergens has become a lot easier. Foods that contain common allergens must be listed in plain language on the ingredient list. There are still some things to watch out for when reading food labels. Watch out for the words “may contain”. Milk may not be an ingredient but the food may be made in a factory which also produces foods made with milk. If you see the words “may contain,” there may be very little of the allergen or there may be a large amount.
A common question from parents is how to avoid cross contamination. Avoid battered or fried foods. The oil is often used for many different items, some of which may contain milk. Separate cooking utensils, cutting boards, and dishes used to prepare dairy products from those used to prepare food for your child.
Your child can still have a healthy diet as well as continue to enjoy some kid favorites. The main nutrients found in milk are protein, calcium, vitamin D and riboflavin. It is important to either take supplements or eat foods that are high in these elements. There’s a lot of protein in milk, poultry, pork, fish, beans, nuts, and seeds. Ask your pediatrician about calcium and vitamin D supplements. Good sources of riboflavin are meat and eggs, whole grain or enriched cereals, and dark green leafy vegetables. Many foods such as bread and orange juice are now supplemented with calcium and vitamin D.
There are several brands of soy and rice milks that are enriched with calcium. They can be used for drinking and to pour on cereal. If milk is part of a recipe just to provide liquid, you can substitute water. Soy and rice milk, as well as fruit juice works well when substitutes baking. Oils, milk-free margarines, and soy butter can take the place of butter.
You can also visit foodallergy.org where there are many other helpful tips. Prepare your child’s lunch at home. Talk with teachers about your child’s needs. Ask the teachers to keep an eye out and explain the situation to other children if needed. Have the teacher call you if there is a special event or party planned so that you could bring a few modified treats that your child enjoys and can share with other kids. Make a card that lists foods and ingredients that should be avoided and give one to the teacher.
Living with food allergies is possible. I’m proof of that. By making others aware of your child’s food allergy, you will keep your child safe. If your child is old enough, even as young as three or four, make sure they are aware of their food allergy. This will empower them to be in charge of their own health.
The day after my birthday at the end of August, I went out for supper with my family at our favorite brew pub in our small town, just prior to a Bluegrass concert we were playing at the Times Square Gazebo. I asked the waitress to exclude dairy from preparing both my food and the food of my daughter’s 15-year-old boyfriend. The young man had been allergic to dairy all his life and knew how to manage it — he never ate when out. I’ve developed a dairy allergy in the last three months after being a happy milk drinker and ecstatic consumer of stinky cheese for almost every one of my 46 years, from breast milk to sheep, goat, cow to mare and camelid.
It wasn’t until I got home that night and felt the rash literally all over my body, that I realized the sheen of oil on the bottom of my plate must have been butter. So that was why I required three different inhalers to play the concert and was breathless by the end! Lucky I didn’t land in the hospital. I’ll be having an uncomfortable discussion with the restaurant owner this evening. I will itch for days despite heavy doses of anti-histamines. I am still in breathing distress.
Most people don’t know this, but you can acquire an allergy at any time in your life, even if you’ve never had one before. Any time your body undergoes a biochemical shift, you can get allergies. The most likely times are the change from infant to toddler, toddler to child, child to adult (puberty), pregnancy, and adult to old age (menopause). I’m undergoing the last shift a bit earlier than most women. I’ve always had allergies, but as they go, my sensitivity to dairy products is among the most severe of them: anaphylaxis. Any time I ingest dairy, the allergy could flare to life-ending proportions. Allergies are unpredictable like that.
The hard truth: If I don’t have a $700 Epi-Pen on me, I could die.
I have to stop eating dairy. All of it. I don’t look forward to this new way of eating with much enjoyment, to be honest. Some of the things I loved most are lost to me forever. I cried over chocolate and blessedly found a non-allergen substitute. It doesn’t taste very good, but at least it’s chocolate. I’ve cried over Parmesan cheese and triple-cream Brie, over cream-cheese-and-olives and creamed-chipped-beef on toast, which my father taught me to love and I taught my children to love, which have always meant “family” to me. I’ve cried over my secret Bleu cheese salad dressing. I have to do without them. I’ve found myself sitting outside the ice cream shop, after buying my daughter a cone, weeping. I didn’t become a person “of size” by not loving food, not having addictive food behaviors and emotional attachments to food. Eating even a scraping of dairy means a week of tightness in my lungs, throat and chest, and crawling skin. Somehow, I have to do this.
So as my children go back to homeschooling, I’m learning how to eat all over again. I cope with multiple disabilities: two genetic diseases and a congenital defect all of which cause widespread physical pain and fatigue. I can barely cook at home because I don’t have the energy. I can’t eat out now, in terror of inattentive cooks and vastly underpaid food workers. Food labels have taken on a whole new importance, as have complicated chemical names I must memorize with my sieve-like Fibro-brains. I make constant errors and itch nine days out of 10. I was barely coping with my health issues before.
When a baby is allergic to milk, it means that his or her immune system , which normally fights infections, overreacts to proteins in cow’s milk. Every time the child has milk, the body thinks these proteins are harmful invaders and works hard to fight them. This causes an allergic reaction in which the body releases chemicals like .
Cow’s milk is in most baby formulas. Babies with a milk allergy often show their first symptoms days to weeks after they first get cow milk-based formula. Breastfed infants have a lower risk of having a milk allergy than formula-fed babies.
People of any age can have a milk allergy, but it’s more common in young children. Many kids outgrow it, but some don’t.
If your baby has a milk allergy, keep two epinephrine auto-injectors on hand in case of a severe reaction (called anaphylaxis). An epinephrine auto-injector is an easy-to-use prescription medicine that comes in a container about the size of a large pen. Your doctor will show you how to use it.
What Are the Signs & Symptoms of a Milk Allergy?
In children who show symptoms shortly after they have milk, an allergic reaction can cause:
- trouble breathing
- throat tightness
- stomach upset
- itchy, watery, or swollen eyes
- a drop in blood pressure causing lightheadedness or loss of consciousness
The severity of allergic reactions to milk can vary. The same child can react differently with each exposure. This means that even though one reaction was mild, the next could be more severe and even life-threatening.
Children also can have:
- an intolerance to milk in which symptoms — such as loose stools, blood in the stool, refusal to eat, or irritability or colic — appear hours to days later , which is when the body has trouble digesting milk
If you’re not sure if your child has an intolerance versus an allergy, talk to your doctor.
If Your Child Has an Allergic Reaction
If your child has symptoms of an allergic reaction, follow the food allergy action plan your doctor gave you.
If your child has symptoms of a serious reaction (like swelling of the mouth or throat or difficulty breathing, or symptoms involving two different parts of the body, like hives with vomiting):
- Give the epinephrine auto-injector right away. Every second counts in an allergic reaction.
- Then, call 911 or take your child to the emergency room. Your child needs to be under medical supervision because, even if the worst seems to have passed, a second wave of serious symptoms can happen.
How Is a Milk Allergy Diagnosed?
If you think your infant is allergic to milk, call your baby’s doctor. He or she will ask you questions and talk to you about what’s going on. After the doctor examines your baby, some stool tests and blood tests might be ordered. The doctor may refer you to an allergist (a doctor who specializes in treating allergies).
The allergist might do skin testing. In skin testing, the doctor or nurse will place a tiny bit of milk protein on the skin, then make a small scratch on the skin. If your child reacts to the allergen, the skin will swell a little in that area like an insect bite.
If the allergist finds that your baby is at risk for a serious allergic reaction, epinephrine auto-injectors will be prescribed.
Avoiding a Milk Allergy Reaction
If You’re Breastfeeding
If your breastfed infant has a milk allergy, talk to the allergist before changing your diet.
If You’re Formula Feeding
If you’re formula feeding, your doctor may advise you to switch to an extensively hydrolyzed formula or an amino acid-based formula in which the proteins are broken down into particles so that the formula is less likely to trigger an allergic reaction.
You also might see “partially hydrolyzed” formulas, but these aren’t truly hypoallergenic and can lead to a significant allergic reaction.
If you’re concerned about a milk allergy, it’s always best to talk with your child’s doctor and work together to choose a formula that’s safe for your baby.
Food intolerance and food allergies often produce similar symptoms, but they’re not the same. If dairy products leave you feeling gassy and bloated or cause diarrhea or nausea, you may have either condition.
What’s the difference? A dairy allergy is an immune system response to milk protein. In addition to feeling bloated or causing diarrhea, symptoms of a dairy allergy can include hives, wheezing, vomiting, cramps, and skin rashes. Dairy intolerance results from inadequate levels of lactase, the enzyme that breaks down milk sugar. While lactose intolerance can cause a lot of discomfort, it isn’t life threatening, while a milk allergy can be.
The severity of lactose intolerance varies. For some people, consuming any dairy product causes their digestive tracts to rebel. Others can enjoy yogurt, ice cream, or even an occasional glass of milk.
The most successful approach to coping with lactose intolerance is to first avoid all dairy products. If you are lactose intolerant and love milk in all its forms, try experimenting with small amounts of dairy. In general, yogurt, cheese, and sour cream may be easier to tolerate because they contain less lactose than milk. However, several studies suggest that many people who are lactose intolerant can consume the equivalent of eight ounces of milk with no ill effects, and somewhat more when the lactose-containing food is part of a meal.
Supplements containing enzymes produced by lactose-digesting bacteria (Lactaid, Lactrase, others) can be taken as tablets or added to foods. Some milk products (Lactaid, Dairy Ease) to which lactase has been added may contain little or no lactose, and they may taste sweeter than untreated products, because the milk sugar has already been broken down. Probiotics (supplements of beneficial bacteria that normally inhabit the intestines) containing Lactobacillus reuteri may reduce symptoms, but not quite as well as enzyme supplements.
The response to these products is highly individual. What works for your will depend on the amount of lactase your body produces, the type of intestinal bacteria that inhabit your colon, and the product itself. Finding the right approach for you can be a trial-and-error process. While this may take some time and expense, experimenting isn’t likely to be harmful.
For more on food intolerances, buy The Sensitive Gut, a Special Health Report from Harvard Medical School.
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Cow’s milk protein allergy is one of the most common food allergies seen in children. It is most commonly seen during the first year of life. Many children who have been allergic to cow’s milk protein become tolerant to it by the time they are 5 years old.
Cow's Milk Protein Allergy
In this article
What is cow’s milk protein allergy?
Cow’s milk protein allergy is an allergic condition which is triggered by drinking cow’s milk or by drinking or eating products made from cow’s milk.
- Skin symptoms, such as rashes and eczema
- Gut (digestive tract) symptoms, such as feeling sick (nausea), being sick (vomiting) and abdominal (tummy) pain
- Breathing (respiratory) symptoms, such as a runny nose and wheezing.
The symptoms are often vague and sometimes it is very difficult for a definite diagnosis to be made.
Cow’s milk protein allergy occurs in about 7% of babies who have formula milk, but in only about 0.5% of exclusively breast-fed babies, who also usually have milder reactions. Exclusive breast-feeding may also protect babies from developing an allergy to cow’s milk protein after they are weaned.
Cow’s milk protein allergy is more likely in children who have other allergic (or atopic) conditions such as asthma, eczema or hay fever, or if close family members have those conditions.
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Allergic reactions to milk
There are two different processes which cause allergic reactions in the body; cow’s milk can trigger either of these in some people. Some people develop symptoms of both types of reaction.
Non-immunoglobulin E-mediated reactions (non-IgE-mediated allergy)
These are slow reactions which can occur hours, or more usually days, after consuming milk. There can be a skin reaction such as eczema, tummy (abdominal) symptoms such as pain, reflux or colic or breathing (respiratory) symptoms.
The best way to find out if the child has this kind of allergy is to exclude cow’s milk from their diet. Milk needs to be excluded for at least two weeks, as the symptoms caused by slow reactions also take quite a long time to settle. If the symptoms settle when milk is removed from the diet, a challenge test can be done in which the child has a small amount of milk. If the milk causes the same reaction as before, the diagnosis can be confirmed. It may take several days for the reaction to show. A challenge test can be repeated every few months, as the child is likely to grow out of this allergy with time.
For babies who are bottle-fed, there is special formula milk available on prescription. This has the proteins broken down so that they do not cause the allergic reaction.
Mothers who are breastfeeding need to exclude milk and milk-containing foods from their diet. They should be prescribed a supplement of calcium and vitamin D, so that they don’t become deficient in these nutrients.
Older babies and children who are on a cow’s milk-free diet for confirmed allergy should see a specialist children’s (paediatric) dietician who can make sure the diet is balanced and contains enough calcium.
It is important to read the labels on food that you buy. Some milk products which are used as ingredients may have names such as casein, whey or curd. More familiar dairy products such as butter, yoghurt and cheese are also found in many packaged foods.
Most children with this kind of allergy grow out of it by the time they are 3 years old.
Immunoglobulin E-mediated reactions (IgE-mediated allergy)
These are usually fast reactions which can cause skin rashes and needing to be sick (vomiting). They occur within two hours of the milk being consumed. They are triggered by the body releasing a chemical called histamine, so antihistamine medicine can be used to treat the symptoms. It is extremely rare that cow’s milk causes a life-threatening anaphylactic reaction.
This type of allergy can be diagnosed with a skin prick test or a blood test. If this type of allergy is suspected, the child would usually be referred to a children’s doctor (paediatrician) who would arrange for the test to be done in hospital.
Most children with this kind of allergy grow out of it by the time they are 5 years old. If the reaction has been severe, it may be safest to carry out a challenge test in hospital.
A referral to a paediatrician should be made for either type of reaction if:
- The child is not growing well.
- There have been any severe reactions.
- Multiple food allergy is suspected.
Mixed IgE- and non-IgE-mediated allergy
Sometimes there can be a mixture of the two types of allergic reaction. This causes a combination of the two types of allergic responses.
If cow’s milk protein allergy is suspected then your doctor can prescribe formula milk suitable for your baby. There are several different types of milk available.
Extensively hydrolysed milk is usually tried first. The protein in hydrolysed milk is broken down (hydrolysed) into smaller pieces so that it does not trigger a reaction. Examples of hydrolysed milks are Similac Alimentum®, Nutramigen Lipil® 1 and 2 and Pepti® 1, 2 and Junior.
If a baby is still having symptoms on a hydrolysed formula then they can try an amino acid (AA) formula. This is sometimes tried first if the allergy is severe or if there are multiple allergies. The protein in AA formula is completely broken down into its smallest units, called amino acids. This should prevent any cow’s milk protein reaction occurring. Examples of amino acid formulas are Neocate® and Nutramigen® AA.
Under the age of 6 months, babies should have either breast milk or specially developed infant formula milk. This should remain their main drink up to the age of 1 year.
Some people give their children goat’s milk or other types of milk which are believed to be more easily digestible than cow’s milk. In fact, the proteins in other available mammal milks are very similar to those in cow’s milk. Therefore, changing to goat’s milk rarely causes improvement in confirmed cow’s milk protein allergy.
Using milk which is low in a sugar called lactose and found in milk will not be helpful. This is because it is the protein and not the lactose in cow’s milk which is causing the problem.
Soya milk is not generally recommended for children who are allergic to cow’s milk. Soya is another common cause of childhood food allergies and those who have one allergy are more likely to develop others. It should not be used as a main drink for babies aged under 6 months. However, it may be recommended by a healthcare professional after that time if the child is not allergic to it.
What is lactose intolerance?
Lactose intolerance is a different condition from cow’s milk protein allergy. It occurs because the body cannot digest a sugar called lactose found in milk, rather than a protein. It is very common worldwide but tends to develop in later childhood or in adulthood.
Lactose intolerance is the inability to digest the main sugar found in milk and other dairy products. This is caused by a deficiency of lactase, the enzyme responsible for metabolizing lactose in the small intestines, according to the National Institutes of Health (NIH).
The prevalence of lactose intolerance in adults varies from less than 5 percent to almost 100 percent among different populations, according to research published in the Scandinavian Journal of Gastroenterology. The lowest prevalence is in northwestern Europe, around the North Sea, and the highest prevalence is in Asians and American Indians. About 30 million American adults are somewhat lactose intolerant by the age of 20, according to the NIH.
People can acquire lactose intolerance at any point in their life, and some people develop it over time, said Dr. Sophie Balzora, a gastroenterologist at NYU Langone Medical Center in New York City.
Lactose intolerance is different from having a milk allergy, since the latter is a reaction to the proteins in milk rather than lactose. It’s also not like celiac disease, an autoimmune disease caused by gluten, which can have detrimental effects if ingested.
Symptoms and causes
People can be genetically predisposed not to produce the lactase enzyme, or the condition can result from illness or injury to the small intestine, including surgery or infections, according to the NIH.
In lactose-intolerant adults, the lactose is fermented and metabolized by bacteria in the colon to produce gas and short chain fatty acids. This results in abdominal cramps, bloating, diarrhea, flatulence and nausea, Balzora said. The severity of symptoms largely depends on how quickly the lactase available in the digestive system is used up.
Although reduced levels of lactase could result in improper absorption of lactose, only people with low lactase levels who exhibit the common symptoms would be properly considered lactose intolerant. According to the Mayo Clinic, most people with lactase deficiencies do not display any signs or symptoms.
Premature babies can also be intolerant to breast milk, but full-term babies don’t show signs of the problem before the age of 2, according to the NIH. The intolerance can develop earlier in African American children than in Caucasian ones.
Diagnosis & tests
Lactose intolerance should be suspected in people with abdominal symptoms — such as cramps and bloating — after consuming milk and other dairy products. The symptoms usually appear 30 minutes to two hours after ingesting a milk product.
The initial diagnosis of lactose intolerance can be very simple.
“The quick and dirty way is to have a patient avoid lactose products for a certain amount of time,” usually about two weeks, Balzora said. Then, these foods can be gradually reintroduced into the diet again, and if the symptoms return, the person is likely somewhat lactose intolerant, she said.
Most patients do not need a referral to a specialist, or diagnostic laboratory tests. However, the symptoms of lactose intolerance can overlap with other gastrointestinal problems, such as irritable bowel syndrome and Crohn’s disease. A hydrogen breath test is an objective, non-invasive, inexpensive and easy-to-perform test that can be used to confirm an initial diagnosis of lactose intolerance. A properly administered breath test can help patients determine whether they need to cut back on milk and dairy products, according to research published in the World Journal of Gastroenterology.
Treatment & medication
Cutting lactose out of the diet is an option, but patients should make sure they aren’t depriving themselves of calcium and vitamin D, Balzora said.
A study published in the June 2017 issue of the Journal of Nutrition found that those with lactose intolerance that cut milk out of their diet have lower levels of vitamin D in their blood. This study of 1,495 Canadian men and women also found that those who cut out milk were also shorter.
Over-the-counter pills or drops that contain lactase can be taken before meals to help alleviate or eliminate symptoms. For example, Lactaid pills or Lactaid milk allow many people to process dairy products without any difficulty, Balzora said. Some people find that taking probiotics can help them digest lactase better, but Lactaid is really the standard, Balzora said.
However, according to the Mayo Clinic, these products do not help all patients. Adults who are lactose intolerant can ultimately recondition their digestive system to tolerate up to 8.5 fluid oz. (250 milliliters) of milk — about a glass — if they drink the milk in gradually increasing amounts. According to a 21-day intervention study conducted in 2000, most people who do this will experience minimal or no discomfort.
A 2017 study by scientists at the North Carolina School of Medicine and North Carolina State University found that probiotics may also be a useful treatment. The study, published in the journal Proceedings of the National Academy of Sciences, found that 70 percent of those that took prebiotics for 35 days had reduced abdominal pain when they resumed drinking milk. Ninety percent of the subjects showed a significant increase in lactose fermenting bacteria, as well.
Lactose intolerance can be treated with simple dietary changes. The most straightforward way is for a person to reduce the amount of milk or daily products in his or her diet. Also, it may help to divide daily milk and dairy products into several small portions and consume them with other foods. Processed dairy such as yogurt and cheeses are usually better tolerated, because the lactose has been partially metabolized by bacteria during their preparation.
Foods high in lactose, according to The Cleveland Clinic, are:
- Milk, milkshakes and other milk-based beverages
- Foods made with milk
- Whipping cream and coffee creamer
- Ice cream, ice milk, sherbet
- Puddings, custards
- Cream soups, cream sauces
There are many products on the market that are lactose-free. This is a good option for those that don’t want to give up their favorite milk products. There are more options on the way. The lactose-free food market is predicted to grow 11.10 percent between 2017 and 2021.
There are also other options, such as rice, soy and almond milk, that can be used as an alternative to cow’s milk. Additionally, there are some milk products that can be easier to digest. According to the NIH, they include:
- Buttermilk and cheeses
- Fermented milk products, like yogurt
- Goat’s milk
- Ice cream
- Aged or hard cheeses
Additional reporting by Alina Bradford, Live Science Contributor.
Cow’s milk contains over 25 different molecules, which have the potential to elicit an allergic reaction. No wonder milk is repeatedly ranked among the top eight offenders for food allergies! In fact, many doctors, scientists, and health specialists recommend going dairy free as an initial test when a food allergy is suspected.
What Exactly is a Milk Allergy?
Although they are often muddled together in conversation, milk allergies and lactose intolerance are quite different. A food allergy is identified as an abnormal and heightened response of the immune system to certain components (most notably proteins) within a food. In milk, the two leading allergy offenders are the milk proteins known as casein and whey. Casein is the curd that forms when milk is left to sour. Whey is the watery part that is left after the curd is removed. A food intolerance is when you develop symptoms after eating a food that your body can’t cope with effectively, but it does not involve an immune response. Head to our Lactose Intolerance section to read more on this topic.
Some scientists believe that there is only one type of “true food allergy” while others report studies of two, three, and even four variations of food allergies. For simplicity sake we will just note the two most commonly sited allergy categories: immediate hypersensitivity reaction and delayed hypersensitivity reaction. In immediate hypersensitivity situations symptoms may begin to appear within minutes of ingesting the offending food. Like the way your friend’s Aunt Martha blows up like a balloon the second she takes a bite of that chocolate bar laced with peanuts. Delayed hypersensitivity reactions have received little attention until recently, so not too much is known about them as of yet. It is believed that these types of reactions elicit a different response from the immune system than the immediate hypersensitivity. With delayed hypersensitivity, symptoms have an onset time of 6 to 24 hours after eating an offending food, tend to reach their peak at about 48 hours, and gradually subside over 72-96 hours. For both immediate and delayed reactions, symptoms may be very mild, and even go unnoticed (i.e. rash or eczema), or they may be quite severe (i.e. Aunt Martha).
How Common are Milk Allergies?
It was previously thought that milk allergies occurred only in infants, and that the problem subsided prior to adulthood. Unfortunately, for many of us this just isn’t so. The numbers are all over the board, but it is estimated that anywhere from 2 to 7.5% of infants have an allergy to cow’s milk. Studies show that approximately 60% of infants allergic to cow’s milk will “outgrow” the allergy by the age of 4, 80% by the age of 6. Bonus for those people, but this leaves up to 4.5 million people in the U.S. alone with a potential milk allergy. This is more than “just a few” people by our estimates. To complicate things further, it seems that it is possible for adults to develop a milk allergy with no childhood history of allergies. Another interesting fact, symptoms associated with milk allergy have the potential to morph over time. One study followed a group of milk allergic children and found that at the beginning of the study most of the children had primarily gastrointestinal symptoms (vomiting, diarrhea), but by the end of the study, many had switched over to respiratory symptoms such as wheezing.
What are the Symptoms of Milk Allergies?
Similar to other food allergies, the majority of milk allergy symptoms can be lumped into three “reaction” categories:
Skin: Itchy, Red Rash; Eczema; Hives; “Shiners” or Black Eyes; Aphthous Ulcers (canker sores) Swelling of the Lips, Mouth, Tongue, Face, or Throat.
Digestive: Abdominal Pain; Abdominal Cramps; Abdominal Bloating; Diarrhea; Gas; Nausea; Vomiting.
Respiratory: Runny Nose / Congestion; Sneezing; Watery Eyes; Itchy Eyes; Coughing; Wheezing; Shortness of Breath; Recurrent “colds”; Sinusitis.
To the pleasant surprise of many “psychological” sufferers, current research has uncovered a fourth category of symptoms, known as Behavioral. Many doctors now believe that food allergies, including dairy, could be a direct cause of fatigue, migraine headaches, hyperactivity (ADHD), irritability, night-waking, anxiety, and sore muscles and joints.
As noted above, these symptoms may be mild or severe and life threatening; they could appear immediately or over a period of several days; and they may vary in response based on mild, moderate, and large quantities of milk intake.
For those unlucky few, anaphylaxis is a reality. Anaphylaxis is a systemic allergic reaction that may involve multiple areas of the body, including the skin, cardiovascular system, respiratory tract, and gastrointestinal tract. Symptoms are sudden, and may come on immediately or up to four hours after coming in contact with the allergen (in this case milk). Anaphylactic reactions can be mild. However, some cases are potentially fatal, and therefore require urgent medical attention. If you are concerned that you or a loved one may be at risk for anaphylactic reactions, refer to the Food Allergy & Anaphylaxis Network (FAAN) for additional information.
How Do I Know if I Have a Milk Allergy?
There are many different types of clinical allergy tests available, all with varying levels of effectiveness, but many doctors are moving towards elimination diets. An elimination diet can easily identify a negative effect to a food, whether it is an allergy, intolerance, or a pure mystery, regardless of what the individual test results say. Doctors and patients are often pleased with this method as it is simple, free, highly effective, and tailored to the individual. This is where our Dairy Free Challenge comes into play; it is a personal “elimination” test for milk.
Can Milk Allergies Be Treated?
As with most allergies, avoiding the offending substance is the top recommended treatment. Utilize the many guides and resources this site has to offer, in order to make it an easy and enjoyable transition.
When you’re lactose intolerant, eating dairy products can bring on a whole host of unpleasant symptoms.
What is lactose?
Lactose is the naturally-occurring sugar found in milk and most dairy products (just like fructose is the sugar found in fruit). Lactose and fructose are different from added sugar, which is added during cooking or processing.
What does it mean to be “lactose intolerant?”
Most people have an enzyme in their gut called lactase, which helps to digest lactose. People with lactose intolerance don’t have enough lactase to fully digest lactose, so they get stomach aches, bloating, gas or diarrhea after eating dairy products.
Is lactose intolerance the same as a milk allergy?
No. These two conditions are completely different. A milk allergy is an allergy to the protein component in milk, whereas lactose intolerance is an inability to digest the sugar component of milk. Here’s more on the difference between an intolerance and allergy.
What can you do if you’re lactose intolerant?
Different people have different levels of sensitivity to lactose. Some people may react severely and decide to avoid dairy altogether, whereas others can tolerate dairy in small amounts. Here are a few options for how to deal:
- Buy lactose-free milk, cream, ice cream, etc.
- Eat dairy products in small amounts.
- Choose low-lactose dairy products, like yogurt, kefir and aged cheeses.
- Take a lactase pill, like Lactaid, before eating dairy.
- Avoid processed foods that contain whey protein concentrate and other dairy derivatives.
- Avoid dairy products altogether.
It may take some trial and error to see which of these options will work best for you. Writing down exactly what you eat and when you experience symptoms for a few weeks can help you determine what most triggers your symptoms.
What can you eat if you’re lactose intolerant?
- Yogurt. Most people with lactose intolerance can eat yogurt. The good bacteria (live, active cultures) found in yogurt will help digest the lactose for you. Choose a high quality yogurt or Greek yogurt (here’s a guide to help) with very few ingredients.
- Kefir.Kefir is like a drinkable yogurt, but with even more probiotics for even better digestion.
- Aged cheeses. The harder a cheese, the less lactose it has. Lactose is found in the watery part of milk, and since harder cheeses have less liquid, they naturally contain less lactose. Extra sharp cheddar, Parmesan, Pecorino, aged gouda and other very hard cheeses are nearly lactose-free.
- Lactase-fortified dairy products. Lactaid is the most well-known lactose-free milk, but many brands now offer similar products, which makes lactose-free life a lot easier. If you like to buy organic, Organic Valley (pictured above) has some great lactose-free organic dairy products.
- Low-fat dairy products in small amounts. Low-fat dairy products can be easier on the system when eaten in small amounts and/or combined with other foods at a meal. (These foods are also higher in protein and calcium than high-fat dairy). Start with small portions so you can see what works for you.
- Dairy products eaten with a lactase pill. Not everyone finds lactase pills helpful, but they’re worth a try. Pop a lactase pill 30-60 minutes before consuming dairy to see if this method works for you. (Note: don’t expect lactase to be a miracle pill…in other words avoid downing a huge milkshake after taking a pill).
What foods should be avoided?
- Large serving sizes of dairy. Even if you’ve found a food that doesn’t cause bad symptoms, small portions are still best. Your body is more likely to tolerate dairy if you eat only a little at a time.
- Very high fat dairy products like ice cream, soft creamy cheeses and cream (or foods made with cream). These actually have less lactose than low-fat products, but tend to be more irritating to those with lactose intolerance or who are sensitive to rich foods. The one exception here is aged cheese, which is high-fat but low-lactose.
- Whey protein concentrate. This is a doozy, because it’s added to a lot of processed foods to make them richer and creamier. But it can wreak havoc on a lactose intolerant person’s system (and on a normal person’s system), because it often contains concentrated lactose.
- Soft-serve ice cream/frozen yogurt. This is mostly because of reason #3. Many soft-serve desserts, smoothies and protein shakes have significant amounts of whey protein concentrate, and can cause bigtime symptoms. If you love ice cream-style desserts, buy real frozen yogurt from the grocery store (Stonyfield, Julie’s Organic, and Straus Family Creamery all contain live active cultures that will help you digest) or make it yourself.
What milk alternatives are best, if I’m going to avoid dairy?
Here’s a chart of milk alternatives so you can decide which give you the best nutritional bang for your buck.
Disclaimer: This advice should not replace the advice of your doctor or medical provider. These are general recommendations and may or may not be appropriate for you or your health conditions.
Cow's Milk Allergy – Understanding What it is and How Long it Lasts
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.
Corinne Savides Happel, MD, is board-certified in allergies/immunology, with a focus on allergic skin disorders. She is a part-time assistant professor at Johns Hopkins School of Medicine.
Verywell / Zorica Lakonic
If your child has an allergy to milk, you may have heard that many children outgrow these allergies. When does this occur? And, importantly, is your child truly allergic to milk in the first place?
Outgrowing a Food Allergy to Milk – How Common and What Age?
Cow’s milk allergy is the most common food allergy occurring in young children, affecting between 2% and 7.5% of kids under age one. Previous studies have shown that a little over half of children will outgrow milk allergy by three to five years of age. That means that a significant proportion of children will continue to be allergic to milk, at least until their adolescent or teenage years, and some may never outgrow their milk allergy.
Is It Really a Milk Allergy?
Your pediatrician may mention the term "allergy" without offering clarification that may help you get a better handle on exactly what your child is facing. Here are the specific types of reactions your child may have to milk:
Classic milk allergy: Classic milk allergy involves both having allergic symptoms within two hours of consuming milk and having the presence of allergic antibodies, or IgE, against various proteins in milk. Allergic symptoms can include hives, swelling, difficulty breathing, nausea/vomiting, diarrhea, and/or anaphylaxis. Presence of antibodies alone does not mean a person has allergy
Food protein-induced enterocolitis syndrome (FPIES): Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE immune-mediated reaction that typically presents with vomiting, diarrhea and/or lethargy around 90 minutes after consuming milk or other trigger. Sometimes milk IgE is elevated but most often it is not. FPIES typically occurs in young infants and is commonly outgrown by age three.
Lactose intolerance: Lactose intolerance is a gastrointestinal syndrome that presents with abdominal discomfort, gassiness, bloating, and/or diarrhea. It is typically caused by insufficient lactase, an enzyme that digests lactose. Replacing lactase enzyme or consuming milk products that have lactose removed, prevents symptoms. Lactose intolerance typically occurs in older children and adults and is less likely to be outgrown.
Diagnosing True Milk Allergy
The diagnosis of true milk allergy may include a combination of a careful history, physical examination, an elimination diet, skin prick tests, specific IgE measurement, and a food challenge test.
Unfortunately, the most sensitive and specific test for milk allergy is a challenge test, having your child drink milk. This involves starting with an elimination diet, followed by an oral food challenge. This is not recommended, however, for children who have had an anaphylactic reaction to cow’s milk for obvious reasons.
Outgrowing True Milk Allergy
Studies over the past decade, in contrast to earlier studies, suggest that outgrowing milk allergy may not be as common as previously thought, and also occurs later in childhood than was expected.
A 2007 study found based on the most accurate definition of milk allergy found that the percentages of previously allergic children who could tolerate milk at various ages were:
- 19% by age four
- 42% by age eight
- 64% by age twelve
- 79% by age 16
Which Children are More Likely to Outgrow Their Food Allergy?
So how can you know if your child is likely to outgrow her allergy or not?
Part of the answer may depend on other allergies your child has. Studies show that children with allergic rhinitis (hayfever), asthma or other common food allergies are less likely to outgrow milk allergy. In addition, children with milk allergy who ever received baby formula during infancy were also less likely to outgrow milk allergy.
As noted under diagnosis, the most sensitive test to determine if a milk allergy is present is not a blood test, but the reaction a child has upon being challenged with the offending food. Unfortunately, some children may never outgrow their milk allergy, and their food allergy may persist into adulthood, or even indefinitely.
Coping with Milk Allergy
It can be difficult to cope with a sensitivity to milk whether it represents a true food allergy, lactose intolerance, or other causes. Because milk products are a common ingredient in many packaged foods, cooking from scratch can be a relatively easy way to avoid hidden sources of milk. Here are some tips on foods and food products to avoid on a milk-free diet.
At the current time, the only treatment available for milk allergy is avoidance, though studies are looking at immunotherapy hoping for other treatments in the future.
Millions of Americans can’t digest a certain sugar in milk and milk products called lactose. If you’re one of them, you have lactose intolerance.
The condition isn’t harmful, but it can be uncomfortable and may be embarrassing. There’s no cure, but you can manage it by watching how much milk or milk products you drink or eat.
Being lactose intolerant is not the same as being allergic to milk.
What Is Lactose?
Lactose is the sugar that’s in milk.
Our bodies use an enzyme called lactase to break down that sugar so we can absorb it into our bodies. But people with lactose intolerance don’t have enough lactase. It’s produced in the small intestine.
Even with low levels of lactase, some people can digest milk products just fine. For people who are lactose intolerant, their low lactase levels gives them symptoms after they eat dairy.
What Happens In My Body If I’m Lactose Intolerant?
When we drink milk or have a milk-based product, lactase in our small intestines breaks down the milk sugar. It then gets absorbed into the body through the small intestines.
But people who are lactose intolerant don’t have it so easy. In them, the lactose doesn’t get broken down. Instead, it goes on to the colon, where it mixes with normal bacteria and ferments. It can cause things like gas, bloating and diarrhea.
The symptoms are no fun, but they’re not dangerous. Most people can manage their symptoms by changing their diet and limiting the amount of lactose they consume. Some people do better by cutting lactose out of their diet altogether.
Your body may be able to handle some lactose without symptoms. Experiment to find out the types and amounts of products with lactose you can eat and drink.
There are some steps you can take to test yourself:
- Go without milk or milk products for a couple of weeks.
- If your symptoms disappear, bring dairy products back into your diet a little at a time to take note of how you react.
- If your symptoms continue after cutting out the dairy — or if they return — see your doctor to find out what’s going on.
Who Develops It?
Believe it or not, most adults around the world can’t digest milk — 40% of humans stop producing enough lactase to digest milk between the ages of 2 and 5.
In the United States, it’s estimated that just over one-third of people are lactose intolerant. It is most common among:
- Asian Americans
- African Americans
- Mexican Americans
- Native Americans
It can also be inherited or associated with other specific diseases.
How Do I Know If I’m Lactose Intolerant?
Our bodies react to milk in ways that are easily measured. Two common tests for adults are:
- Breath test. This will show if you have high levels of hydrogen when you exhale. If you do, you might be lactose intolerant. That’s because hydrogen is given off when lactose is broken down in the colon. The hydrogen gets taken by the blood up to your lungs, and then you exhale it.
- Blood test. This can show how your body reacts after you drink something with a lot of lactose. However, this test is usually not done.
Doctors can also take a stool sample from babies and young children.
What If I Have It?
You may still be able to eat or drink small amounts of milk. Some people do better if they have their dairy with a meal. And, some dairy products, like hard cheese or yogurt, may be easier to digest.
Also, there are lots of lactose-free dairy products at the supermarket. Or you can take commonly found over-the-counter supplements (like Lactaid) to break down the milk sugars if you still want the real thing.
Talk to your doctor about a liquid lactase replacement. These are over-the-counter drops that you add to milk.
But if you give up milk completely, you can still get plenty of calcium, vitamin D and other nutrients in a healthy diet.
Instead of milk, you can substitute these foods:
- Dried beans
- Collards -fortified orange juice and soy milk
- Fatty fish, like salmon, tuna and mackerel
- Egg yolks
- Beef liver
Watch for Hidden Lactose
Always read labels. Many foods have lactose, including snack foods, bakery products, candy, dry mixes, dried vegetables, and infant formulas.
Many medicines also have lactose, which is used as a filler, especially in white tablets. Many birth control pills and medications used to treat gas and stomach acid contain lactose. Your doctor or pharmacist can let you know if any prescription medications you take contain lactose.
Some high-lactose foods to watch out for:
- Milk and heavy cream
- Condensed and evaporated milk
- Cottage cheese
- Ricotta cheese
- Sour cream spreads
Some milk substitutes you could try:
- Soy milk. It’s high in protein, potassium and antioxidants
- Rice beverages
- Lactose-free milk. It’s high in calcium and protein and contains many other vitamins, such as A, B, and K, zinc, potassium and magnesium
- Almond milk
- Coconut milk
If you have symptoms of lactose intolerance, see your doctor. And if you’re diagnosed with it, talk with them about how to be sure you’re eating right.
Cleveland Clinic: “Lactose Intolerance.”
Mayo Clinic: “Lactose intolerance.”
Johns Hopkins Medicine: “Lactose intolerance.”
National Institutes of Health: “Lactose intolerance.”
National Institutes of Health: “Evolution of lactase persistence: an example of human niche construction.”
National Institute of Diabetes and Digestive and Kidney Diseases: “Definition & Facts for Lactose Intolerance.”
Foodreactions.org: “Hidden Milk and Lactose.”
Go Dairy Free: “How to Substitute Milk (Skim, Low Fat, Whole).”
International Foundation for Functional Gastrointestinal Disorders: “Lactose Intolerance.”