Allergy - Milk allergy and milk free diet

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

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How common is cow’s milk allergy?

Cow’s milk allergy is one of the most common food allergies in childhood affecting about 1-2% of preschool children. Cow’s milk allergy is much less common in school age children (less than 0.1%). It is often due to allergy (IgE) antibodies against milk proteins. These antibodies can be detected with an allergy test such as a skin prick test. Not all children with a positive milk allergy antibody test develop reactions on having milk or foods containing milk. If your child has a positive allergy test but has never had milk, your doctor will discuss with you the chance of developing a reaction if there is exposure to milk.

What are the symptoms of cow’s milk allergy?

Reactions can range from mild to severe. Mild to moderate reactions consist of any one or more of the following:

  • Hives or welts
  • Swelling of the lips/face/eyes
  • Tingling of the mouth
  • Abdominal pain or vomiting.

Severe reactions (anaphylaxis) include one or more of the following: 

  • Difficulty/noisy breathing
  • Swelling of the tongue
  • Swelling or tightness in the throat
  • Difficulty talking and or hoarse voice
  • Wheeze or persistent cough
  • Persistent dizziness or collapse, pale and floppy (in young children)

It is rare (but possible) for these symptoms to occur alone without hives and/or vomiting. Very rarely, very sensitive individuals have died from a severe allergic reaction to milk.

Milk can also cause delayed reactions which are not due to IgE allergy antibodies. These delayed reactions can have symptoms such as worsening of eczema, diarrhoea and vomiting.

How is cow’s milk allergy diagnosed?

In most cases the symptoms of cow’s milk allergy start soon after drinking milk or eating foods containing milk (a few minutes to 1-2 hours). The presence of allergy IgE antibodies to milk can be confirmed by an allergy skin prick test or a blood test (called a RAST test). Not every child with a positive allergy test will develop symptoms when exposed to milk and the test should be discussed with your doctor.

Allergy skin tests and blood tests are not helpful in diagnosing delayed reactions to milk. These delayed reactions can only be diagnosed by a process of removing foods containing milk from the diet and rechallenge if the symptoms resolve. Milk based foods should not be removed from your child’s diet without the advice of your doctor and the assistance of a Dietitian.

Is lactose intolerance the same as milk allergy?

No. Lactose intolerance occurs because the sugar in milk (lactose) cannot be completely digested (broken down) in the bowel. The usual symptom is diarrhoea. A formula without any lactose (e.g. lactose-free infant formula) used to treat lactose intolerance can still cause milk allergy.

Can my child grow out of milk allergy?

Most infants and young children will grow out of their milk allergy. Children with the delayed reactions (not caused by IgE antibodies) are more likely to outgrow their milk allergy at an earlier age than children with milk allergy due to IgE allergy antibodies. Approximately 90% of children with delayed and 50% with immediate reactions will grow out of their allergy by 3-5 years of age. Those children who have had more severe immediate reactions with breathing problems may be less likely to outgrow their allergy than children with milder reactions. Your doctor can determine whether your child has outgrown immediate milk allergy by monitoring the allergy tests every 12 months or so.

Is my child likely to have a severe reaction from casual contact with milk product on benches, other children's hands or by smelling milk?

No. Severe reactions from casual contact are extremely rare.

Can I prevent milk allergy in my future children?

There are no steps which can guarantee a child will not develop milk allergy.  Avoiding cow’s milk during pregnancy and breastfeeding is not recommended, as this has not been shown to prevent allergies.

What is an Epipen?

Epipens are emergency devices called adrenaline autoinjectors that inject a dose of adrenaline into the muscle. They are used to treat severe allergic reaction (anaphylaxis). The drug adrenaline reverses the severe allergic reaction and can be lifesaving.

Should my child carry an adrenaline autoinjector?

All allergists agree that children who have had a serious reaction with involvement of the breathing passages should have an adrenaline autoinjector. The need for other children to have an adrenalin autoinjector depends on a number of factors which should be discussed with your doctor.

If you have an adrenaline autoinjector it is very important that you understand how and when to use it and that you have a written anaphylaxis action plan provided by your doctor.

Milk free (Dairy Free) diet

  • Cow’s milk (dairy) is found in many foods and often in foods we don’t expect e.g. margarine, bread and some soy yoghurts
  • Unless the doctor says otherwise, all cow’s milk (dairy) needs to be strictly avoided
  • Usually children who react to cow’s milk will also react to goat’s milk and milk from other animals.
  • Children sensitive to cow's milk are not usually sensitive to beef. 

How do I avoid exposing my child to milk?

Milk or milk products may be found in foods we don't always expect them to be in. It is important to:

  • Understand the different words used to describe cow’s milk or dairy products e.g. butter, buttermilk, cream, curd, ghee, milk, cheese, dairy, milk solids, whey, yoghurt, casein and caseinates. The following food will contain milk:

Butter

Buttermilk

Casein and caseinates

Cheese

Cheese powder

Condensed milk

Cottage cheese

Cream

Curds

Custard

Dairy solids

Hydrolysates (casein, milk protein, whey)

Evaporated milk

Ghee, butter oil, butter fat

Goat's and sheep's milk

Ice cream

Infant formula (cow’s milk based)

Low fat milk

Malted milk

Milk

Milk derivative

Milk protein                       

Milk solids

Non-fat dairy solids

Non-fat milk solids

Nougat

Pro-biotic drinks

Skim milk

Skim milk solids

Sour cream

Sour milk

Whey

Yoghurt

  • Learn to how to read food labels carefully- always check the food list on the label even if it says” dairy-free”, or is a product you have used before.
  • avoid foods that don’t have a food label or that you haven’t made yourself, as there is no guarantee that the food doesn’t contain milk

  • plan eating out and travelling and talk to staff serving you about your child’s allergy
  • avoid food that is served using spoons/tongs that are also used to serve food containing milk (e.g. ice-cream shops)
  • prepare safe meals at home for your child to take out
  • teach your child about their allergy

What about foods with a label that says "may contain traces of milk"?

Some foods may carry a warning on the label "may contain traces of milk". This usually indicates that the food is made in a facility that also makes a food containing milk. Discuss what to do about these foods with your doctor.

What about baby formula?

The most commonly used formula are made from cows’ milk proteins and will cause reactions in cows’ milk allergic children. Hypo-allergenic formulas (HA are not appropriate for babies with diagnosed milk allergy. Some infant formula are made from soy and do not contain milk. Soy based formulas are suitable for many infants who are allergic to cows’ milk.  

There are special formulas made for milk allergic children that can be prescribed by your doctor if your baby cannot have a soy formula.

Is low fat, skim or A2 milk less likely to cause an allergic reaction?

No. The allergy producing part of the milk is in the protein not the fat part of the milk.

Is goat or sheep milk a good alternative?

No. There is a lot of overlap in the allergy causing parts of goat and sheep milk and cows’ milk. 90% of children will react to these milks if they are cows’ milk allergic.

Is your child getting enough calcium?

Cow’s milk and dairy products are the main source of calcium in our diet. When it isn’t possible to use cow’s milk it is essential to make sure your child gets it from other sources such as calcium fortified soy milk. You need to discuss other options with your doctor and possibly a dietician to ensure your child meets their daily requirement for calcium that is so important for your child growing up.

Some suitable Cow’s milk replacement are listed below:

Instead of:

Use

Cow’s milk infant formula for a child less than  I year of age

Breast milk, soy formula, hydrolysed formula or amino acid formula.

Speak with a medical professional to choose the right one based on your child’s diagnosis

Cow’s milk - for a child over 1 year of age

Soy drink - choose one with more than 120mg calcium /100mls soy drink

Rice drink – choose one with more than 120mg calcium /100mls rice drink

Yoghurt

Soy yoghurt

Cheese, sour cream

Soy cheese, soy sour cream

Ice cream

Soy ice cream, sorbet, milk free gelato

Butter and margarine

Milk free margarine eg Becel®, Sundew®, Nuttelex®

Some soy products may contain small amounts of cow's milk protein and may need to be avoided if your child is highly allergic. Ask your doctor or dietitian.

These include:

Soy yoghurt (a milk-based starter may be used)

Soy cheese (may contain casein).

Note: Toffuti brand sour cream, cream cheese and cheese is milk free

Coconut oil based cheeses such as Bio cheese and Oilana usually don’t contain cow’s milk.

Milk and Nut-Free Chocolates

Sweet William - milk chocolate/ tangerine milk chocolate (dairy free, gluten free, lactose free, peanut free) chocolate spread (gluten free, lactose free, dairy free, peanut free) www.sweetwilliam.com.au  

Available in Woolworths, Coles (health food isle), IGA (confectionery isle), health food shops.

Kinnerton -Allergy free-chocolates:  Easter Eggs, Chocolate bars & Lollipops (Dairy free, gluten free, egg free, nut free).

Children’s character chocolates (Nut safe)

Available at selected Target, Big W, Woolworths, Coles, David Jones, Aldi & IGA stores.  

 Also available online at www.kinnerton.com.au

Willow  - chocolate bars, Christmas, Easter and Valentine novelties, frogs

Available 03 9587 1079 or via www.allergyblock.com.au

Remember:

  • Most children will outgrow their milk allergy by the age of 5-8 years.
  • Learn to recognize the different types of food labels which indicate that the food contains cows’ milk products.

Where can I find more information on the Internet?

·   The Australian Society of Clinical Immunology and Allergy (ASCIA) website contains useful information on food allergy written by Australian specialists: www.allergy.org.au.

·   FSANZ - Food Standards Australia and New Zealand for information on food labelling: www.foodstandards.gov.au

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The Children's Hospital at Westmead
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Sydney Children's Hospital, Randwick
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Hunter New England Kids Health
www.hnekidshealth.nsw.gov.au

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