Milk Allergy

Overview

Who gets a milk allergy?

In this article, milk refers specifically to cow’s milk and not to other types of milk such as soymilk, rice milk, goat’s milk, etc., unless otherwise specified.

Milk is one of the most common food allergens. An allergen is a food that causes an allergic reaction, such as hives, swelling, and trouble breathing. Although a milk allergy occurs most often in young children, it can appear at any age. The allergic reaction can be triggered by milk-containing foods that had been previously eaten without any problems.

A milk allergy can develop in both formula-fed and breastfed infants. Some infants have a type of cow’s milk allergy commonly referred to as “cow’s milk protein allergy,” which causes blood in the stool. Other infants have an allergic reaction that includes immediate symptoms, such as hives and vomiting. In both cases, many infants will outgrow the symptoms during childhood.

A milk allergy is not the same thing as lactose intolerance. Lactose intolerance is the inability to digest lactose, a sugar found in many dairy products. This leads to bloating and diarrhea after eating or drinking lactose-containing foods. Lactose intolerance is uncommon in infants and young children and is more common in adults.

Symptoms and Causes

What are the symptoms of a milk allergy?

Allergic reactions to foods usually begin within minutes of eating the allergen-containing food though may occur up to 2-3 hours after ingestion. The severity of symptoms can vary widely from one person to another. Mild symptoms may include itching and a few hives while a severe allergic reaction may include life-threatening symptoms, such as difficulty breathing and a sudden drop in blood pressure. The symptoms of an allergic reaction may include any or several of the following:

Other things to keep in mind if you or a loves one has milk allergy:

  • Many people allergic to cow’s milk may not tolerate milk from other mammals, such as milk of goats or sheep.
  • Less commonly, some people with cow’s milk allergy may have a reaction after eating beef.
  • History of a mild reaction does not mean a subsequent reaction will also be mild.
  • History of a severe reaction does place you at risk for a subsequent severe reaction.

Your doctor can make recommendations on alternatives to milk-based on your child’s age.

Diagnosis and Tests

How is milk allergy diagnosed?

Your doctor will use one or more of the following methods to diagnose a milk allergy:

  • Medical history: Your doctor will ask questions about your general health and the health of your family, including whether or not your family members have food allergies and what happens when you eat or drink something containing milk.
  • Skin prick test (also called a scratch or puncture test): Your doctor will put a solution containing the allergen on your skin and then scratch or prick the skin to let the solution enter. A small bump will form if you are at risk of being allergic to the allergen.
  • Blood test: Your blood will be examined for something called immunoglobulin E (IgE) antibodies. These antibodies are what cause your body to react against substances that it sees as harmful.
  • Feeding test (or oral food challenge): The goal of this test is to confirm or rule out a food allergy, and it is usually performed after skin and/or blood testing has been performed. This test entails you eating the food in question under the supervision of an allergist. Allergic reactions usually happen within 30 minutes up to 3 hours. Healthcare providers will treat a reaction should one occur. This test should only be performed under the guidance of an allergy specialist.

Management and Treatment

How do you avoid exposure if you have a milk allergy?

If you have a milk allergy, strict avoidance of milk is the only way to prevent an allergic reaction. The Food and Drug Administration (FDA) requires food manufacturers to list common food allergens on food labels in plain terms to make it easier to identify the food allergens. Food labels must clearly list eight allergens which account for almost 90% of all food allergies: cow’s milk, soy, wheat, egg, peanut, tree nuts, fish, and shellfish.

The common allergens are listed either within the ingredient list or after the list. For example, if a product contains casein, a milk protein, the product's label should list the term “milk” either after the term casein, or state “contains milk” after the list of ingredients. The FDA currently does not require manufacturers to state if the food was processed in a facility that also processes the 8 common food allergens.

Anyone allergic to milk should avoid the following ingredients/foods:

  • Milk: in all forms, including condensed, dry, evaporated, and powdered milk, and milk from mammals (such as goat or sheep).
  • Casein and casein hydrolysates.
  • Caseinates (such as sodium caseinate).
  • Whey.
  • Lactalbumin, lactalbumin phosphate, lactoglobulin, lactoferrin and lactulose.
  • Butter: including butter, butter fat, butter oil, artificial butter flavor.
  • Buttermilk.
  • Cheese and cream cheese.
  • Cream, half & half, and ice cream.
  • Cottage cheese and curds.
  • Custard, pudding and yogurt.
  • Ghee.
  • Sour cream, sour milk.

Many children with a milk allergy can tolerate highly heated – baked – forms of milk, such as muffins and cake. Discuss this with your doctor for specific dietary recommendations.

Milk products are an important source of calcium and Vitamin D, so it's important that you eat other foods rich in these nutrients, such as broccoli and spinach. To ensure that you eat a well-balanced, healthy diet that provides adequate nutrients, you may talk to a registered dietitian.

How can you be prepared if you have a milk allergy?

  • Always know what you are eating and drinking.
  • Always check the label ingredients before you use/consume a product, even if the food was safe the last time you ate it. Manufacturers can change recipes and a milk-containing food may be added to the recipe.
  • Teach children who have milk allergy not to accept food from classmates or friends.
  • When dining out, ask detailed questions about ingredients and how the food was prepared. You want to make sure there is no problem with cross-contact.
  • Wear a medical alert bracelet with information about your allergy or carry an alert card with you. Also, add your food allergy to your cell phone’s medical emergency setting or app.
  • Talk with your doctor about how to prepare for a reaction. Your doctor will prescribe self-injectable epinephrine to carry with you at all times in case you have a severe reaction.

Prevention

How can you prevent milk allergy?

The cause of milk allergy remains unknown as do prevention strategies, but your healthcare provider may be able to provide guidance for parents of new babies if someone in the family has been found to have a certain type of allergy.

If you do have an allergy to milk or milk products, you can best prevent a reaction by completely avoiding milk and milk products.

Living With

When should you contact a doctor about a milk allergy?

If you suspect that you or your child has a milk allergy, you should contact a healthcare professional – either your own care provider or an allergist – to be evaluated. If you have been diagnosed with a milk allergy, you should follow up with your allergist annually as new treatments are coming available.

If you have a milk allergy, epinephrine should be carried with you at all times. Also, you should always call 9-1-1 and go to an emergency room when you have used epinephrine, not because the medication is dangerous but because the reaction you are having is dangerous.

Resources

Where can you find more information on living with milk allergy?

You might find it helpful to contact one of the following organizations:

Last reviewed by a Cleveland Clinic medical professional on 06/24/2019.

References

  • Food Allergy Research & Education (FARE). Milk Allergy. (https://www.foodallergy.org/common-allergens/milk-allergy) Accessed 6/25/2019.
  • American College of Asthma, Allergy, & Immunology. Milk & Dairy Allergy. (https://acaai.org/allergies/types-allergies/food-allergy/types-food-allergy/milk-dairy-allergy) Accessed 6/25/2019.
  • American Academy of Pediatrics. Milk Allergy. (https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Milk-Allergy.aspx) Accessed 6/25/2019.
  • Lifschitz C, Szajewska H. Cow's milk allergy: evidence-based diagnosis and management for the practitioner. (https://link.springer.com/article/10.1007%2Fs00431-014-2422-3) Eur J Pediatr. 2015;174(2):141-50. Accessed on 6/25/2019 at https://doi.org/10.1007/s00431-014-2422-3. (https://doi.org/10.1007/s00431-014-2422-3)

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