A milk allergy, or milk protein allergy, is a reaction to one or more proteins present in the cow’s milk. There are over 20 proteins in cow’s milk that may cause allergic reactions. Casein and whey are the two main components of cow’s milk responsible for the vast majority of reactions. Casein is the curd that forms when milk is left to sour. The watery part which is left after the curd is removed is called whey.
Casein accounts for 80 percent of the protein in milk and is the most important allergen found in cheese. The harder the cheese, the more casein it contains. Whey accounts for the other 20 percent of milk. It consists of two main allergenic proteins, alpha-lactalbumin and beta-lactaglobulin.
Cow’s milk allergy is a common food allergy, especially during the first year of life and can be present in both breastfed and formula-fed children. Studies show that two to three percent of infants are allergic to milk. Fortunately, most children tend to outgrow it within the first few years. Sixty percent of milk allergic children outgrow it by the age of four and eighty percent by the age of six. Although the majority become allergic as infants, cow’s milk allergy can be acquired later in life.
Even though milk allergy presenting in infancy commonly resolves spontaneously, some children continue to have chronic symptoms from milk. The presenting symptoms such as colic, irritability, spitting, diarrhea, and eczema may disappear, but a new pattern of illness and symptoms may emerge such as nasal and sinus symptoms, recurrent abdominal pain, headaches, generalized lethargy, and dark circles under the eyes. Milk allergy is probably more common in older children, teenagers, and adults than recognized, as its presentation can subtle and difficult to diagnose.
Allergy to cow’s milk is a well-studied form of food allergy, and there are both immediate and delayed patterns of milk allergy. Immediate type allergy tends to be obvious, and symptoms can range between mild and severe. Symptoms will result within minutes of ingestion of mild, but can also occur after contact to the skin. The presence of this immediate reaction to milk is easily diagnosed or confirmed by skin or blood tests.
Symptoms of delayed onset milk allergy are not so obvious, and tend to cause less severe, chronic, sometimes nonspecific symptoms. A milk elimination diet can help recognize the presence of delayed allergy to milk.
The terms milk allergy and lactose intolerance are often incorrectly used interchangeably to describe reactions to milk. They are, however, two separate disorders which have absolutely nothing to do with one another. A milk allergy is the immune system’s response to one or more of the proteins found in cow’s milk.
Lactose intolerance, on the other hand, occurs when the intestine lacks a critical enzyme called lactase. Lactase is necessary to break down lactose, the predominant sugar in milk, into two simple sugars, glucose and galactose, so that the sugars can be utilized by the body. When lactose is not broken down in the small intestine, it is passed to the large intestine where it is fermented by bacteria, resulting in various gastrointestinal symptoms such as gas, bloating, and abdominal discomfort, nausea, or diarrhea. It is estimated that 30 to 50 million people suffer from this intolerance.
Important information about avoiding milk and milk products
Food manufactures may change the ingredients in the product without warning. Be sure to always read the food label before giving the item to your child to eat. It is easier to prevent a food-allergy reaction than to treat one. If you are not certain that a food is milk-free, check with the manufacturer. To avoid milk and milk products ask about ingredients at restaurants and others’ homes, read food labels, and become familiar with the technical or scientific terms for milk.
Food Group: Breads and Grains
Foods Allowed: Milk-free breads (wheat, white, rye, challah,corn, graham, gluten, and soy breads made without milk or milk products), some French bread, Graham crackers or rice wafers
Foods Not Allowed: Breads prepared with milk, such as muffins, pancakes, biscuits, french toast
Food Group: Potatoes and Other Starches
Foods Allowed: White or Sweet Potatoes, rice or pasta prepared without milk or milk products, plain chips.
Foods Not Allowed: Any potato, rice, or pasta prepared with milk or milk products - au gratin, creamed, and scalloped potatoes, instant potatoes, macaroni and cheese, ranch flavored snacks
Food Group: Vegetables
Foods Allowed: All vegetables - fresh, frozen, canned. All vegetable juices.
Foods Not Allowed: Any vegetable prepared with milk, cheese or butter - au gratin, creamed, scalloped.
Food Group: Fruits
Foods Allowed: All fruits- fresh, frozen, canned
Foods Not Allowed: Any fruit prepared with milk, cream or butter
Food Group: Milk and Milk Products
Foods Allowed: Soy based infant formulas, calcium fortified soy and rice milk, soy cheese and yogurt, hydrolyzed protein formulas** (**Hydrolyzed protein formulas: Nutramigen, Pregestimil, Alimentum, Neocate, Vivonex Pediatric, Neocate Junior, and Pediatric E028)
Foods Not Allowed: All cow’s milk, powdered, evaporated, and condensed milk, half and half, cream, ice cream, yogurt, cheese, cottage cheese, goat’s milk, cow’s milk-based infant formulas and supplements
Food Group: Meat and Meat Substitutes
Foods Allowed: Beef, poultry, turkey, fish, lamb, pork, beans, lentils, nuts, peanut butter, plain eggs, legumes, tofu
Foods Not Allowed: Any prepared with milk or milk products such as meatloaf, hot dogs, deli meats, scrambled eggs, egg substitutes
Food Group: Desserts and Sweets
Foods Allowed: Hard candy, candies and desserts made without milk or milk products, fruit ices, sorbet, popsicles, juice bars, Jell-O. Corn syrup, honey, jam, and jelly Granulated, brown, or powdered sugar
Foods Not Allowed: Candies containing cow’s milk - caramels, milk chocolate, nougats, and fondants. Desserts prepared with cow’s milk: cakes, pastries, cream pies, ice cream, ice milk, sherbet, frozen dairy products with simplesse, custard, pudding, donuts.
Food Group: Fats and Oils
Foods Allowed: Soy oil, corn oil, safflower oil, coconut oil, vegetable oil, olive oil, peanut oil, milk-free margarines, mayonnaise, salad dressing
Foods Not Allowed: Cream, sour cream, fats prepared with added milk solids - butter, margarine, milk-based gravies, some coffee creamers, artificial butter flavor, butter flavored oil
Food Group: Seasonings and Condiments
Foods Allowed: Salt, spices, oil based dressings, ketchup, mustard, relish, herbs
Foods Not Allowed: Cheese sauces, hollandaise sauce, white sauce, alfredo sauce, butter-flavored syrup, some salad dressings
Food Group: Miscellaneous
Foods Allowed: Clear broth, vegetable soup, meat soups, homemade soups without milk, carbonated beverages, tea, coffee, nuts, herbs, chili powder, salt, spices
Foods Not Allowed: Frozen dinners with cheese sauces, canned spaghetti sauce with cheese, cream soups, chowders, some diet drinks
Substitute equal amounts of these items for milk in your recipes:
Food manufacturers may occasionally change the ingredients in the product without warning. It is a good idea to always read the product label before using it. It is much easier to prevent a food-allergic reaction than to treat one.