- 8 Common Signs and Symptoms of a Cow Milk Allergy
- When to Ask if Your Baby Might Have a Cow Milk Allergy?
- Digestive: Persistent Diarrhea or Constipation
- Digestive: Blood and/or Mucus in the Stool
- Digestive: Frequent Vomiting, Reflux or Spitting Up
- Digestive: Persistent Gassiness
- Skin: Unexplained Rash
- Respiratory Problems
- General: Excess Fussiness, Sleeplessness or “Colic”
- General: Low or No Weight Gain or Failure to Thrive (FTT)
- MY BABY HAS ONE OR MORE SYMPTOMS OF A COW MILK ALLERGY
- Know the Signs of a Milk Allergy
- What Is a Milk Allergy?
- Milk Allergy or Lactose Intolerance?
- Living With a Milk Allergy
- 4 Unexpected Signs You May Be Allergic to Dairy
- 5 Signs You’re Allergic To Dairy That You Should Keep An Eye Out For
- 3. Hives
- 4. Facial Flushing
- 5. Abdominal Cramps
8 Common Signs and Symptoms of a Cow Milk Allergy
More and more children are developing food allergies. Did you know, cow milk protein is the most common food allergen in early childhood? It’s even more prevalent in infancy than peanut allergy. In fact, more than 100,000 babies each year – 2-5% of infants – suffer from this allergy in the US. Cow milk allergy (CMA) can also be called milk protein allergy, milk protein intolerance or cow milk protein allergy (CMPA). Want even more acronyms? Infants allergic to both milk and soy: milk soy protein intolerance (MSPI) or multiple food allergies (MFA). With such prevalence, do you know the common signs and symptoms of a cow milk allergy?
Children with a cow milk allergy often experience several signs and symptoms. These can affect multiple body parts, or systems (digestive, skin, respiratory or general). These are not specific to CMA, meaning they can signal other conditions. That makes CMA difficult to identify. First you must identify the cause of these signs and symptoms, then you can manage the condition and symptoms.
Parents often tell us they waited months before their child was officially diagnosed with CMA. This often involves multiple doctor visits with few answers. Being able to spot possible signs of CMA may lead to recognizing it earlier. That can mean quicker solutions, often a hypoallergenic amino acid-based formula like Neocate®.
When to Ask if Your Baby Might Have a Cow Milk Allergy?
The following video outlines 8 signs and symptoms that may cause a healthcare team to suspect CMA. The list comes from a Board-certified pediatric allergist.
This is certainly not a comprehensive list – some signs and symptoms are less common. Also, not every infant with one or more of these signs will be diagnosed with CMA. Finally, every infant who develops an allergy will have a unique experience. Here’s a bit more information on those 8 signs.
Now, let’s dive a bit deeper into eight common signs of a cow milk allergy. Parents who see these in their baby can ask the doctor if they might signal CMA.
Digestive: Persistent Diarrhea or Constipation
Diarrhea can be very concerning to someone caring for an infant. Every infant has loose stools from time to time. However, if you see multiple loose or liquid stools a day, it could signal a milk allergy. (“Multiple” = average of 2-4 times a day for more than 5-7 days.) Over half of children with CMA can have diarrhea, the most common digestive symptom.
Remember: diarrhea has many causes. Ask your healthcare team if you think your little one has diarrhea. Here are great resources with more detail about baby bowel movements:
- Track baby poop with Neocate® Footsteps® App
- What is normal and what is not when it comes to baby poop
- What color should baby poop be?
Believe it or not, constipation can also signal CMA in infants. While constipation is a less common sign than diarrhea, it’s possible for infants with CMA to have constipation.
Digestive: Blood and/or Mucus in the Stool
Blood in the stool is a likely sign of CMA in infants. The blood results from inflammation in the gut. It can appear in the diaper as either red or black. Red blood means the bleeding is in the lower end of the gut. Black color usually signals bleeding higher up, like from uncontrolled reflux. If you notice red or black in your baby’s diaper, call the doctor.
Mucus looks like what comes out of your nose when you have a cold or runny nose. It looks sticky when you open the diaper. A little bit can be normal, but if you see a lot or it lasts a while, it can signal a food allergy.
Digestive: Frequent Vomiting, Reflux or Spitting Up
Babies often spit up (or “regurgitate”), but anything beyond the occasional post-meal spit-up should be examined by a doctor. Many infants who spit up don’t seem bothered by it and maintain a healthy weight – we call them “happy spitters.” For other infants, spitting up may represent something more concerning like gastroesophageal reflux disease (GERD) or vomiting. It can lead to low or no weight gain.
In infants, frequent reflux or vomiting can be related to CMA. Almost 50% of infants with reflux may be diagnosed with CMA. In those cases, taking cow milk out of the diet should help resolve reflux. Read more information on reflux and vomiting in infancy. (In one extreme allergic condition –Food Protein Induced Enterocolitis (FPIES)– violent vomiting a few hours after feeding is the hallmark sign.)
Digestive: Persistent Gassiness
Gas happens when there is excess air in the stomach or intestines. This can result in discomfort, burping, or passing gas. Discomfort can cause an infant to be “fussy”, “cranky”, or “colicky.” All babies have gas, but when it occurs with several other signs, it signals a possible allergy to cow milk.
Skin: Unexplained Rash
There are many causes for skin rashes, like atopic dermatitis (eczema) or hives (urticaria). CMA is a possible cause, especially when other CMA signs are present. Up to 70% of infants with CMA have skin-related signs. Rashes related to CMA may be very uncomfortable, with nonstop itching and scratching. This may be worse after feedings.
Rashes often appear on the face, but can appear anywhere on the body. Remember, it is important to check with your child’s physician if you suspect the rash to be related to CMA. For more information about skin rashes and when it might signal CMA, check out Baby Rashes from Acne to Eczema.
Children can have different respiratory issues with CMA. Up to 30% of infants with CMA have respiratory signs. These generally fall into two types; either mild or severe.
- Mild–Includes runny noses, sneezing, and nasal congestion. These look like what you might see when your child has a cold.
- Severe–Includes shortness of breath, struggling to breathe or wheezing: all need immediate attention. Shortness of breath can look like sudden and/or severe gasping or difficulty breathing. Your child may look to be in pain and frightened. Wheezing is a whistling or rattling sound in the chest when a child breathes. Both indicate obstructed airways. If your child shows a severe respiratory symptom, seek immediate medical assistance.
The scariest respiratory symptom of all is the shortness of breath that occurs with anaphylactic shock. Anaphylaxis is a sudden reaction to a food allergen. This requires immediate attention, as trouble breathing can quickly become life-threatening.
The following post related to food allergies and asthma – an allergic condition that affects breathing – may be worth a look:
General: Excess Fussiness, Sleeplessness or “Colic”
Every baby cries, but crying continuously and inconsolably for extended periods is unusual. You might hear someone say a baby who cries a lot has colic. Some doctors find colic controversial, but excess crying comes from somewhere, often with insomnia. Doctors also often downplay fussiness, which can delay diagnosing CMA. We hear this from parents all too often!
When should you suspect that crying is excessive (“colic”) and something serious is happening? The going adage is to talk to the doctor if it happens in threes. That is: if your baby cries for 3+ hours in a day, for 3+ days in a week, for over 3 weeks. That can signal gastrointestinal pain, which could result from CMA.
Extreme fussiness can also come with reflux, a rash, or other factors. Keep this in mind when asking your child’s doctor about the possibility of CMA.
General: Low or No Weight Gain or Failure to Thrive (FTT)
Most infants double their birth weight by six months and triple it by 12 months. Each dot on a growth chart is a percentile. The dots form a growth curve that shows a pattern of growth relative to the population. A child’s head circumference, weight, and height (length, for infants) generally follow a consistent trend over time.
Sometimes though, slow weight gain may lead to a diagnosis of ‘Failure to Thrive’ (FTT), which is one of the symptoms of a cow milk allergy. Slow weight gain is gaining weight more slowly than other children the same age and gender.
Many factors contribute to slow weight gain, and often several factors are at play. Food allergy reactions can cause problems digesting or absorbing food, leading to failure to thrive. For example, babies may not get the nutrition they need because of excessive diarrhea or vomiting. The body may not get all the nutrients needed, which can mean they can’t grow as quickly as they should.
As always, ask your child’s healthcare professional if you are concerned about your child’s weight.
MY BABY HAS ONE OR MORE SYMPTOMS OF A COW MILK ALLERGY
Ask the healthcare team! The ideal way they confirm the symptoms of a cow milk allergy is to:
- Remove cow milk from the diet, and
- Re-introduce cow milk, often under a doctor’s supervision.
Many doctors won’t go past step 1 if signs improve. However, step 2 is the best way to confirm a food allergy. If you add cow milk back to the diet and symptoms reappear, CMA can be diagnosed.
Babies allergic with symptoms of a cow milk allergy who require formula need one that’s hypoallergenic, like Neocate® Syneo® Infant. Neocate is safe for babies with food allergies because it contains amino acids, building blocks of protein. Amino acids can’t trigger an allergic reaction the way proteins or peptides in other formulas can. (Read about formula types.)
If you suspect CMA, ask your child’s doctor for a thorough evaluation. Bring this information with you and ask your doctor if your baby might benefit from Neocate. For more on CMA, check out the following resources:
- CMA Symptom Checker
- CMA Guidelines
- The Difference Between CMA and Lactose Intolerance
- Outgrowing CMA
Know the Signs of a Milk Allergy
Data from the National Institutes of Health (NIH) suggests anywhere from 30 to 50 million Americans could be lactose intolerant, meaning they experience abdominal bloating, cramping, and other digestive issues after ingesting dairy products.
But some people experience a more severe reaction to dairy, including skin rash and hives — and these cases aren’t due to lactose intolerance, but to a milk allergy.
Milk allergies are particularly common in young children; roughly 2 to 5 percent of children have a milk allergy during their first year of life. “In most cases, milk allergies will be outgrown,” says Julie McNairn, MD, an allergist/immunologist in Cincinnati. But sometimes a milk allergy can persist into adulthood. Some children, however, will carry a milk allergy with them throughout their life.
What Is a Milk Allergy?
If you suffer from a milk allergy, your body has produced antibodies called IgE (for immunoglobulin E) specific to milk protein, explains Dr. McNairn. Those proteins are called casein and whey, and can be found in dairy and non-dairy products. Some brands of canned tuna fish even contain casein.
When you are exposed to milk protein, the IgE antibodies cause allergy symptoms. These symptoms can occur within minutes or hours. Luckily, less severe symptoms are more common in a milk allergy, but there is a risk of a life-threatening allergic reaction called anaphylaxis.
Common symptoms of a milk allergy include:
- Skin rash, hives, or eczema, which is an inflammation and redness of the skin
- Abdominal cramping
- Nausea or vomiting
- Runny nose
- Itchy, watery eyes
- Breathing problems
- Swelling of the lips or tongue
In addition, young children may not gain weight and may have bloody stool.
Milk Allergy or Lactose Intolerance?
It is common to confuse lactose intolerance with a milk allergy since their symptoms — abdominal cramping, for instance — can be similar. But lactose intolerance and milk allergy are two separate conditions with distinct causes. “Lactose intolerance is due to an enzyme deficiency in the colon,” explains McNairn. In lactose intolerance, “the patient cannot break down the milk sugar.” And unlike in a milk allergy, skin rashes, hives, or lip and tongue swelling do not occur.
Living With a Milk Allergy
“It is not clear why one person will have a reaction and another person won’t,” says McNairn. But if you do have a milk allergy, your best bet is to “avoid milk in all forms,” she says, including butter, cream, yogurt and cheese. While new labeling laws require food manufacturers to clearly state if a food contains a potential allergen, it’s also important for you to inspect the ingredients yourself. Just because something says it is milk-free doesn’t mean it contains no milk protein. Avoid eating foods that are fried or that may have milk protein in them. Before ordering at a restaurant, ask your waiter or hostess whether the meal contains any dairy products.
Your allergist probably will recommend that you keep a self-injector of epinephrine with you at all times. Don’t be afraid to use the epinephrine and immediately dial 911 if you accidentally consume something that contains a milk protein and you have worrisome symptoms such as swelling, chest pain, or difficulty breathing.
Having a milk allergy doesn’t mean you can’t enjoy food anymore. It just means you have to be a bit more careful about what you eat.
Cow’s milk protein Allergy (CMPA), is seen in 2-7.5% of infants globally and the amount of milk which is required to elicit an immediate reaction can be as low as one drop . CMPA usually appears within the first few months of life, often within days or weeks after the introduction of a cow’s milk based formula into the diet. Symptoms may also occur with exclusive breast feeding, if the mother ingests cow’s milk .
The slower onset reaction is more common. Symptoms may include gastrointestinal symptoms like vomiting, abdominal pain, diarrhoea, and occasional bloody stools. Respiratory symptoms are rare, but nasal pruritus and congestion, rhinorrhoea, and sneezing occur in some cases. Most of the children will outgrow this type of reaction after 2 years of age and some of them may outgrow it after adolescence. Rapid onset reactions come on suddenly, with symptoms like irritability, vomiting, wheezing, urticaria, itchy bumps on the skin and bloody diarrhoea. Severe allergic reactions (anaphylaxis) can occur in some cases. The risk of atopy increases if a parent or sibling has atopic disease (20-40% and 25-35% respectively) and it is higher still if both parents are atopic (40-60%). In our case, there was no history of atopy in the family .
In most of the cases, the condition is IgE-mediated and manifestation is usually atopic eczema, allergic rhinitis or Asthma. In our case cow’s protein allergy was confirmed by observing the elevated Serum Ig E levels and the resolution of the lesions on stopping cow’s milk. The possibility of rashes being caused by zinc deficiency alone was not considered, as third recurrence of lesions occured inspite of the normal zinc levels at that period of time. The low zinc levels initially may have been caused by chronic diarrhoea which may have led to secondary zinc deficiency. Undiagnosed food allergy can also lead to mild zinc deficiency and the presentation can be dermatitis, diarrhoea and increase in Serum Ig E levels .
The message is that zinc deficiency and cow’s milk protein allergy can give rise to same kind of symptoms and signs and that a differentiation between them is possible only on excluding cow’s milk from the diet. Reintroduction of cow’s milk may bring back the symptoms and signs, but it may sometimes be dangerous Alternative diets which have been suggested are an extensively hydrolyzed formula (eHF), amino acid formula or partially hydrolysed formula based on rice protein which were not used here due to non availability .
I have long been sceptical of people claiming they had a food allergy. These days, it’s all lactose-intolerant this and gluten-substitute that. Surely, I thought, the whole idea of food allergies and intolerance was just a “read-it-in-the-papers-so-I-must-have-it-too” scenario.
The figures certainly bear this out. One in five of us thinks we have a food allergy, but a 2008 survey by the Food Standards Agency found that only one in 70 UK adults has a genuine, or “classic” allergy to food – most commonly to peanuts and tree nuts (walnuts and hazelnuts), shellfish and fish, but also to cows’ milk, eggs, soya and wheat.
A classic food allergy can be a serious business. A morsel of your allergy-producing food triggers the immune system, which mistakenly believes that food to be harmful and produces antibodies, which bind to “mast cells” in the eyes, nose, throat, lungs, gut, cardiovascular system and skin. At subsequent exposure to the same food these mast cells will release chemicals such as histamine, leading to swelling, itching and flushing in the skin; vomiting and diarrhoea; coughing, wheezing or a runny nose; swelling of the lips; and sore, red and itchy eyes.
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These reactions happen within a few minutes of eating the food and, at worst, entail a severe, whole-body reaction called anaphylaxis, which can be fatal.
An intolerance, on the other hand, is far more common (around 10-15 per cent of Northern and Western Europeans have a dairy intolerance). Those affected have varying degrees of difficulty digesting certain foods. The most common culprits are lactose, a sugar found in dairy products and gluten, a protein found in cereals and grains.
But my scepticism took a knock when I researched a piece about dairy allergies in children and realised that many of the symptoms – eczema, acid reflux, rhinitis, bloating, gas and digestive problems – were ones I had been ignoring for more than a year. I had these symptoms daily, had never had them as a child, but was soldiering on. So, this summer, I found myself describing my symptoms to Dr Rita Mirakian, consultant in allergy and immunology at the London Allergy Clinic. She immediately thought an allergy was unlikely: “In adults, milk allergy does exist, but is not common. The majority of adults who react badly to dairy have an intolerance, because they lack an enzyme critical for the absorption of that particular food.”
So if I was intolerant to dairy, I was probably just consuming too much. As a tea/coffee/cheese fanatic, I was at the thick end of the dairy-consumption scale. But what of late-onset allergies – do they happen? “Absolutely,” said Dr Mirakian. “I have a 90-year-old woman who developed an anaphylactic reaction to peanuts at the age of 84.” It’s hard to say why an allergy, or indeed an intolerance, develops in later life, but it may be linked to infections, illness and lifestyle, which can weaken our digestive systems. Stress may also be a culprit, as may airborne pollution or the many chemicals to which we’re exposed on a daily basis.
To eliminate any chance of an allergy, Dr Mirakian first took a medical and symptom history and then gave me one of the two gold-standard allergy tests: “skin-prick” tests for the common allergens (pictured, left). This is a key point, skin-prick and blood tests are the only clinically proven allergy tests. In the skin-prick test, a drop of common allergens – dust mite, cat, dog, allergy-producing fungi, milk, egg, wheat and oat – was placed on my forearm, then the skin pricked to allow the allergen to penetrate my skin. If the skin pricking triggered a red lump and itching, I would have been allergic, but there was none.
To check for an intolerance to dairy, I was put on a three-week “exclusion” diet, which involved removing every trace of dairy from my diet, then reintroducing them in a four-day “challenge” of a pint of milk a day. If the symptoms returned, an intolerance would be likely. So, did my symptoms subside? Not really. I was gassy and bloated. My acid reflux bubbled. I coughed and my eczema got worse. At least my nose stopped running.
The first thing I realised was how much dairy (and wheat) I consumed. The second was that dairy products are everywhere. Crisps! Olive oil spreads! Sausages! Non-dairy creamer! I used soya milk in my tea (passable) and cappuccino (disgusting).
I gazed longingly at shelves laden with brie, cheddar and parmesan in supermarkets. I ate pasta without grated cheese (dull) and eschewed my beloved pizza. All for nowt. Back in Dr Mirakian’s office, she confirmed that allergies were definitely out and a serious dairy intolerance unlikely. Could it be wheat, then, I asked? “The only way to check is to eliminate wheat and put it back again – and if you found dairy hard to give up, wheat is far more difficult,” she replied. “Instead, you should reduce the wheat and dairy in your diet, especially foods that ferment, like cheese, bread and alcohol.”
I had hoped for a simple solution. I contacted Jos Swinger, a nutritionist. He picked up on the fact I had gone through recent periods of stress.
“The more stressed you are, the less likely you will be to digest sugars such as lactose, in dairy,” he said. He stressed that, when reducing the amount of dairy or wheat in your diet, it’s vital to replace one food with another. So cow’s milk can be replaced with soya, oat, rice or almond milk; wheat products such as bread with starchy vegetables.
For a final opinion I turned to Lindsey McManus of Allergy UK. “It is very difficult to pinpoint intolerances,” she said. “You may be intolerant, or you might just be a bit under the weather. Either way, it’s often a good idea to cut back on wheat and dairy. Most people in the UK eat far too much of both. It’s easy to eat toast for breakfast, a sandwich for lunch and pasta for dinner – that’s three wheat-based meals in a day. If we all varied our diets more and ate more healthily, many of these problems would sort themselves out.”
www.londonallergyclinic.com; www.allergyuk.org; Jos Swingler: www.bespokenutrition.com
Do you have an allergy?
A true or “classic” food allergy is estimated to affect one in 70 adults.
It’s more likely to be food intolerance – 10-15 per cent of northern and Western Europeans have a dairy intolerance.
A true allergy involves an immune-mediated reaction to a particular food (various nuts, fish and shellfish).
An intolerance does not involve the immune system and is an inability to digest a particular food.
There are only two clinically-proven tests available: an IgE blood test and a skin-prick test.
The only clinically proven test for intolerance is exclusion or elimination, with the suspect food removed from your diet for a few weeks, then reintroduced.
Lactose intolerance occurs when your body can’t digest the sugars in milk. It can result in eczema and digestive problems
Allergic reactions to nuts can vary from mild to very severe, and are sometimes life-threatening
Coeliac disease is a gut disorder caused by gluten (a protein found in wheat, rye, and barley), which damages the intestine. About one in 100 people in the UK have coeliac disease
An allergy to fish may begin in childhood and is likely to be lifelong. People allergic to one type of fish or shellfish are often advised to avoid all kinds of seafood
4 Unexpected Signs You May Be Allergic to Dairy
Many people think they don’t have a dairy allergy because they don’t have typical symptoms like lip swelling, a rash, or wheezing. But there is a type of delayed allergy (called non-IgE mediated) where it can take up to three days for symptoms to manifest, and sometimes so mildly that you don’t notice until five to seven days after eating something with dairy in it.
Food sensitivities are a great disease mimicker, and they can underlie many ‘thick note syndromes’ (patients with long medical history files that no doctors have been able to help). Once the immune system is triggered by an offending food, antibodies can circulate everywhere, and cause havoc anywhere there is a weakness in the body.
Here are some of the most common manifestations of a dairy sensitivity:
1. Eczema, acne and other skin complaints
There are now multiple studies supporting a link between acne and dairy consumption. Since food sensitivity can cause a delayed reaction manifesting as eczema, a lot of my patients reported their skin issues improved once they eliminated dairy from their diet.
2. Joint pains
Studies as far back as 1986 have illustrated improvements in joint symptoms (and even rheumatoid arthritis) with an elimination diet.
3. Asthma, sinus issues, or other respiratory problems
The casein in dairy can cause increased mucus production in the airways and lungs; this can cause asthma symptoms, and recurrent sinus problems like chronic sinusitis.
4. Fatigue and weight loss resistance
This is such a common symptom, and while there are many other causes like issues with your thyroid or hormonal imbalance, if a full medical workup has been conducted and no cause for fatigue can be identified, discuss the possibility of a food sensitivity with your medical provider.
The unifying mechanism underlying all these symptoms is inflammation. A dairy (or other food) sensitivity can lead to a chronically activated immune system with inflammation in the body.
So, what can you do if you have these symptoms and want to know if dairy sensitivity could be a culprit? Eliminate dairy from your diet for three weeks. It’s important that vital nutrients are replaced with non-dairy foods, so work with a dietician or a practitioner. Monitor your symptoms and keep a diary. Then at the end of the three weeks, reintroduce dairy and take note of what symptoms start to reappear, such as anxiety, fatigue, joint aches or skin issues. Continue eating dairy every day for the next three to five days, and see if symptoms reappear.
This content is for informational or educational purposes only. Please consult your healthcare provider in regards to recommendations and treatments as this material cannot be used as medical advice.
This article was originally published on Covey Club.
5 Signs You’re Allergic To Dairy That You Should Keep An Eye Out For
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When it comes to allergic reactions, some people develop a skin rash called hives, or urticaria. They’re characterized by smooth, pink bumps that cause a burning sensation. Hives can develop anywhere on the body within just a few minutes.
This is another result of the immune system causing inflammation in response to an allergen. If you develop hives after consuming milk, try scrubbing the area with soap and water. The hives will also subside after taking allergy medicine. Do your best to avoid scratching the heck out of the bumps; this may lead to scarring and bleeding. Ouch.
4. Facial Flushing
Another result of an inflamed immune system is facial flushing. This flushing, which might also affect the neck and chest, is usually accompanied with a rise in body temperature. The skin may be warm to the touch, too.
If you have facial flushing after eating a milk product, it’s likely that you also have one or more of the previous signs. It’s your body’s way of telling you that something is up.
5. Abdominal Cramps
While abdominal cramps are often seen in lactose intolerance, Mayo Clinic shares that it can show up in milk allergies too. Other possible symptoms include loose stools and diarrhea, which may be bloody.
So, are your stomach pains caused by an allergy or intolerance? The only way to know for sure is to visit a primary care doctor or allergist. They’ll be able to determine what’s going on based on your medical history, symptoms, and specialized tests.
If you do have a milk allergy, Eaton recommends being diligent about checking food labels on processed foods. “Milk can be hidden in meat products such as sausage, deli meats, and hot dogs,” she says.
“Check for these ‘hidden’ milk proteins: lactalbumin, whey lactoferrin and lactoglobulin, butter, and ghee. Someone with a true milk/dairy allergy should avoid these ingredients.”
This article was originally published on April 4, 2016 and was updated on July 1, 2019.
To prevent a reaction, it is very important that you avoid cow’s milk and cow’s milk products. Always read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.
If you are allergic to cow’s milk, your doctor may recommend you also avoid milk from other domestic animals. For example, goat’s milk protein is similar to cow’s milk protein and may cause a reaction in people who have a milk allergy.
Milk is one of the eight major allergens that must be listed on packaged foods sold in the U.S., as required by federal law.
Avoid foods that contain milk or any of these ingredients:
- Butter, butter fat, butter oil, butter acid, butter ester(s)
- Casein hydrolysate
- Caseinates (in all forms)
- Cottage cheese
- Lactalbumin, lactalbumin phosphate
- Milk (in all forms including condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, low-fat, malted, milkfat, non-fat, powder, protein, skimmed, solids, whole)
- Milk protein hydrolysate
- Rennet casein
- Sour cream, sour cream solids
- Sour milk solids
- Whey (in all forms)
- Whey protein hydrolysate
Other Possible Sources of Milk:
- Artificial butter flavor
- Baked goods
- Caramel candies
- Lactic acid starter culture and other bacterial cultures
- Luncheon meat, hot dogs and sausages, which may use the milk protein casein as a binder. Also, deli meat slicers are often used for both meat and cheese products, leading to cross-contact.
- Non-dairy products, as many contain casein
- Shellfish is sometimes dipped in milk to reduce the fishy odor. Ask questions when buying shellfish.
- Tuna fish, as some brands contain casein
- Some specialty products made with milk substitutes (i.e., soy-, nut- or rice-based dairy products) are manufactured on equipment shared with milk.
- Many restaurants put butter on grilled steaks to add extra flavor. You can’t see the butter after it melts.
- Some medications contain milk protein.
Allergens are not always present in these food and products, but milk protein can appear in surprising places. Again, read food labels and ask questions if you’re ever unsure about an item’s ingredients.
Milk in Kosher Foods
Kosher Dairy: A “D” or the word “dairy” following the circled K or U on a product label means the product contains or is contaminated with milk protein. Avoid these products if you have a milk allergy.
Kosher Pareve: A food product labeled “pareve” is considered milk-free under kosher dietary law. However, a product may be considered pareve even if it contains a very small amount of milk protein—possibly enough to cause an allergic reaction in certain people. Do not assume that these products will always be safe.
Do These Ingredients Contain Milk?
People allergic to milk often have questions about the following ingredients. These ingredients do not contain milk protein and are safe to eat.
- Calcium lactate
- Calcium stearoyl lactylate
- Cocoa butter
- Cream of tartar
- Lactic acid (however, lactic acid starter culture may contain milk)
- Sodium lactate
- Sodium stearoyl lactylate