Milk

Milk Allergy

Cow's milk allergy, along with egg, is one of the most common allergies in children. It is an IgE antibody-mediated reaction to proteins in cow’s milk. It was once thought that infants and children will outgrow their milk allergy prior to elementary school age. However, some milk (and egg) allergic infants and children keep these allergies well into the school years and beyond according to one large study. Studies have shown about 75% of individuals may tolerate small amounts of cow’s milk protein in extensively heated milk, such as in baked goods.

Most cow’s milk allergy patients cannot tolerate milk from other mammals (i.e. goat). Approximately 90% of cow’s milk allergic patients will react to goat and/or sheep’s milk. Many milk allergic infants will tolerate soy formula, but soy is a major allergen with an independent rate of allergy, and some doctors elect to try a different type of formula. Infants with cow’s milk allergy may tolerate extensively hydrolyzed formulas containing minimal residual amounts of milk. A substitution with an elemental formula is the most conservative management, and may be your doctor’s recommendation. Because of the different needs of each milk allergic child, please seek the assistance of a board certified allergist to find the correct formula that will assist with the milk allergic child’s developmental stage.

To confirm milk allergy, an Oral Food Challenge (OFC) can be performed in a clinical setting with a board certified allergist. OFC’s are also used to confirm when milk allergy is outgrown. Please consult with a board certified allergist for further instructions on cow’s milk in baked goods OFC, as risks may be involved, or whether the allergic individual should continue to avoid milk.

Lactose intolerance, may be commonly confused with milk allergy, but this condition is not an IgE-mediated food allergy. In lactose intolerance, individuals cannot digest the sugars (lactose) in the milk because they have a deficiency of the lactase in the lining of the gut, which leads to abdominal cramps, gas or diarrhea. This is not an immunologic reaction. In milk allergy, patients can experience cramping or diarrhea similar to lactose intolerance.

Milk can be an important source of protein, calcium, vitamin D and vitamin B12. In order to replace these dietary needs, allergic individuals may need to look at other food sources. A consultation with a pediatric nutritionist, who has experience with food allergies, may also be helpful to ensure balanced and adequate nutrition is achieved.^[1]

Other Sources of Protein^[6] - (it may be necessary to seek the assistance of a nutritionist to be sure the allergic individual is receiving the proper balance of amino acids).

• Meat
• Fish*
• Egg*
• Soy*
• Beans*
• Legume*
• Grains* (such as wheat germ)

Other Sources of Calcium^[3]:

• Leafy Green Vegetables
• Broccoli
• Collards
• Kale
• Mustard Greens
• Turnip Greens
• Bok Choy or Chinese Cabbage
• Almonds*
• Brazil Nuts*
• Sunflower Seeds*
• Tahini*
• Dried Beans*
• Fortified juices (read labels)

Other Sources of Vitamin D^[4]:

• Fatty Fish* (tuna, salmon, mackerel)
• Oysters*
• Supplements* (be aware that some supplements contain milk)

Other Sources of Vitamin B12^[5]:

• Eggs*
• Fortified Foods
• Meat
• Organ Meats (liver and kidney)
• Poultry
• Shellfish*

*Be aware these are the most common allergenic foods. However, almost any food can cause an allergic reaction. It is recommended to speak with a board certified allergist before adding any new foods to the allergic individual’s diet.

FAACT

Did you know that some products with the term “dairy-free” may still contain milk? The labeling of “dairy-free” have no regulatory definition by the FDA and therefore it is necessary to read ingredient labels to check for allergens. The term “non-dairy” has a regulatory definition. However, it DOES allow presence of milk protein, casein in products. Non-dairy is commonly used on coffee creamers made of caseinate, a milk protein, rather than milk or cream. If a milk allergic individual is unsure of a product, call the manufacturer to confirm safety prior to consumption.^[1]