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Milk Allergy Diet

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WHAT IS A MILK ALLERGY?

Your child has been diagnosed with a cow’s milk allergy. Food allergy happens when your immune system overreacts to a specific food protein. When you eat or drink the milk protein, it can trigger an allergic reaction. Symptoms can range from mild (rashes, hives, itching, swelling, etc.) to severe (trouble breathing, wheezing, loss of consciousness, etc.). Milk allergy can be potentially life-threatening, a reaction is called anaphylaxis. How allergic a child is to cow’s milk varies from person to person, and reactions can be unpredictable. If your child has a milk allergy, keep an epinephrine auto-injector (such as an EpiPen®, Auvi-Q™ or Adrenaclick®) with you/your child at all times. Epinephrine is the first-line treatment for anaphylaxis.

MILK ALLERGY OR MILK INTOLERANCE

Allergy to cow’s milk is the most common food allergy in infants and young children. About 2.5 percent of children under three years old are allergic to milk. Nearly all infants who develop an allergy to milk do so in their first year of life. Milk allergy should not be confused with lactose intolerance. Unlike milk allergy, milk intolerance does not involve the immune system. People who are lactose intolerant are missing the enzyme lactase. Lactase breaks down lactose, a sugar found in milk and dairy products. As a result, people with lactose intolerance are unable to digest these foods. Symptoms include nausea, cramps, gas, bloating and diarrhea. Lactose intolerance is not life-threatening.

AVOIDING MILK

Milk is one of the eight allergens that fall under the labeling requirements of the Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004. This means that manufacturers of packaged food items sold in the United States containing milk or a milk-based ingredient must state, in clear language, the presence of milk in the product. Advisory statements such as “may contain milk” or “made in a facility with milk” are voluntary. Advisory statements are not required by any federal labeling law. Discuss with your doctor if you may eat products with these labels or if you should avoid them. If you do not know what is in the food, do not give it to your child.

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. Other similar milks that should be avoided include: sheep, deer, ibex, and buffalo milk.

HOW TO READ A LABEL FOR A MILK-FREE DIET

AVOID foods that contain any of these milk ingredients:

 
  • Butter, butter fat, butter oil, butter acid, butter ester(s)
  • Buttermilk
  • Casein
  • Casein hydrolysate
  • Caseinates (in all forms)
  • Cheese
  • Cottage cheese
  • Cream
  • Curds
  • Custard
  • Diacetyl
  • Ghee
  • Half-and-half
  • Lactalbumin, lactalbumin phosphate
 
  • Lactoferrin
  • Lactose
  • Lactulose
  • 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
  • Pudding
  • Recaldent(R)
  • Rennet casein
  • Sour cream, sour cream solids
  • Sour milk solids
  • Tagatose
  • Whey (in all forms)
  • Whey protein hydrolysate
  • Yogurt 

 

Ingredients that MAY indicate the presence of milk protein:

  • Artificial butter flavor
  • Baked goods
  • Caramel candies
  • Chocolate
  • 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.
  • Margarine
  • Nisin
  • Non-dairy products, as many contain casein
  • Nougat
  • 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

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.

NUTRITION FOR A MILK FREE DIET

Milk provides a good source of many nutrients essential for bone mineralization and growth. This is especially important during peak growth periods. These nutrients include: protein, calcium, vitamin D, vitamin A, vitamin B12, riboflavin and phosphorus.

When your child avoids foods containing milk, he may lose essential nutrients from his diet. You will need to choose foods with care to replace these lost nutrients. Meats, poultry, eggs, fish, nuts and legumes can easily provide needed protein. However, to replace calcium, your child may need to consume lots of non-dairy food sources containing calcium or provide dietary supplements.

You may be able to use milk alternatives as an acceptable substitute if your child is over one year old.

Examples include:

  • Soy milk
  • Fortified rice milk
  • Fortified grain or seed milks (oat milk, flax milk)
  • Fortified nut milks (almond or cashew milk)
  • Fortified coconut milk

Any of these milk substitutes can be used, if tolerated. Make sure they are a good source of calcium and additional nutrients. Review the nutrition information on the package to check the amount of protein, which ideally should be 8 grams per 8 ounce serving.

Calcium fortified juices will provide additional calcium but are not a good source of other nutrients.

WILL MY CHILD OUTGROW A MILK ALLERGY?

Most children eventually outgrow a milk allergy. The allergy is most likely to continue in children who have high levels of cow’s milk antibodies in their blood. Skin tests and blood tests that measure these antibodies can help your allergist determine whether or not a child is likely to outgrow a milk allergy. You should not test your child at home to see if they have outgrown the milk allergy but rather arrange for an oral food challenge to milk to make sure it its safe.

Recent studies suggest that 70–80% of children cow’s milk allergy will tolerate “baked milk” products. The ability to add safer, less allergenic forms of milk such as in baked goods, into the diets of milk-allergic children has several benefits, including broadening diet, improving the quality of life, and speeding up how quickly your child outgrows regular milk allergy. Baking milk thoroughly alters proteins making it less allergenic. While blood and skin testing are helpful for predicting whether your child will tolerate baked milk, an oral food challenge (OFC) remains the most useful method for determining tolerability. A recipe for the food challenge cake or muffin will be provided by your allergist. Make sure the product is baked completely through.

When your child has passed the baked milk challenge, he or she will be able to eat extensively baked products with baked milk as an ingredient. Should your child develop an allergic reaction to the food that contains baked milk, please record the offending food, amount eaten, preparation technique, and symptoms. Contact your allergist at your earliest convenience to review the reaction.

BAKED MILK DIET

Once your allergist feels it is safe to eat baked milk, your child may now eat the following:

  • Store-bought baked products with milk ingredient listed as the third ingredient or further down the list of ingredients.
  • Home-baked products that have no more than one-sixth cup of milk per baked serving. For example, a recipe that has 1 cup milk per batch of a recipe that yields 6 servings.
  • Remember to check store-bought products and ingredients on the basis of your child’s food allergies to avoid a reaction to other allergens.
  • All baked products must be baked thoroughly and not wet or soggy in the middle.

Your child should continue to avoid unbaked milk-based foods such as the following:

  • Baked products with milk listed as the first or second ingredient.
  • Product that may have a milk ingredient that has not been baked, such as a milk ingredient containing frosting on a cookie or cupcake, or a cheese flavoring on a cracker that may not have been baked (e.g. flavorings may be applied topically after the product is baked).
  • Milk chocolate chips that will melt during baking but not bake. Please continue to use milk-free chocolate chips.
  • Regular milk or dairy in any form including whole, low-fat, nonfat, or skim milk, lactose-free products, dry milk powder, yogurt, sour cream, butter, hard and soft cheeses, ice cream, sherbet, butter, etc.
  • Frosting with milk ingredient.
  • French toast and pancakes.
  • Homemade waffles.
  • Cooked milk products that are not baked, such as pudding.

Great resources for more information include:

  • www.foodallergy.org FARE Food Allergy Research and Education
  • www.allergicliving.com Allergic Living Magazine
  • www.kidswithfoodallergies.org Kids with Food Allergies
  • www.acaai.org American College of Allergy. Asthma and Immunology
  • www.aaaai.org American Academy of Allergy, Asthma and immunology

Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 09/2018

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