Allergy to cow’s milk is the most common food allergy in infants and young children. Symptoms of a milk allergy reaction can range from mild, such as hives, to severe, such as anaphylaxis. Therefore it is advised that people with milk allergy have quick access to an epinephrine auto-injector (such as an EpiPen®, Auvi-Q® or Adrenaclick®) at all times. To prevent a reaction, strict avoidance of cow’s milk and cow’s milk products is essential. Always read ingredient labels to identify cow’s milk ingredients.
Approximately 2.5 percent of children younger than three years of age are allergic to milk. Nearly all infants who develop an allergy to milk do so in their first year of life. Most children eventually outgrow a milk allergy. The allergy is most likely to persist in children who have high levels of cow’s milk antibodies in their blood. Blood tests that measure these antibodies can help your allergist determine whether or not a child is likely to outgrow a milk allergy.
Sensitivity to cow’s milk varies from person to person. Some people have a severe reaction after ingesting a tiny amount of milk. Others have only a mild reaction after ingesting a moderate amount of milk. Reactions to milk can be severe and life-threatening (read more about anaphylaxis).
Differences between Milk Allergy and Lactose Intolerance
Milk allergy should not be confused with lactose intolerance. A food allergy is an overreaction of the immune system to a specific food protein. When the food protein is ingested, in can trigger an allergic reaction that may include a range of symptoms from mild symptoms (rashes, hives, itching, swelling, etc.) to severe symptoms (trouble breathing, wheezing, loss of consciousness, etc.). A food allergy can be potentially fatal.
Unlike food allergies, food intolerances do not involve the immune system. People who are lactose intolerant are missing the enzyme lactase, which breaks down lactose, a sugar found in milk and dairy products. As a result, lactose-intolerant patients are unable to digest these foods, and may experience symptoms such as nausea, cramps, gas, bloating and diarrhea. While lactose intolerance can cause great discomfort, it is not life-threatening.
Formula for Infants with a Milk Allergy
It is recommended that formula-fed infants who are allergic to milk use an extensively hydrolyzed, casein-based formula. This type of formula contains protein that has been extensively broken down so it is different than milk protein and not as likely to cause an allergic reaction. Examples of casein-hydrolysate formulas are Alimentum® and Nutramigen®. If the child is not allergic to soy, his or her doctor may recommend a soy-based formula.
A milk-free formula is an excellent source of necessary nutrients, so many doctors recommend continuing its use well past the age of one year for children on restricted diets due to food allergy. Discuss your options with your doctor or dietitian to be sure that the child’s nutritional requirements are all being met.
The federal Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that all packaged food products sold in the U.S. that contain milk as an ingredient must list the word “Milk” on the label.
Read all product labels carefully before purchasing and consuming any item. Ingredients in packaged food products may change without warning, so check ingredient statements carefully every time you shop. If you have questions, call the manufacturer.
As of this time, the use of advisory labels (such as “May Contain”) on packaged foods is voluntary, and there are no guidelines for their use. However, the FDA has begun to develop a long-term strategy to help manufacturers use these statements in a clear and consistent manner, so that consumers with food allergies and their caregivers can be informed as to the potential presence of the eight major allergens.
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, lowfat, malted, milkfat, nonfat, 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
Milk is sometimes found in the following:
- Artificial butter flavor
- Baked goods
- Caramel candies
- Lactic acid starter culture and other bacterial cultures
- Luncheon meat, hot dogs, sausages
- Nondairy products
Some Unexpected Sources of Milk*
- Deli meat slicers are frequently used for both meat and cheese products.
- Some brands of canned tuna fish contain casein, a milk protein.
- Many non-dairy products contain casein (a milk derivative), listed on the ingredient labels.
- Some specialty products made with milk substitutes (i.e., soy-, nut- or rice-based dairy products) are manufactured on equipment shared with milk.
- Some meats may contain casein as a binder. Check all labels carefully.
- Shellfish is sometimes dipped in milk to reduce the fishy odor. Ask questions about the risk of milk contact when purchasing shellfish.
- Many restaurants put butter on steaks after they have been grilled to add extra flavor. The butter is not visible after it melts.
- Some medications contain milk protein.
*Note: This list highlights examples of where milk has been unexpectedly found (e.g., on a food label for a specific product, in a restaurant meal, in creative cookery). This list does not imply that milk is always present in these foods; it is intended to serve as a reminder to always read the label and ask questions about ingredients before eating a food that you have not prepared yourself.
Keep in mind the following:
- Individuals who are allergic to cow’s milk are often advised to also avoid milk from other domestic animals. For example, goat's milk protein is similar to cow's milk protein and may, therefore, cause a reaction in individuals who have a milk allergy.
- Kosher Dairy: A “D” or the word “dairy” following the circled K or U on a product label indicates the presence of milk protein or a risk that the product is contaminated with milk protein. These products should be avoided.
- Kosher Pareve: A product labeled “pareve” is considered milk-free under kosher dietary law. However, a food product may be considered pareve even if it contains a very small amount of milk protein – potentially enough to cause an allergic reaction in susceptible individuals. Do not assume that pareve-labeled 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 need not be restricted by someone avoiding milk:
- 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
Download our PDF on how to read a label for a milk-free diet.