Milk Allergies

What is a milk allergy?

A milk allergy occurs when a child’s immune system mistakenly recognizes cow’s milk protein as a foreign invader. Milk allergies are most common in infants and young children.

Children who have a milk allergy will typically show symptoms immediately, within minutes and up to 2 hours of consuming milk or products containing milk proteins. Milk is among the foods most likely to cause anaphylaxis, a life-threatening allergic response. Other symptoms may include difficulty breathing, nausea and hives.

Cow’s milk is the most common milk allergen, but children can also have allergic reactions to milk from other animals, including goats and sheep.

About 2.5 percent of children younger than 3 years old are allergic to milk. However, most children outgrow their milk allergy.

Causes of milk allergy

Milk allergies are typically caused when the body misidentifies the proteins in milk as being harmful. The body defends itself by releasing histamine, a chemical that causes symptoms such as coughing, wheezing and hives.

Signs and symptoms of milk allergies

If your child is allergic to milk protein, it may cause symptoms in multiple areas of the body, including:

Skin: hives (red, blotchy skin that can itch) and may include mild to severe swelling
Lungs: difficulty breathing, shortness of breath, coughing or wheezing
Eyes: itching, tearing or redness
Throat: tightness, trouble breathing or inhaling
Stomach: repeated vomiting, nausea, abdominal pain and cramping,  or diarrhea
Nose: congestion, copious clear discharge, sneezing or itching
Neurologic: change in behavior or mood, dizziness
Drop in Blood Pressure: This is the most dangerous symptom of a severe allergic reaction

If your child experiences any of these symptoms after consuming milk or dairy, call your pediatrician and arrange to have your child tested by a pediatric allergist.

If a child has any two systems involved from the above list, this means they may be experiencing anaphylaxis.

If your child has symptoms of anaphylaxis, call 911 immediately.

Milk allergy vs. lactose intolerance

The difference between a milk allergy and lactose intolerance is the involvement of the immune system. When a child has a milk allergy, the body’s immune system creates IgE antibodies to milk protein which lead to release of histamine and other chemicals that cause symptoms typical of allergic reactions

Lactose intolerance, on the other hand, involves more of the GI system. Those with lactose intolerance lack an enzyme that breaks down the sugars in milk and dairy products. This causes GI symptoms that may include nausea, cramps, gas, bloating and diarrhea.

Testing and diagnosis of milk allergy

If you suspect your child is allergic to milk, clinicians at Children’s Hospital of Philadelphia will take a detailed medical history of your child, including information on prior food reactions. Based on your child’s history and findings, our clinicians may order one or more of the following tests:

Skin test

In allergy skin testing, a very small amount of the food allergen is introduced to the skin  — typically on your child’s forearm — through a gentle pinprick. The appearance of a hive-like bump may indicate a milk allergy.

Blood test

In allergen-specific IgE blood tests, a small amount of your child's blood is drawn and tested for antibodies the child may have produced in response to exposure to an allergen.

Food challenge

A food challenge test involves giving your child a small increasing amounts of milk protein in a controlled, highly supervised clinical setting to monitor for any reactions. 

Treatments for milk allergy

Once your child is confirmed to have a milk allergy, the first step in treatment is avoiding milk and dairy products.

Your child’s doctor can give you detailed information on how to read food labels to help you identify and avoid milk protein.

No matter how careful you are, there may be times when your child accidentally ingests milk protein and has a reaction. When that happens, you can treat the symptoms with antihistamines or epinephrine.

If more than one body system is involved in the allergic reaction — for example the throat and skin — it is recommended to use epinephrine. Epinephrine comes in a variety of forms, including auto-injectors such as Epi-Pen, Auvi-Q and other generic forms.

If your child’s reaction is mild and only involves a few hives, an over-the-counter or prescription strength antihistamine can ease their symptoms. Your child’s doctor can help you decide which option is best for your child in each circumstance.

Children with milk allergies should carry epinephrine with them, or it should be readily available at places where they routinely spend time, such as school, daycare and home.

When to call 911

If your child has a severe reaction or signs of anaphylaxis, administer epinephrine and then call 911 right away. In some circumstances, children may need more than one dose of epinephrine, so it is important to have medical assistance in these situations if needed.

Oral immunotherapy

Oral immunotherapy (OIT), may help desensitize your child to milk. Your child will ingest small quantities of milk protein in a controlled setting to monitor for reactions, then continue that amount of milk protein every day at home. The amount of milk protein will be gradually increased under close medical supervision at the hospital. Your healthcare provider can help you decide if oral immunotherapy may be appropriate for your child. If so, you'll receive a referral to CHOP’s Oral Immunotherapy Program.

Follow-up care for milk allergies

Most of the ongoing treatment for allergies can be done at home. Once your child has been diagnosed with milk allergy, you and your family will be given more information on how to avoid exposure to milk and treat any reactions you child may experience.

You may also want to share information about your child's allergy with your extended family, close friends and your child's school so they can help reduce the chance of accidental exposure outside your home.

Some children with food allergies, including milk, will eventually outgrow the. It's important that your child undergo a supervised test — such as a food challenge — to determine if they must continue avoiding the food or can incorporate it into their diet.

Dairy-free Diet

The key to an allergy-free diet is to avoid giving your child the foods or products containing the food to which he or she is allergic. The items that your child is allergic to are called allergens. Milk and milk products are found in many foods. Obvious forms of milk are cream, cheese, butter, ice cream and yogurt. Milk and milk products may also be hidden sources in commonly eaten foods. To avoid foods that contain milk products, it is important to read food labels.

  • The words "nondairy" on a product label indicates it does not contain butter, cream or milk. However, this does not necessarily indicate it does not have other milk-containing ingredients.
  • The Kosher food labeled "pareve" or "parve" almost always indicates the food is free of milk and milk products. A "D" on a product label next to the circled "K" or "U" indicates the presence of milk protein. These products should be avoided.
  • Processed meats, including hot dogs, sausages and luncheon meats, frequently contain milk or are processed on milk-containing lines. Carefully read all food labels.

Learn more about a dairy-free diet in children.

Foods: What's allowed and what's not

Beverages

Allowed:

  • Water
  • Carbonated beverages
  • Coffee
  • Tea
  • Soy substitute-milk formulas
  • Fruit drinks

Not allowed:

  • All milks (whole, low-fat, skim, buttermilk, evaporated, condensed, powdered or hot cocoa)
  • Yogurt, eggnog, milkshakes, malts
  • All beverages made with milk or milk products

Breads

Allowed:

  • Milk-free breads
  • French bread
  • Wheat, white, rye, corn, graham, gluten and soy breads made without milk or milk products
  • Graham cracker and rice wafers

Not allowed:

  • Wheat, white or rye breads that contain milk
  • Biscuits, donuts, muffins, pancakes, waffles, zwieback, crackers, saltines that contain milk. There are now several mixes available that do not contain milk. Be sure to carefully read labels.
  • Most commercially prepared breads and rolls contain milk or milk products
  • French toast made with milk

Cereals

Allowed:

  • Any cereal to which no milk or milk products have been added

Not allowed:

  • Prepared and precooked cereals with milk solids, casein or other milk products added

Desserts

Allowed:

  • Meringue, gelatin, popsicles, fruit ice, fruit whip and angel food cake
  • Cakes, cookies and pie crusts made without milk or milk products such as Vegan desserts

Not allowed:

  • Cake, cookies, custard, pudding, cream desserts or sherbet containing milk products
  • Ice cream, cream pie
  • Pastries brushed with milk

Eggs

Allowed:

  • Prepared without milk

Not allowed:

  • Scrambled with milk, creamed eggs or egg substitutes

Fats

Allowed:

  • Vegetable oil, meat fat, lard, bacon, shortening, milk-free gravy
  • Peanut butter (made without milk solids)
  • Margarine without milk solids
  • Kosher margarine
  • Vegan butter substitute

Not allowed:

  • Butter, cream, margarine
  • Salad dressing or mayonnaise containing milk, milk solids or milk products
  • Some butter substitutes and nondairy creamers

Fruits  

Allowed:

  • Fresh, frozen or canned fruits and juices

Not allowed:

  • Any fruits served with milk, butter or cream such as whipped cream

Meats, fish, poultry and cheese

Allowed:

  • Baked, broiled, boiled, roasted or fried: beef, veal, pork, chicken, turkey, lamb, fish, organ meats or tofu (prepared without milk or milk products)
  • Sausage, deli/luncheon meats or ham if made without milk products

Note: A small number of people with cow's milk allergy may develop a reaction to beef. Thus, those with cow's milk allergy should be careful when consuming beef or foods containing beef.      

Not allowed:

  • All cheese, cottage cheese, cream cheese
  • Some sausage products, bologna and frankfurters
  • Breaded meats, meatloaf, croquettes, casseroles, hamburgers (unless made without milk)
  • Commercial entrees made with milk or milk solids

Potatoes and substitutes

Allowed:

  • Macaroni, noodles, spaghetti and rice
  • White or sweet potatoes prepared without milk, butter, cream or allowed margarine

Not allowed:

  • Au gratin, buttered, creamed, scalloped potato or substitutes
  • Macaroni and cheese
  • Mashed potatoes containing milk or butter
  • Frozen French fries sprayed with lactose

Soups

Allowed:

  • Bouillon, broth, consommé or soups with broth base plain or with all allowed foods

Not allowed:

  • Bisques, chowders, creamed soups
  • All soups made with milk or milk products

Sweets

Allowed:

  • Corn syrup, honey, jam and jelly
  • Hard candy and candy made without milk or milk products
  • Granulated, brown or powdered sugar

Not allowed:

  • Candy made with milk, such as chocolate, fudge, caramels or nougat

Vegetables

Allowed:

  • All fresh, frozen or canned vegetables without milk or milk products added
  • All vegetable juices

Not allowed:

  • Au gratin, buttered, creamed or scalloped vegetables
  • Batter and dipped vegetables
  • Vegetable souffles

Miscellaneous

Allowed:

  • Ketchup, olives, pickles, nuts, herbs, chili powder, salt, spices, condiments
  • Any foods that are milk-free, cheese-free, or butter-free, or that do not contain powdered milk or whey

Not allowed:  

  • All items containing milk, cheese, butter, whey casein, caseinates, hydrolysates, lactose, lactalbumin, lactoglobulin or milk solids, or artificial butter flavor
  • Nondairy substitutes containing caseinate

How to read a label for a milk-free diet

Be sure to avoid foods that contain any of the following ingredients:

  • Artificial butter flavor
  • Butter, butter fat
  • Buttermilk
  • Casein
  • Caseinates (ammonium, calcium, magnesium, potassium, sodium)
  • Cheese, cottage cheese, curds
  • Cream
  • Custard, pudding
  • Ghee
  • Half and Half
  • Hydrolysates (casein, milk protein, protein, whey, whey protein)
  • Lactalbumin or lactalbumin phosphate
  • Lactoglobulin
  • Lactose
  • Milk (derivative, protein, solids, malted, condensed, evaporated, dry, whole, low-fat, nonfat or skim)
  • Nougat
  • Pudding
  • Rennet casein
  • Sour cream
  • Sour cream solids
  • Whey (delactosed, demineralized or protein concentrate)
  • Yogurt

Other possible sources of milk or milk products:

  • Brown sugar flavoring
  • Caramel candies
  • Caramel flavoring
  • Chocolate
  • High protein flour
  • Luncheon meats, hot dogs, sausages
  • Margarine
  • Natural flavoring
  • Simplesse