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What is a dairy allergy (cow’s milk allergy)?
A milk allergy (also called dairy allergy or cow’s milk allergy) is an adverse immune response to the protein in cow’s milk.
Please note that the body may react similarly to the milk proteins from other mammals, such as goat, sheep, buffalo and camel, since they are similar.
It is advisable not to consume other animal’s milk products if allergic to cow’s milk. (4)
Milk allergy is rare in adults and more common in infants. It affects approximately 2.5% of infants in developed countries.
Most children outgrow cow’s milk allergy completely by the age of 4 years. However, this process happens at different stages:
- 1 year of age in up to 50% of children,
- 2 years of age in up to 75% of children,
- 3 years of age in up to 90% of children.
The allergy may continue in some cases, but rarely reaches adulthood. (7)
About 75% of the children with cow’s milk allergy can consume baked milk products, such as muffins, cakes or breads, without experiencing any symptoms.
Adding these products to the affected children’s diet, improves tolerance to regular milk products quicker than avoiding them.
The other 25% of children have a more severe type of allergy and a greater chance of severe anaphylaxis to milk. This group experiences allergic reactions to baked milk products.
Milk allergy symptoms (dairy allergy symptoms)
The majority of infants with milk allergy will experience more than two symptoms in more than two organ systems:
- gastrointestinal (diarrhea, nausea, vomiting);
- skin (angioderma, dermatitis, eczema, hives);
- respiratory (asthma, coughing, rhinitis, wheezing). ((https://waojournal.biomedcentral.com/track/pdf/10.1097/WOX.0b013e3181defeb9?site=waojournal.biomedcentral.com
Different symptoms may occur at different times, depending on the amount of dairy consumed and the severity of the individual’s allergy:
An immediate reaction to a small amount of milk – occurring any time between a few minutes to 2 hours – with the following symptoms:
- Anaphylaxis is the most severe, life threatening reaction and requires an immediate epinephrine (adrenaline) shot. (5)
- Abdominal pain and cramps
- Colic, in babies
- Diarrhea or loose stools (may contain blood)
- Itchy skin rash around the mouth
- Swelling of the face
- Watery eyes and runny nose
A delayed reaction to a moderate amount of milk – occurring a few hours after – producing the following symptoms:
- Eczema getting worse
A delayed reaction to a normal amount of cow’s milk – after a day or up to a few days – with the following symptoms:
Diagnosis of cow’s milk allergy
Milk allergy can easily be misdiagnosed because similar symptoms, unrelated to milk allergy, can occur in 5-15% of cases. (1)
The diagnosis in the case of an immediate reaction that occurs within two hours of consuming milk, is straight forward. It can be done using an allergy skin prick test or blood allergen specific IgE test by your doctor.
You should be aware that, since cow’s milk allergy may result in severe reactions, including anaphylaxis, the allergic food elimination test is not recommended for diagnosis.
Delayed reactions can be difficult to diagnose since the symptoms may be due to various causes and requires a referral from an allergy specialist.
Treatment of cow’s milk allergy
There is no cure for cow’s milk allergy, but the symptoms can be stopped by the complete removal of dairy products from the diet.
Since individuals who are allergic to cow’s milk are also allergic to other dairy products, such as goat’s milk, sheep’s milk and other animal’s milk, a complete avoidance of any dairy products is necessary.
Foods that contain dairy to avoid
The list of foods to avoid includes not only cow’s milk products but other dairy products and other animal’s milk products.
Many processed, packaged, frozen non-dairy products may also contain milk proteins, so it is advisable to carefully search for ingredients on the labels of the foods listed in the image below.
You can find the list of foods to avoid on the website of The Australasian Society of Clinical Immunology and Allergy (ASCIA). (8)
Dairy substitute foods
Dairy foods contain high amounts of a wide a variety of nutrients. When eliminating these foods from the diet, other foods of similar nutritional values should take their place in order to avoid deficiencies.
For infants and children, the most important nutrients for their development that are present in milk include: protein, energy nutrients, vitamin D and calcium.
The best substitute for dairy for infants is breast milk or a special formula advised by the doctor.
For children over one year old, products such as soy, rice, oat or nut drinks, soy yogurt, soy cheese, soy sour cream, oil or milk free margarine, soy cream or rice cream may be suitable
For older children, teenagers and adults with milk allergy, the following table shows the list of the most abundant nutrients in milk and the best food sources of each nutrient, ranked by the highest nutrient contents per its usual serving.
Please note that being allergic to milk, you might also be allergic to some of the foods shown in the table.
Before changing your diet, it is best to contact your medical professional to conduct full allergic tests to identify all the other allergens.
|White and red meats||Beef liver, cooked||Beef liver, cooked||Clam, cooked||Poppy seeds||Cuttlefish, cooked||Coconut water||Brazil nuts||Oysters|
|Fish and seafood||Cuttlefish, cooked||Swordfish, cooked||Beef liver, cooked||Sesame seeds||Carp, cooked||Cuttlefish, cooked||Oysters||Beef, lean|
|Soybeans, cooked||Duck, cooked||Tuna, cooked||Octopus, cooked||Turnip greens||Beef liver, cooked||Octopus, cooked||Cuttlefish, cooked||Beef liver, cooked|
|Lentils, cooked||Egg large||Veal lean, cooked||Oysters||Chia seeds||Pumpkin seeds||Clam, cooked||Mussel, cooked||Lamb lean, cooked|
|Soy milk||Mackerel, cooked||Trout, cooked||Mussel, cooked||Cuttlefish, cooked||Clam, cooked||Adzuki beans, cooked||Octopus, cooked||Crab, cooked|
|Pinto beans, cooked||Clam, cooked||Beef, lean||Mackerel, cooked||Spinach, cooked||Scallops, cooked||Halibut, cooked||Clam, cooked||Cuttlefish, cooked|
|Kidney beans, cooked||Mussel, cooked||Salmon, cooked||Herring, cooked||Collards, cooked||Swordfish, cooked||Avocado||Swordfish, cooked||Octopus, cooked|
|Black beans, cooked||Goose, cooked||Quail, cooked||Tuna, cooked||Soy Yogurt||Tuna, cooked||Pork lean, cooked||Flounder, cooked||Goose, cooked|
|Navy beans, cooked||Lamb lean, cooked||Pork lean, cooked||Crab, cooked||Perch, cooked||Pork lean, cooked||Lima beans, cooked||Perch, cooked||Veal lean, cooked|
|Adzuki beans, cooked||Pork lean, cooked||Rabbit, cooked||Rabbit, cooked||Dandelion greens||Chia seeds||Snapper, cooked||Abalone, cooked||Quail, cooked|
|Lima beans, cooked||Oysters||Halibut, cooked||Cuttlefish, cooked||Scallops, cooked||Goose, cooked||Soybeans, cooked||Mackerel, cooked||Turkey, cooked|
|Chickpeas, cooked||Almonds||Mackerel, cooked||Trout, cooked||Oats, cooked||Herring, cooked||Banana||Snapper, cooked||Scallops, cooked|
|Pumpkin seeds||Herring, cooked||Chicken breast filet||Pollock, cooked||Octopus, cooked||Flounder, cooked||Scallops, cooked||Grouper, cooked||Lobster, cooked|
|Peanuts||Quail, cooked||Turkey, cooked||Snapper, cooked||Crab, cooked||Poppy seeds||Grouper, cooked||Halibut, cooked||Clam, cooked|
|Pistachios||Chicken breast filet||Lamb lean, cooked||Crayfish, cooked||Soybeans, cooked||Halibut, cooked||Pollock, cooked||Herring, cooked||Mussel, cooked|
|Almonds||Tuna, cooked||Duck, cooked||Lobster, cooked||Clam, cooked||Mussel, cooked||Trout, cooked||Pollock, cooked||Duck, cooked|
|Sunflower seeds||Veal lean, cooked||Haddock, cooked||Lamb lean, cooked||Trout, cooked||Pollock, cooked||Pinto beans, cooked||Tuna, cooked||Poppy seeds|
|Spelt, cooked||Oats, cooked||Eel, cooked||Eel, cooked||Flaxseed||Pike, cooked||Jackfruit||Pork lean, cooked||Sesame seeds|
|Flaxseed||Soybeans, cooked||Peanuts||Salmon, cooked||Almonds||Octopus, cooked||Lentils, cooked||Lobster, cooked||Pumpkin seeds|
|Cashew nuts||Mushrooms, crimini||Oats, cooked||Flounder, cooked||Pollock, cooked||Quail, cooked||Carp, cooked||Salmon, cooked||Rabbit, cooked|
|Poppy seeds||Turkey, cooked||Herring, cooked||Pike, cooked||Navy beans, cooked||Mackerel, cooked||Kidney beans, cooked||Haddock, cooked||Adzuki beans, cooked|
|Sesame seeds||Soy milk||Goose, cooked||Swordfish, cooked||Herring, cooked||Perch, cooked||Herring, cooked||Crab, cooked||Pine Nuts|
|Tofu||Pollock, cooked||Pollock, cooked||Beef, lean||Soy milk||Oysters||Navy beans, cooked||Shrimp, cooked||Eel, cooked|
|Amaranth, cooked||Beef, lean||Octopus, cooked||Shrimp, cooked||Pike, cooked||Trout, cooked||Mackerel, cooked||Rabbit, cooked||Chicken breast filet, cooked|
|Chia seeds||Rabbit, cooked||Clam, cooked||Carp, cooked||Amaranth, cooked||Salmon, cooked||Haddock, cooked||Cod, cooked||Pork lean, cooked|
Difference between milk allergy and lactose intolerance
Allergy is an adverse immune reaction to the protein of certain foods. In this case it is an allergy to a milk protein called casein.
Lactose intolerance, on the other hand, is food sensitivity resulting from insufficient enzymes that break-down milk sugars, called lactose, and is of a non-allergenic nature.
While milk allergy affects mostly babies up to four years old and is rare in adults, lactose intolerance affects mostly adults.