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.

A protein called casein (αs1-, αs2-, β-, and κ-) and whey proteins (α-lactalbumin and β-lactoglobulin) are the major allergens in milk. (1, 2, 3)

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 infants with a milk allergy develop symptoms within the first month of life and often within 1 week after introducing a formula containing cow’s milk. (5, 3, 6)

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). (8)

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
• Coughing
• Diarrhea or loose stools (may contain blood)
• Eczema
• Itchy skin rash around the mouth
• Hives
• Swelling of the face
• Vomiting
• Watery eyes and runny nose
• Wheezing

A delayed reaction to a moderate amount of milk – occurring a few hours after – producing the following symptoms:

• Diarrhea
• Eczema getting worse
• Vomiting

A delayed reaction to a normal amount of cow’s milk – after a day or up to a few days – with the following symptoms:

• Asthma
• Eczema
• Diarrhea

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). (9)

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.

Protein	Riboflavin Vit B2	Pantothenic Acid Vit B5	Vit B12	Calcium	Phosphorus	Potassium	Selenium	Zinc
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.

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