Milk Protein Allergy

Cow milk allergy is the most common food allergy in young children. Fortunately, most babies outgrow milk allergies by their second or third year. In the meantime, parents of babies with milk allergies can be reassured that – although there is no treatment that can cure milk allergies – symptoms can be controlled through a dairy-free diet.

What is cow’s milk (protein) allergy?

Milk Protein Allergy

Regular milk is made up of protein, carbohydrates or sugar, fat, vitamins and minerals, and water. It’s the milk protein that causes the allergic reaction in cow’s milk allergy. Cow’s milk protein allergy can develop in both breastfed and formula-fed children. However, breastfed children are usually less likely to develop food allergies of any sort. Occasionally, though, breastfed children develop cow’s milk allergy when they react to the slight amount of cow’s milk protein that’s passed along from their mother’s diet into her breast milk. In other cases, certain babies can become sensitized to the cow’s milk protein in their mother’s breastmilk, but don’t actually have an allergic reaction until they’re later introduced to cow’s milk themselves.

What are the symptoms of cow’s milk protein allergy?

Babies who develop cow’s milk protein allergy may have one or several of the following symptoms:

  • eczema or skin rash
  • abdominal pain or cramps
  • vomiting
  • or diarrhea

Less commonly, some children may have a very serious allergic reaction called anaphylaxis. This reaction usually occurs within minutes after eating or drinking food that they’re allergic to. The most serious symptom of an anaphylactic reaction is the swelling of the face, mouth, and tongue leading to difficulty breathing. Hives, itchy rash and flushing, and severe vomiting are other signs that may be present should an anaphylactic reaction occur If your child ever has these symptoms, get medical help immediately because untreated anaphylaxis can quickly become fatal. Fortunately, anaphylaxis is rare.

How is cow’s milk allergy confirmed?

There are two very important reasons for making sure that a doctor evaluates your baby’s condition to confirm whether or not your child has a milk allergy. The first reason is that cow’s milk allergy is not the only cause of abdominal pain, eczema, rash, vomiting, diarrhea, or excessive crying. These symptoms can be caused by other conditions, which would need a different treatment. The second reason is because of the danger of an anaphylactic reaction. It’s extremely important to know for certain if your child has a cow’s milk protein allergy because if he does, you’ll have to be very careful about making sure that all milk and milk products are removed from his diet. Because each child is unique, a baby with a suspected milk allergy should have an individualized medical assessment, treatment plan, and follow-up. After the doctor has carefully reviewed your child’s medical history he or she may recommend that you modify your diet if you’re breastfeeding, or that you switch formulas. In some mild cases, the doctor may recommend re-introducing milk after a month or so on a dairy-free diet to see if the child still has symptoms of milk allergy. In other cases, the doctor may refer the child to an allergist. The allergist will try to determine the cause of the baby’s symptoms by doing a skin test or by taking a special blood test.

How is cow’s milk allergy treated?

  • The breastfed child: If you’re breastfeeding, and your child has been diagnosed with a cow’s milk allergy, you don’t need to stop breastfeeding. In fact, your baby’s allergic symptoms can be relieved by simply removing dairy products from your own diet, as well as your baby’s. Your doctor can advise you about a healthy, dairy-free diet that would be appropriate for you.
  • The formula-fed child: If your child is diagnosed with a milk allergy, and is being fed milk-based formula, your doctor will probably recommend switching to either soy-based or hydrolysate formulas. But simply switching to another type or brand of milk-based formula won’t help, as it’s necessary to avoid the cow’s milk protein which is found in all regular formulas. If the child has been diagnosed with a severe milk allergy, the doctor may prescribe special medications in addition to a dairy-free diet. These medications, such as antihistamines or epinephrine (Epipen), are to be used as directed if your child accidentally consumes dairy products and experiences an allergic reaction.

When can babies restart dairy products?

As your baby grows older, you may be able to start introducing cow’s milk into the diet – but only on the advice of your physician or allergist. Infants often outgrow milk allergy, but the age at which it’s safe to re-introduce milk and milk products back into the diet varies with each individual child. Your doctor will probably recommend that your child’s diet be free of dairy products for at least the first 12 to 18 months. He or she may then re-test the child every 6 months until she determines that your baby is no longer allergic to cow’s milk. Once your doctor confirms that your child has outgrown the milk allergy, make sure to follow his recommendations as to how to introduce dairy foods back into the diet. But until your doctor tells you that it is safe to do so, don’t try to re-introduce milk into your child’s diet on your own. And if milk or milk products ever caused an immediate, severe reaction – or anaphylaxis – you should never under any circumstances re-introduce it into your child’s diet unless allergy tests have confirmed that your child has outgrown the allergy. In those severe cases, it may sometimes be recommended to introduce milk into your child’s diet under close medical supervision like in a hospital setting.

What other foods or products need to be avoided?

When your baby starts eating solid foods, you’ll have to be very careful not to give her cow’s milk or any food containing milk or milk products for as long as she remains allergic to milk. And if you have any doubts about what’s in a particular food, it’s best to play it safe and not give it to your child. Here’s a helpful list of some foods and food ingredients to avoid:

  • Any type of cow’s milk or food containing cow’s milk (including skim, dried, solid, evaporated, and condensed)
  • Lactaid ®, which is milk that has been specially processed for lactose intolerant people. But Lactaid ® still contains cow’s milk protein, so should not be given to children with milk allergies.
  • Cheese, cheese curds, yogurt, and ice cream
  • Butter and buttermilk. Also, many margarines have milk in them, so be sure to carefully check the ingredients.
  • Soy products containing cow’s milk. Many of the popular soy-based products now on the market, such as frozen soy desserts, actually contain small amounts of cow’s milk in them. So again, be sure to read labels carefully for product ingredients.
  • Pre-mixed cereals containing powdered cow’s milk
  • Any products containing casein, caseinate, sodium and/or calcium caseinate, lactalbumin or whey. These terms all indicate milk protein.

This list only shows you some of the foods to avoid, so be sure to consult your doctor or dietician for more information about which other foods should be removed from your child’s diet.

Can a cow’s milk protein allergic child eat beef?

Parents often wonder whether their children can eat beef since milk and beef both come from cows. But recent studies have shown that children with cow’s milk protein allergy only rarely have problems eating beef or veal. Therefore, most milk-allergic children can eat beef without any problem.

What can parents tell their allergic child?

As your child gets older, explain his condition to him in understandable terms. Teach him to never accept food from friends or other people, and about how to be cautious without being fearful. Also, be creative in your preparation of meals, so that they still look and taste good even though they’re dairy-free. Your child will feel more comfortable with a diet if that’s similar to what those around him are eating.


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Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.