Milk Allergy

Milk allergy is the most common allergy among children. One to two percent of young U.S. children have a milk allergy.

Children with a milk allergy must avoid milk in all forms. This includes all milk and dairy products, including “lactose free” versions of milk products. Children with milk allergy also must avoid anything containing traces of milk ingredients in it. It is important to know the symptoms of a severe allergic reaction called anaphylaxis.

How to Read a Label for Milk

Always read the entire ingredient label to look for the names of milk. Milk ingredients may be within the list of the ingredients. Or milk could be listed in a “Contains: Milk” statement beneath the list of ingredients. Learn more about the U.S. food allergen labeling law.

Advisory statements such as “may contain milk” or “made in a facility with milk” are voluntary. Advisory statements are not required by any federal labeling law. Discuss with your doctor if you may eat products with these labels or if you should avoid them.

Did you know that galactose, ghee and casein all contain milk? The FDA food allergen label law requires foods to state if they contain a top 8 allergen such as milk. But, there are many foods and products that are not covered by the law, so it is still important to know how to read a label for milk ingredients. Products exempt from plain English labeling rules: (1) Foods that are not regulated by the FDA. (2) Cosmetics and personal care items. (3) Prescription and over-the-counter medications. (4) Toys, crafts and pet food. Download and print our Milk Allergy Avoidance List and Travel Cards to carry with you and share.

CONTAIN MILK

The following ingredients found on a label indicate the presence of milk protein. All labels should be read carefully before consuming a product, even if it has been used safely in the past.

Milk — acidophilus milk, buttermilk, buttermilk blend, buttermilk solids, cultured milk, condensed milk, dried milk, dry milk solids (DMS), evaporated milk, fat‐free milk, fully cream milk powder, goat’s milk, Lactaid® milk, lactose free milk, low fat milk, malted milk, milk derivative, milk powder, milk protein, milk solids, milk solid pastes, nonfat dry milk, nonfat milk, nonfat milk solids, pasteurized milk, powdered milk, sheep’s milk, skim milk, skim milk powder, sour milk, sour milk solids, sweet cream buttermilk powder, sweetened condensed milk, sweetened condensed skim milk,whole milk, 1% milk, 2% milk
Butter — artificial butter, artificial butter flavor, butter, butter extract, butter fat, butter flavored oil, butter solids, dairy butter, natural butter, natural butter flavor, whipped butter
Casein & caseinates — ammonium caseinate, calcium caseinate, hydrolyzed casein, iron caseinate magnesium caseinate, potassium caseinate, sodium caseinate, zinc caseinate
Cheese — cheese (all types), cheese flavor (artificial and natural), cheese food, cottage cheese, cream cheese, imitation cheese, vegetarian cheeses with casein
Cream, whipped cream
Curds
Custard
Dairy product solids
Galactose
Ghee
Half & Half
Hydrolysates — casein hydrolysate, milk protein hydrolysate, protein hydrolysate, whey hydrolysate, whey protein hydrolysate Ice cream, ice milk, sherbet
Lactalbumin, lactalbumin phosphate
Lactate solids
Lactyc yeast
Lactitol monohydrate
Lactoglobulin
Lactose
Lactulose
Milk fat, anhydrous milk fat
Nisin preparation
Nougat
Pudding
Quark
Recaldent
Rennet, rennet casein
Simplesse® (fat replacer)
Sour cream, sour cream solids, imitation sour cream
Whey — acid whey, cured whey, delactosed whey, demineralized whey, hydrolyzed whey, powdered whey, reduced mineral whey, sweet dairy whey, whey, whey protein, whey protein concentrate, whey powder, whey solids
Yogurt (regular or frozen), yogurt powder

MILK IS SOMETIMES FOUND IN

Natural flavoring
Flavoring
Caramel flavoring
High protein flour
Lactic acid (usually not a problem)
Lactic acid starter culture
“Non-dairy” products (may contain casein)
Rice cheese
Soy cheese

However, if the product is an FDA regulated food, the word "Milk" must appear on the label.

SHOULD BE SAFE

These milk derivatives should be safe for most individuals with milk allergy, but check with your doctor before using.
Lactoferrin
Tagatose (Naturlose®)

Download Hidden Names for Milk Patient Guide

Download Travel Cards for Hidden Names for Milk

Download our Hidden Names for Milk Guide and Travel-Size Cards

Nondairy Products

Current U.S. food labeling regulations allow for an item to be labeled as "nondairy" on the package. A food can be labeled nondairy even if it has casein in it, a milk protein. The ingredient statement on nondairy products will list "casein" or "caseinates" and the word "milk" if it is an ingredient.

Kosher Labeling

Kosher labeling in general cannot be used as a guide to determining whether a product does or does not contain milk. A person with a milk allergy cannot rely on the kosher pareve (parve) designation alone. A person with a milk allergy can also not rely on the lack of a kosher dairy designation in determining the safety of a particular food.

It is possible for a kosher pareve (parve) food to contain a trace level of dairy contamination.

Lactose Intolerance vs. Milk Allergy

Lactose intolerance is not the same as milk allergy. In lactose intolerance, the body can’t digest lactose (milk sugar) found in milk and milk products. Symptoms of lactose intolerance may include bloating, belly pain and cramps. Milk allergy is an immune system reaction to milk protein. Milk allergy can be severe and life-threatening and may include hives, vomiting, difficulty breathing or other symptoms associated with anaphylaxis. Unlike food allergy, lactose intolerance doesn’t cause the immune system to react.

Cross Reactivity

Cross-reactivity occurs when the proteins in one food are similar to the proteins in another. When that happens, the body's immune system sees them as the same. There is a high degree of cross-reactivity between cow's milk and the milk from other mammals such as goat and sheep. In studies, the risk of allergy (resulting in symptoms) to goat's milk or sheep's milk in a person with cow’s milk allergy is about 90%.

The risk is much lower, about 5%, for allergy to mare's milk (or donkey's milk) which is less cross-reactive with cow's milk.

Nutrition for a Milk-Free Diet

Milk provides a good source of many nutrients essential for bone mineralization and growth. This is especially important during peak growth periods. These nutrients include: protein, calcium, vitamin D, vitamin A, vitamin B12, riboflavin and phosphorus.

When your child avoids foods containing milk, he may lose essential nutrients from his diet. You will need to choose foods with care to replace these lost nutrients. Meats, poultry, eggs, fish, nuts and legumes can easily provide needed protein. However, to replace calcium, your child may need to consume lots of non-dairy food sources containing calcium. This may be more than a young child is capable of eating.

Many non-dairy sources of calcium are not foods that are favorites of most children. For example, one cup of leafy greens contains as much calcium as 4 ounces of milk. A child who needs 500 milligrams of calcium daily would need to eat as much as 4 cups of leafy greens to meet the need. Would your child eat that much leafy greens? Probably not. So, you will need to read labels carefully to find a variety of calcium-fortified foods.

In some cases, you may need to give your child dietary supplements. However, if he or she is at an age when a specialized milk-free formula is a large part of his daily diet, supplementation may not be necessary.

You may be able to use milk alternatives as an acceptable substitute if your child is over one year old. Examples include:

Soy milk
Fortified rice milk
Fortified grain or seed milks (oat milk, flax milk)
Fortified nut milks (almond or cashew milk)
Fortified coconut milk

Any of these milk substitutes can be used, if tolerated. Make sure they are a good source of calcium and additional nutrients. Review the nutrition information on the package to check the amount of protein, which should be 8 grams per 8 ounce serving.

Calcium fortified juices will provide additional calcium but are not a good source of other nutrients.

Soy or rice milk can be used for children who are eating a variety of other foods. The soy or rice milk must be calcium fortified or contain 30 percent calcium.

NUTRIENTS LOST WHEN AVOIDING MILK	SUGGESTED ALTERNATE SOURCES (if not allergic)
Protein, Calcium, Riboflavin, Phosphorus, Vitamins A, D, B12	Increase other protein foods: meat, fish, poultry, legumes, eggs (if safe for your child), fortified milk subsitutes; leafy greens, calcium-fortifed foods

Milk Substitutions

There are many milk alternatives based on legumes, seeds and grains. These include rice, hemp, soy, sunflower, oat, and coconut milks. Those not allergic to nuts may also consider nut milks (the most common of which is almond milk). Most of these milks can be substituted one-for-one in recipes. Many are available in original (plain), vanilla, and chocolate flavors. Many are also available in sweetened and unsweetened varieties. Generally, the unsweetened and unflavored versions work best in recipes.

When cooking, you can substitute non-dairy margarine or oils (in equal amounts) for butter.

Soy-based, coconut-based, and pea-based yogurt, sour cream, and cream cheese products are available at many grocery stores. Milk-free ice creams and other products are also available. Be sure to check the ingredient statements to make sure that they contain no milk ingredients.

Learn more about MILK SUBSTITUTES.