How to cope with a milk allergy

Millions of Americans can’t digest a certain sugar in milk and milk products called lactose. If you’re one of them, you have lactose intolerance.

The condition isn’t harmful, but it can be uncomfortable and may be embarrassing. There’s no cure, but you can manage it by watching how much milk or milk products you drink or eat.

Being lactose intolerant is not the same as being allergic to milk.

What Is Lactose?

Lactose is the sugar that’s in milk.

Our bodies use an enzyme called lactase to break down that sugar so we can absorb it into our bodies. But people with lactose intolerance don’t have enough lactase. It’s produced in the small intestine.

Even with low levels of lactase, some people can digest milk products just fine. For people who are lactose intolerant, their low lactase levels gives them symptoms after they eat dairy.

What Happens In My Body If I’m Lactose Intolerant?

When we drink milk or have a milk-based product, lactase in our small intestines breaks down the milk sugar. It then gets absorbed into the body through the small intestines.

But people who are lactose intolerant don’t have it so easy. In them, the lactose doesn’t get broken down. Instead, it goes on to the colon, where it mixes with normal bacteria and ferments. It can cause things like gas, bloating and diarrhea.

The symptoms are no fun, but they’re not dangerous. Most people can manage their symptoms by changing their diet and limiting the amount of lactose they consume. Some people do better by cutting lactose out of their diet altogether.

Your body may be able to handle some lactose without symptoms. Experiment to find out the types and amounts of products with lactose you can eat and drink.

There are some steps you can take to test yourself:

  1. Go without milk or milk products for a couple of weeks.
  2. If your symptoms disappear, bring dairy products back into your diet a little at a time to take note of how you react.
  3. If your symptoms continue after cutting out the dairy — or if they return — see your doctor to find out what’s going on.

Who Develops It?

Believe it or not, most adults around the world can’t digest milk — 40% of humans stop producing enough lactase to digest milk between the ages of 2 and 5.

In the United States, it’s estimated that just over one-third of people are lactose intolerant. It is most common among:

  • Asian Americans
  • African Americans
  • Mexican Americans
  • Native Americans

It can also be inherited or associated with other specific diseases.

How Do I Know If I’m Lactose Intolerant?

Our bodies react to milk in ways that are easily measured. Two common tests for adults are:

  • Breath test. This will show if you have high levels of hydrogen when you exhale. If you do, you might be lactose intolerant. That’s because hydrogen is given off when lactose is broken down in the colon. The hydrogen gets taken by the blood up to your lungs, and then you exhale it.
  • Blood test. This can show how your body reacts after you drink something with a lot of lactose. However, this test is usually not done.

Doctors can also take a stool sample from babies and young children.

What If I Have It?

You may still be able to eat or drink small amounts of milk. Some people do better if they have their dairy with a meal. And, some dairy products, like hard cheese or yogurt, may be easier to digest.

Also, there are lots of lactose-free dairy products at the supermarket. Or you can take commonly found over-the-counter supplements (like Lactaid) to break down the milk sugars if you still want the real thing.

Talk to your doctor about a liquid lactase replacement. These are over-the-counter drops that you add to milk.

But if you give up milk completely, you can still get plenty of calcium, vitamin D and other nutrients in a healthy diet.

Instead of milk, you can substitute these foods:

  • Almonds
  • Dried beans
  • Tofu
  • Collards -fortified orange juice and soy milk
  • Fatty fish, like salmon, tuna and mackerel
  • Egg yolks
  • Beef liver

Watch for Hidden Lactose

Always read labels. Many foods have lactose, including snack foods, bakery products, candy, dry mixes, dried vegetables, and infant formulas.

Many medicines also have lactose, which is used as a filler, especially in white tablets. Many birth control pills and medications used to treat gas and stomach acid contain lactose. Your doctor or pharmacist can let you know if any prescription medications you take contain lactose.

Some high-lactose foods to watch out for:

  • Milk and heavy cream
  • Condensed and evaporated milk
  • Cottage cheese
  • Ricotta cheese
  • Sour cream spreads

Some milk substitutes you could try:

  • Soy milk. It’s high in protein, potassium and antioxidants
  • Rice beverages
  • Lactose-free milk. It’s high in calcium and protein and contains many other vitamins, such as A, B, and K, zinc, potassium and magnesium
  • Almond milk
  • Coconut milk

If you have symptoms of lactose intolerance, see your doctor. And if you’re diagnosed with it, talk with them about how to be sure you’re eating right.

Sources

Cleveland Clinic: “Lactose Intolerance.”

Mayo Clinic: “Lactose intolerance.”

Johns Hopkins Medicine: “Lactose intolerance.”

National Institutes of Health: “Lactose intolerance.”

National Institutes of Health: “Evolution of lactase persistence: an example of human niche construction.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Definition & Facts for Lactose Intolerance.”

Foodreactions.org: “Hidden Milk and Lactose.”

Go Dairy Free: “How to Substitute Milk (Skim, Low Fat, Whole).”

International Foundation for Functional Gastrointestinal Disorders: “Lactose Intolerance.”

When someone has a milk allergy, the body’s immune system, which normally fights infections, overreacts to proteins in milk. If the person drinks or eats a product that contains milk, the body thinks these proteins are harmful invaders. The immune system responds by working very hard to fight off the invader. This causes an allergic reaction.

Milk is among the most common foods that cause allergic reactions. Some kids with a milk allergy outgrow it as they get older.

What Happens in a Milk Allergy?

People who are allergic to milk react to one or more of the proteins in it. Some people are allergic to casein (KAY-seen) protein and some are allergic to whey (WAY) protein. Some people are allergic to both casein and whey.

When a person with a milk allergy eats these proteins, the body releases chemicals like histamine. This can cause symptoms like:

  • wheezing
  • trouble breathing
  • coughing
  • hoarseness
  • throat tightness
  • belly pain
  • vomiting
  • diarrhea
  • itchy, watery, or swollen eyes
  • swelling
  • a drop in blood pressure, causing lightheadedness or loss of consciousness

Allergic reactions to milk can vary. Sometimes the same person can react differently at different times. Some reactions to milk are mild and involve only one part of the body, like hives on the skin. But even when someone has had only a mild reaction in the past, the next reaction can be serious.

Milk allergies can cause a severe reaction called anaphylaxis. Anaphylaxis can begin with some of the same symptoms as a less severe reaction, but can quickly get worse. The person may have trouble breathing or pass out. More than one part of the body might be involved. Anaphylaxis that isn’t treated can be life-threatening.

Milk allergy is often confused with lactose intolerance because it can cause some of the same symptoms, like belly pain or diarrhea. While lactose intolerance can upset someone’s digestive system, it can’t cause a life-threatening reaction the way that a milk allergy can.

How Is a Milk Allergy Diagnosed?

If your child might have a milk allergy, the doctor may want you to go to an allergist or allergy specialist for more testing. They will ask about how often the reaction happens, the time it takes between when your child eats a particular food and the start of the symptoms, and whether any family members have allergies or conditions like eczema and asthma.

The allergy specialist may do a skin test. This involves placing tiny amounts of milk protein on your child’s forearm or back, making a small scratch or prick on the skin, and waiting to see if a reddish, raised spot forms. If so, it may indicate a milk allergy.

Your child may need to stop taking some medicines (such as over-the-counter antihistamines) 5 to 7 days before the skin test because they can affect the results. Check with the allergist’s office if you’re not sure about what medicines to stop or for how long.

An allergist might do a blood test as well as skin testing. A small blood sample will go to a lab for testing. The lab checks the blood for IgE antibodies to specific foods. If your child’s blood has enough IgE antibodies to milk, a milk allergy is very likely.

If the results of the skin and blood tests are still unclear, though, an allergist might do something called a food challenge. During this test, your child will get slowly increasing amounts of milk while the doctor watches for symptoms.

How Is an Allergic Reaction to Milk Treated?

Kids with a milk allergy should always carry two epinephrine auto-injectors in case of a severe reaction. An epinephrine auto-injector is a prescription medicine that comes in a small, easy-to-carry container. It’s easy to use. Your doctor will show you how. Always have two auto injectors with your child in case one doesn’t work or they need a second dose.

The doctor can also give you an allergy action plan, which helps you prepare for, recognize, and treat an allergic reaction. Share the plan with anyone else who needs to know, such as other caregivers, babysitters, relatives, school officials, and coaches. Also consider having your child wear a medical alert bracelet.

Every second counts in an allergic reaction. If your child has serious allergic symptoms, like trouble breathing or throat tightness, use the epinephrine auto-injector right away. Also use it right away if your child’s symptoms involve two different parts of the body, like hives with vomiting. Then call 911 and have them take your child to the emergency room. This is because even if the worst seems to have passed, a second wave of serious symptoms can happen.

What Else Should I Know?

Kids with a milk allergy must not eat or drink any products that contain milk or milk proteins.

Be sure to read food labels carefully and teach your child to do the same. Milk and milk proteins can be in unexpected places, such as processed lunchmeats, salad dressings, baked goods, chocolate, and crackers. Even foods that say “non-dairy” still may contain milk protein.

One thing that might not show up on a label is cross-contamination risk. This can happen if a manufacturer uses the same equipment to grind lots of different foods, for example. Some companies put statements on their labels about the risk of cross-contamination, like: “May contain milk,” “Processed in a facility that also processes milk,” or “Manufactured on equipment also used for milk.” Your child should avoid products that have these kinds of alerts.

But companies are not required to put cross-contamination alerts on a food label. So it’s best to contact the company to see if a product might have come in contact with milk. You may be able to get this information from a company website. If not, contact the company and ask.

When someone has a milk allergy, the body’s immune system, which normally fights infections, overreacts to proteins in milk. If the person drinks or eats a product that contains milk, the body thinks these proteins are harmful invaders. The immune system responds by working very hard to fight off the invader. This causes an allergic reaction.

Milk is among the most common foods that cause allergic reactions. Some kids with a milk allergy outgrow it as they get older.

What Happens With a Milk Allergy?

People who are allergic to milk react to one or more of the proteins in it. Some people are allergic to casein (pronounced: KAY-seen) protein and some are allergic to whey (pronounced: WAY) protein. Some people are allergic to both casein and whey.

When a person with a milk allergy eats these proteins, the body releases chemicals like histamine. The release of these chemicals can cause someone to have symptoms like:

  • wheezing
  • trouble breathing
  • coughing
  • hoarseness
  • throat tightness
  • belly pain
  • vomiting
  • diarrhea
  • itchy, watery, or swollen eyes
  • swelling
  • a drop in blood pressure, causing lightheadedness or passing out

Allergic reactions to milk can vary. Sometimes the same person can react differently at different times. Some reactions to milk are mild and involve only one part of the body, like hives on the skin. But even when someone has had only a mild reaction in the past, the next reaction can be serious.

Milk allergies can cause a severe reaction called anaphylaxis. Anaphylaxis can begin with some of the same symptoms as a less severe reaction, but can quickly get worse. The person may have trouble breathing or pass out. More than one part of the body might be involved. If it isn’t treated, anaphylaxis can be life-threatening.

Milk allergy is often confused with lactose intolerance because people can have some of the same symptoms, like belly pain or diarrhea. While lactose intolerance can upset someone’s digestive system, it can’t cause a life-threatening reaction the way that a milk allergy can.

How Is a Milk Allergy Diagnosed?

If you might have a milk allergy, your doctor probably will want you to see an allergist or allergy specialist for more testing. They will ask about things like how often you have the reaction, the time it takes between eating a particular food and the start of the symptoms, and whether any family members have allergies or conditions like eczema and asthma.

The allergy specialist may do a on you. This involves placing tiny amounts of milk protein on your forearm or back, making a small scratch or prick on the skin, and waiting to see if a reddish, raised spot forms. If so, it may mean there is an allergy to milk.

You may need to stop taking some medicines (such as over-the-counter antihistamines) 5 to 7 days before the skin test because they can affect the results. Check with the allergist’s office if you’re not sure about what medicines to stop or for how long.

An allergist also might do a blood test. A small blood sample will go to a lab for analysis. The lab checks the blood for IgE antibodies to specific foods. If you have enough IgE antibodies to milk in your blood, you’re likely allergic to it.

If the results of the skin and blood tests are still unclear, though, an allergist might do something called a food challenge. During this test, a person gets slowly increasing amounts of milk while the doctor watches for symptoms.

How Is an Allergic Reaction to Milk Treated?

If you have a milk allergy, always carry two epinephrine auto-injectors in case of a severe reaction. An epinephrine auto-injector is a prescription medicine that comes in a small, easy-to-carry container. It’s easy to use. Your doctor will show you how. Always have two auto-injectors with you in case one doesn’t work or you need a second dose.

The doctor can also give you an allergy action plan, which helps you prepare for, recognize, and treat an allergic reaction. Share the plan with anyone else who needs to know, such as relatives, school officials, and coaches. Also consider wearing a medical alert bracelet.

Every second counts in an allergic reaction. If you start having serious allergic symptoms, like trouble breathing or throat tightness, use the epinephrine auto-injector right away. Also use it right away if your symptoms involve two different parts of the body, like hives with vomiting. Then call 911 and have them take you to the emergency room. You need to be under medical supervision because even if the worst seems to have passed, a second wave of serious symptoms can happen.

What Can I Do to Stay Safe With a Milk Allergy?

If you have a milk allergy, you must not eat or drink any products that contain milk or milk proteins.

Avoiding milk involves more than just leaving cheese off your sandwich. Be sure to read food labels carefully and not eat anything that you’re not sure about.

Milk and milk proteins can show up in unexpected places, such as processed lunchmeats, salad dressings, baked goods, chocolate, and crackers. Even foods that say “non-dairy” still may contain milk protein.

One thing that might not show up on a label is cross-contamination risk. Cross-contamination happens when a food you are not allergic to comes in contact with a food you are allergic to. This can happen if a manufacturer uses the same equipment to grind lots of different foods, for example.

Some companies put statements on their labels about the risk of cross-contamination, like: “May contain milk,” “Processed in a facility that also processes milk,” or “Manufactured on equipment also used for milk.” You’ll want to avoid products that have these kinds of alerts. But companies are not required to put cross-contamination alerts on a food label. So it’s best to contact the company to see if a product might have come in contact with milk. You may be able to get this information from a company website. If not, contact the company and ask.

Cross-contamination is also a risk when you dine out or eat at a friend’s house. Foods you’re allergic to can get into your food when someone uses the same surfaces, utensils, or oil to prepare different foods.

When you’re not at home, ask what’s in a food you’re thinking of eating. Find out how the food is cooked. Many people find it’s best to bring safe food from home or eat at home before heading out. If friends you’re visiting or eating with don’t know about your allergy, tell them in plenty of time so they can prepare. Don’t share a drink or eating utensils with friends if they’re eating foods you’re allergic to, and avoid tasting any of their food.

Getting used to living with a milk allergy can take some time. But by being careful with what you eat and always having two epinephrine auto-injectors with you in case of a reaction, you can stay safe with your allergy.

The following is a general guide to using ingredient substitutions for milk allergy. Please verify the ingredients and safety of any products named to ensure that it is safe for your child’s unique allergy issues.

If you need additional assistance in finding product suggestions or where to find ingredients for substituting, post a message in the KFA Food and Cooking Support Forum to get suggestions from other parents who are also managing the same food allergies with their children.

Basic Ingredient Substitutions for Food Allergies
Many common allergens are also common ingredients in your favorite recipes. There are some ingredients for which you can easily and successfully use non-allergenic substitutes, and there are others for which satisfactory substitutes do not exist.

Whether or not a “safe” version of a recipe can be successfully made often depends on two important factors. First: what is the role of the allergen in the recipe? Second: how many of the recipe’s ingredients require substitutions? If the recipe only has 5 ingredients and you need to swap out 4 of them, the end result might bear little resemblance to the original dish. The bottom line: sometimes you can create a “safe” version of a recipe, and sometimes you are better off finding a different recipe altogether.

Substitutes for Dairy Ingredients

Be aware that some brands and varieties of soy-based products (especially soy cheeses) may contain casein (a milk protein) or are made in production facilities on equipment shared with dairy.

Substituting for Butter

One of the easiest substitutions to make is for butter: simply use a dairy-free margarine instead. However, you may need to do some searching and taste-testing to find the best dairy-free margarine available in your area, as a good margarine can make a big difference in many recipes. For baked goods, try to find a dairy-free margarine with a low water content and high fat content (e.g., stick of margarine usually contains less water than a tub of margarine). Margarines with high water content may affect your baked goods.

Substituting for Yogurt, Sour Cream, and Cream Cheese

Soy-based, coconut-based, and pea-based “yogurt,” “sour cream,” and “cream cheese” products are available. These generally work very well in recipes.

Substituting for Cheese

Dairy-free cheeses are a bit of a challenge. If a child is old enough to remember “real” cheese, you may want to wait a while before introducing a milk-free version. Younger children will usually adapt more easily. Soy cheeses do not taste or melt like traditional dairy cheeses. In some cases, soy cheese will not appear melted, but will in fact be melted inside. There are now milk-free and soy-free cheeses available from several brands. They are available in shreds, blocks and slices. These milk-free and soy-free cheeses also melt much better than milk-free cheeses of the past.

Milk-free cheese may not work well in recipes for cheese sauces. If you would like to make a dairy-free “cheese sauce,” check our Safe Eats ® recipe database for “cheese sauce” recipes based on nutritional yeast.

Substituting for Milk

There are a number of commercially-produced cow’s milk alternatives made from soy, coconut, rice, potato, oat, almond, hazelnut, cashew, hemp, flax, sunflower, and even macadamia. Most of these are available in a few different flavors (such as “regular,” “vanilla,” “chocolate,” and “mocha”). All of these milks can be substituted 1-for-1 in recipes.

Note: Goat’s milk is not considered a safe alternative for those allergic to cow’s milk.

Alisa Fleming has done extensive taste-testing to determine which types of milks work best in which types of recipes. The following information is reprinted with permission from her book, “Dairy Free Made Easy” by Alisa Fleming of www.godairyfree.org:

  • In general, soy milk is considered “hearty” among the non-dairy beverages, and is excellent when you are craving something thick and creamy.
  • The plain varieties have a faintly sweet and nutty flavor.
  • Taste and consistency vary widely among soy milk brands.
  • Soy milk can easily be substituted for cow’s milk in all baking needs, over cereal, for pancakes and waffles, in smoothies, or straight from the glass.
  • The unsweetened varieties work equally well in savory dishes.
  • Soy milk does have a more pronounced flavor, so it may not be the top choice for delicate desserts and sauces.
  • For many, rice milk has that “true milk flavor.” It is one of the lightest, sweetest, and most refreshing of the dairy substitutes.
  • With its natural sweetness, rice milk is perfect in desserts and baked goods.
  • Its delicate texture also works well in curries as well as lighter cream soups and sauces.
  • Rice milk is best avoided in the broader savory foods arena.
  • Oat milk is light in texture and has a very mild flavor with just a hint of sweetness. It substitutes very well for low-fat or fat-free milk.
  • Oat milk has been successfully trialed as a substitute for cow’s milk in both sweet and savory dishes.
  • In addition to drinking it straight from the glass, oat milk is recommended for your morning cereal; smoothies; baked goods; curries; lighter cream soups and sauces; and mashed potatoes.

Substituting for Sweetened Condensed Milk and Evaporated Milk

You can make your own sweetened condensed milk substitute by making a “safe” evaporated milk and adding sugar. Evaporated milk is milk that has water content reduced by 60%. Simmer any quantity of soy or rice milk in a pan until it reduced by 60% to get evaporated milk. Approximately 3 cups of rice or soy milk will leave 1 cup of evaporated milk left at the end. Be careful not to scald it. For sweetened condensed milk, mix one cup of evaporated milk with 1-1/4 cups of sugar. Heat until the sugar is completely dissolved. Cool. It will yield 1-1/2 cups of evaporated milk substitute. It will keep in the refrigerator for several days.

Another alternative for evaporated milk is to substitute coconut milk 1:1 in the recipe. This will impart a coconut flavor to the recipe, so it works in some recipes but not all.

Substituting for Buttermilk

You can make your own buttermilk substitute by mixing one tablespoon vinegar plus 1 cup milk alternative such as rice milk or soy milk.

Substituting for Light Cream, Sweet Cream, or Heavy Cream

Substitutes for light cream: light (or “lite”) canned coconut milk, soy creamer, coconut-based creamers, almond-based creamers

Full fat coconut milk can be substituted for heavy cream. A coconut milk substitute will impart a coconut flavor to a recipe, so it will work for some recipes, but not all.

You can use Kineret® brand whipped topping as a substitute for sweet cream if used straight out of the carton and not whipped.

Cow’s milk contains over 25 different molecules, which have the potential to elicit an allergic reaction. No wonder milk is repeatedly ranked among the top eight offenders for food allergies! In fact, many doctors, scientists, and health specialists recommend going dairy free as an initial test when a food allergy is suspected.

What Exactly is a Milk Allergy?

Although they are often muddled together in conversation, milk allergies and lactose intolerance are quite different. A food allergy is identified as an abnormal and heightened response of the immune system to certain components (most notably proteins) within a food. In milk, the two leading allergy offenders are the milk proteins known as casein and whey. Casein is the curd that forms when milk is left to sour. Whey is the watery part that is left after the curd is removed. A food intolerance is when you develop symptoms after eating a food that your body can’t cope with effectively, but it does not involve an immune response. Head to our Lactose Intolerance section to read more on this topic.

Some scientists believe that there is only one type of “true food allergy” while others report studies of two, three, and even four variations of food allergies. For simplicity sake we will just note the two most commonly sited allergy categories: immediate hypersensitivity reaction and delayed hypersensitivity reaction. In immediate hypersensitivity situations symptoms may begin to appear within minutes of ingesting the offending food. Like the way your friend’s Aunt Martha blows up like a balloon the second she takes a bite of that chocolate bar laced with peanuts. Delayed hypersensitivity reactions have received little attention until recently, so not too much is known about them as of yet. It is believed that these types of reactions elicit a different response from the immune system than the immediate hypersensitivity. With delayed hypersensitivity, symptoms have an onset time of 6 to 24 hours after eating an offending food, tend to reach their peak at about 48 hours, and gradually subside over 72-96 hours. For both immediate and delayed reactions, symptoms may be very mild, and even go unnoticed (i.e. rash or eczema), or they may be quite severe (i.e. Aunt Martha).

How Common are Milk Allergies?

It was previously thought that milk allergies occurred only in infants, and that the problem subsided prior to adulthood. Unfortunately, for many of us this just isn’t so. The numbers are all over the board, but it is estimated that anywhere from 2 to 7.5% of infants have an allergy to cow’s milk. Studies show that approximately 60% of infants allergic to cow’s milk will “outgrow” the allergy by the age of 4, 80% by the age of 6. Bonus for those people, but this leaves up to 4.5 million people in the U.S. alone with a potential milk allergy. This is more than “just a few” people by our estimates. To complicate things further, it seems that it is possible for adults to develop a milk allergy with no childhood history of allergies. Another interesting fact, symptoms associated with milk allergy have the potential to morph over time. One study followed a group of milk allergic children and found that at the beginning of the study most of the children had primarily gastrointestinal symptoms (vomiting, diarrhea), but by the end of the study, many had switched over to respiratory symptoms such as wheezing.

What are the Symptoms of Milk Allergies?

Similar to other food allergies, the majority of milk allergy symptoms can be lumped into three “reaction” categories:

Skin: Itchy, Red Rash; Eczema; Hives; “Shiners” or Black Eyes; Aphthous Ulcers (canker sores) Swelling of the Lips, Mouth, Tongue, Face, or Throat.

Digestive: Abdominal Pain; Abdominal Cramps; Abdominal Bloating; Diarrhea; Gas; Nausea; Vomiting.

Respiratory: Runny Nose / Congestion; Sneezing; Watery Eyes; Itchy Eyes; Coughing; Wheezing; Shortness of Breath; Recurrent “colds”; Sinusitis.

To the pleasant surprise of many “psychological” sufferers, current research has uncovered a fourth category of symptoms, known as Behavioral. Many doctors now believe that food allergies, including dairy, could be a direct cause of fatigue, migraine headaches, hyperactivity (ADHD), irritability, night-waking, anxiety, and sore muscles and joints.

As noted above, these symptoms may be mild or severe and life threatening; they could appear immediately or over a period of several days; and they may vary in response based on mild, moderate, and large quantities of milk intake.

For those unlucky few, anaphylaxis is a reality. Anaphylaxis is a systemic allergic reaction that may involve multiple areas of the body, including the skin, cardiovascular system, respiratory tract, and gastrointestinal tract. Symptoms are sudden, and may come on immediately or up to four hours after coming in contact with the allergen (in this case milk). Anaphylactic reactions can be mild. However, some cases are potentially fatal, and therefore require urgent medical attention. If you are concerned that you or a loved one may be at risk for anaphylactic reactions, refer to the Food Allergy & Anaphylaxis Network (FAAN) for additional information.

How Do I Know if I Have a Milk Allergy?

There are many different types of clinical allergy tests available, all with varying levels of effectiveness, but many doctors are moving towards elimination diets. An elimination diet can easily identify a negative effect to a food, whether it is an allergy, intolerance, or a pure mystery, regardless of what the individual test results say. Doctors and patients are often pleased with this method as it is simple, free, highly effective, and tailored to the individual. This is where our Dairy Free Challenge comes into play; it is a personal “elimination” test for milk.

Can Milk Allergies Be Treated?

As with most allergies, avoiding the offending substance is the top recommended treatment. Utilize the many guides and resources this site has to offer, in order to make it an easy and enjoyable transition.

If you have a food allergy, your doctor will tell you how to avoid an allergic reaction. Here are some general tips on living with food allergies.

How Do I Avoid an Allergic Reaction?

The only real way to prevent a reaction is to completely avoid foods you’re allergic to. Eating even a tiny bit of a food you are allergic to can cause a serious reaction.

Avoiding a food you’re allergic to means more than not eating that food. Some people even have to avoid touching or breathing in foods they’re allergic to. Sometimes things that aren’t food — like cosmetics — may still contain ingredients you’re allergic to.

Here are important ways to avoid coming into contact with foods you may be allergic to:

1. Read Food Labels

In the United States, food manufacturers must say on their labels if foods contain any of these most common allergens:

Food allergy information will be on the label in one of two ways:

  1. The food will show up in the list of ingredients.
  2. There will be an alert somewhere on the label (e.g., “contains peanuts” or “contains shellfish”).

Foods sold in the United States are supposed to label foods clearly so people with common allergies can stay safe. But not all allergens will be included in ingredient lists or named in a recognizable way. This is often the case with allergens other than the eight most common ones. Sometimes, an allergen could be hidden in a long list of scientific-sounding ingredients or included in “natural flavors,” “coloring,” “spices,” or other additives.

Products sometimes change ingredients, and different size versions of the same product may have different ingredients, so check every package every time.

2. Know About Cross-Contamination

One thing that might not show up on a label is cross-contamination risk. Cross-contamination happens when a food you are not allergic to comes in contact with a food you are allergic to. This can happen if a manufacturer uses the same equipment to grind lots of different foods, for example.

Some companies put statements on their labels to alert customers to the risk of cross-contamination — messages like: “May contain peanuts,” “Processed in a facility that also processes nuts,” or “Manufactured on equipment also used for shellfish.” You’ll want to avoid products that have these kinds of alerts about foods you’re allergic to.

But companies are not required to put cross-contamination alerts on a food label. So it’s best to contact the company to see if a product might have come in contact with a food you are allergic to. You may be able to get this information from a company website. If not, contact the company and ask.

How Can I Stay Safe When Eating Away From Home?

Restaurants, cafeterias, and food courts are getting better about preparing foods for people with allergies. But cross-contamination is still a risk when you dine out: Foods you’re allergic to can get into your food when kitchen staff use the same surfaces, utensils, or oil to prepare different foods.

When you’re not at home, ask what’s in a food you’re thinking of eating. Find out how the food is cooked. Many people find it’s best to bring safe food from home or eat at home before heading out. If friends you’re visiting or eating with don’t know about your allergy, tell them in plenty of time so they can prepare. Don’t share a drink or eating utensils with friends if they’re eating foods you’re allergic to, and avoid tasting any of their food.

You also can carry a personalized “chef card.” It details your allergies and helps restaurant staff understand how to prepare a safe meal for you. You can find chef cards in many different languages on food allergy websites (like FARE, the Food Allergy Research and Education). If the manager or owner of a restaurant seems uncomfortable about your request for safe food preparation, don’t eat there.

It may be best to avoid some types of restaurants:

  • If you have a peanut or tree nut allergy, you may want to avoid places that use lots of peanuts, peanut oil, or tree nuts in their foods. If you have a fish or shellfish allergy, you may need to avoid places with open stovetops or steam tables where fish or shellfish is cooked.
  • Buffets and salad bars can be risky since people might move serving spoons and other utensils from one food to another.
  • Be careful in bakeries, ice cream parlors, or candy shops. The risk of cross-contamination from shared scoops or machinery is high.
  • When eating at restaurants, avoid fried foods. Many places cook multiple foods in the same oil.

What If I Have an Allergic Reaction?

Always carry two auto-injectors with you in case of a reaction. This way you are prepared to treat a serious reaction. Your doctor will give you an allergy action plan so that you know when you should use your epinephrine. Talk to your friends about your allergy, and make sure they know where to find your epinephrine in case you need it.

Always tell an adult if you are having symptoms of a reaction — even if they are mild. The adult can help you follow your allergy action plan to treat any reactions. Sometimes serious reactions start with mild symptoms.

By avoiding the foods you are allergic to, being prepared, and always carrying your epinephrine, you can keep yourself safe.

The following is a general guide to using ingredient substitutions for milk allergy. Please verify the ingredients and safety of any products named to ensure that it is safe for your child’s unique allergy issues.

If you need additional assistance in finding product suggestions or where to find ingredients for substituting, post a message in the KFA Food and Cooking Support Forum to get suggestions from other parents who are also managing the same food allergies with their children.

Basic Ingredient Substitutions for Food Allergies
Many common allergens are also common ingredients in your favorite recipes. There are some ingredients for which you can easily and successfully use non-allergenic substitutes, and there are others for which satisfactory substitutes do not exist.

Whether or not a “safe” version of a recipe can be successfully made often depends on two important factors. First: what is the role of the allergen in the recipe? Second: how many of the recipe’s ingredients require substitutions? If the recipe only has 5 ingredients and you need to swap out 4 of them, the end result might bear little resemblance to the original dish. The bottom line: sometimes you can create a “safe” version of a recipe, and sometimes you are better off finding a different recipe altogether.

Substitutes for Dairy Ingredients

Be aware that some brands and varieties of soy-based products (especially soy cheeses) may contain casein (a milk protein) or are made in production facilities on equipment shared with dairy.

Substituting for Butter

One of the easiest substitutions to make is for butter: simply use a dairy-free margarine instead. However, you may need to do some searching and taste-testing to find the best dairy-free margarine available in your area, as a good margarine can make a big difference in many recipes. For baked goods, try to find a dairy-free margarine with a low water content and high fat content (e.g., stick of margarine usually contains less water than a tub of margarine). Margarines with high water content may affect your baked goods.

Substituting for Yogurt, Sour Cream, and Cream Cheese

Soy-based, coconut-based, and pea-based “yogurt,” “sour cream,” and “cream cheese” products are available. These generally work very well in recipes.

Substituting for Cheese

Dairy-free cheeses are a bit of a challenge. If a child is old enough to remember “real” cheese, you may want to wait a while before introducing a milk-free version. Younger children will usually adapt more easily. Soy cheeses do not taste or melt like traditional dairy cheeses. In some cases, soy cheese will not appear melted, but will in fact be melted inside. There are now milk-free and soy-free cheeses available from several brands. They are available in shreds, blocks and slices. These milk-free and soy-free cheeses also melt much better than milk-free cheeses of the past.

Milk-free cheese may not work well in recipes for cheese sauces. If you would like to make a dairy-free “cheese sauce,” check our Safe Eats ® recipe database for “cheese sauce” recipes based on nutritional yeast.

Substituting for Milk

There are a number of commercially-produced cow’s milk alternatives made from soy, coconut, rice, potato, oat, almond, hazelnut, cashew, hemp, flax, sunflower, and even macadamia. Most of these are available in a few different flavors (such as “regular,” “vanilla,” “chocolate,” and “mocha”). All of these milks can be substituted 1-for-1 in recipes.

Note: Goat’s milk is not considered a safe alternative for those allergic to cow’s milk.

Alisa Fleming has done extensive taste-testing to determine which types of milks work best in which types of recipes. The following information is reprinted with permission from her book, “Dairy Free Made Easy” by Alisa Fleming of www.godairyfree.org:

  • In general, soy milk is considered “hearty” among the non-dairy beverages, and is excellent when you are craving something thick and creamy.
  • The plain varieties have a faintly sweet and nutty flavor.
  • Taste and consistency vary widely among soy milk brands.
  • Soy milk can easily be substituted for cow’s milk in all baking needs, over cereal, for pancakes and waffles, in smoothies, or straight from the glass.
  • The unsweetened varieties work equally well in savory dishes.
  • Soy milk does have a more pronounced flavor, so it may not be the top choice for delicate desserts and sauces.
  • For many, rice milk has that “true milk flavor.” It is one of the lightest, sweetest, and most refreshing of the dairy substitutes.
  • With its natural sweetness, rice milk is perfect in desserts and baked goods.
  • Its delicate texture also works well in curries as well as lighter cream soups and sauces.
  • Rice milk is best avoided in the broader savory foods arena.
  • Oat milk is light in texture and has a very mild flavor with just a hint of sweetness. It substitutes very well for low-fat or fat-free milk.
  • Oat milk has been successfully trialed as a substitute for cow’s milk in both sweet and savory dishes.
  • In addition to drinking it straight from the glass, oat milk is recommended for your morning cereal; smoothies; baked goods; curries; lighter cream soups and sauces; and mashed potatoes.

Substituting for Sweetened Condensed Milk and Evaporated Milk

You can make your own sweetened condensed milk substitute by making a “safe” evaporated milk and adding sugar. Evaporated milk is milk that has water content reduced by 60%. Simmer any quantity of soy or rice milk in a pan until it reduced by 60% to get evaporated milk. Approximately 3 cups of rice or soy milk will leave 1 cup of evaporated milk left at the end. Be careful not to scald it. For sweetened condensed milk, mix one cup of evaporated milk with 1-1/4 cups of sugar. Heat until the sugar is completely dissolved. Cool. It will yield 1-1/2 cups of evaporated milk substitute. It will keep in the refrigerator for several days.

Another alternative for evaporated milk is to substitute coconut milk 1:1 in the recipe. This will impart a coconut flavor to the recipe, so it works in some recipes but not all.

Substituting for Buttermilk

You can make your own buttermilk substitute by mixing one tablespoon vinegar plus 1 cup milk alternative such as rice milk or soy milk.

Substituting for Light Cream, Sweet Cream, or Heavy Cream

Substitutes for light cream: light (or “lite”) canned coconut milk, soy creamer, coconut-based creamers, almond-based creamers

Full fat coconut milk can be substituted for heavy cream. A coconut milk substitute will impart a coconut flavor to a recipe, so it will work for some recipes, but not all.

You can use Kineret® brand whipped topping as a substitute for sweet cream if used straight out of the carton and not whipped.

Do you think your baby might be lactose intolerant? When someone is lactose intolerant, it means their body doesn’t produce enough of an enzyme called lactase. This enzyme is necessary for the digestion of lactose, which is the main sugar present in dairy milk and other dairy products.

If the lactose can’t be digested, it remains in the intestines and causes gastrointestinal problems that are usually uncomfortable but not dangerous. During the third trimester of pregnancy, the unborn baby’s lactase levels rise.

Premature babies are unable to produce enough lactase for some time. Real lactose intolerance tends to show up when a child is in grade school or a teenager. Although it is possible for symptoms to appear earlier on, it’s not likely that your baby is truly lactose intolerant.
How to cope with a milk allergy

Symptoms of lactose intolerance

If your baby is lactose intolerant, s/he might have the following symptoms around 30 minutes to 2 hours after eating dairy products such as yogurt or cheese or drinking breast milk. Note that infants should not have cow’s milk until they are at least 1 year old.

  • Gas
  • Bloating
  • Diarrhea

Causes of lactose intolerance

Scientists don’t yet know why some people are lactose intolerant, and others aren’t, but it’s pretty common. In fact, up to 50 million people in America suffer from it. Genetics are certainly implicated. For example, around 75 percent of Native American, African American, Hispanic American, and Jewish Americans are lactose intolerant, as well as about 90 percent of Asian Americans. Just 15 percent of people of northern European descent, on the other hand, suffer from the condition.

The fact is, very few babies are born with lactose intolerance. It requires both parents to have the gene and pass it on to their baby. Babies with true lactose intolerance have severe diarrhea from birth, and won’t be able to tolerate either their mother’s breast milk or cow’s milk formula. These babies require lactose-free baby formula.

Some medications cause a decrease in the production of lactase and temporary lactose intolerance.

People with conditions that affect the digestive system on a long-term basis such as Crohn’s disease or celiac disease sometimes have lactose intolerance too.

If your baby has bad diarrhea, s/he might temporarily produce less lactase which could result in temporary lactose intolerance.

Are lactose intolerance and an allergy to milk the same thing?

While lactose intolerance is a condition of the digestive system, an allergy is an immune response. However, the symptoms of lactose intolerance and a milk allergy can be similar. For example, diarrhea or abdominal pain after consuming milk products could be caused by lactose intolerance or by a milk allergy.

The symptoms of a milk allergy include the following:

  • A rash that is dry and itchy.
  • Swelling of the mouth, lips or face.
  • Hives.
  • Running nose.
  • Watery eyes.

If your baby develops any of these symptoms when consuming dairy products, s/he might be allergic to one of the proteins in cow’s milk. Severe swelling needs emergency help.

How you can tell if your baby is lactose intolerant

As we said earlier, most babies are not lactose intolerant. The best thing to do is to talk to your baby’s doctor. Tell him or her about the symptoms your baby is showing, and s/he will be able to let you know if it’s possible your baby is lactose intolerant. Your doctor might suggest eliminating all lactose-containing products from your baby’s diet for a while to see if the symptoms clear up.
How to cope with a milk allergy

What can you do if your baby is lactose intolerant?

There is no treatment for lactose intolerance, and there’s no way of preventing your baby from having it. If your baby is very sensitive, avoid all products containing milk and its by-products. Read food labels carefully.

Keep track of how your baby reacts to different foods. Different people are able to tolerate different levels of lactose. Some lactose intolerant babies can tolerate dairy products when they eat them along with other foods.

Live-culture yogurt is usually much easier to digest than milk and other dairy products because the healthy bacteria in the yogurt encourage lactase production.