In partnership with Primary Children’s Hospital

Milk Allergy

What is a milk allergy? What do I do for my child with A milk allergy is an allergic reaction to the protein in milk allergy? milk. Casein is the main protein in milk. Children To treat a milk allergy, your child should not eat or with a milk allergy must not drink or eat milk products drink milk or any foods with milk or dairy products. or foods with milk proteins. The most common milk You and your child will need to read labels on food allergy symptoms include the following: for milk products. Skin Reactions: What do I look for when I read the •• itchy red rash •• allergic “shiners” food labels? •• hives (black eyes) •• Labels on food that are regulated by the FDA have to •• eczema •• swelling of lips, mouth, say if the food contains the 8 most common food tongue, face, and throat allergens: milk, egg, soy, wheat, peanuts, tree nuts, shellfish, or fish. Always read the ingredient list to be Stomach Reactions: sure and check all food labels carefully. Manufacturers •• abdominal pain and •• vomiting may change ingredients without warning. bloating •• gas •• Allergen Advisory Statement—“May contain •• diarrhea •• cramps (usually very runny) [allergen]” or “Produced in a facility that also produces products containing [allergen].” Nose, Throat, and Lung Reactions: •• Avoid any food product that contains an Advisory •• runny nose •• coughing Statement for your child’s food allergies. •• sneezing •• wheezing Below is an example of a food label: •• water or itchy eyes •• shortness of breath Milk allergy is not the same as lactose intolerance. Ingredients Lactose intolerance means the body does not make Whole Oats, Brown Rice Syrup, Rice Crisps (Milled Rice, enough lactase. Lactase digests the sugar in milk. Sugar, Salt, Barley Malt), Diced Apples, Evaporated Cane Juice Syrup, Raisins, Roasted Soy Beans, Almond Butter, People with lactose intolerance can have belly pain, Honey, Pear and Grape Juice Concentrate, Brown Rice gas, and bloating. If you think your child has lactose Flour, Soy Protein Isolate, Glycerin, Natural Flavors, intolerance you should discuss treatment options with Cinnamon, Nonfat Milk your child’s pediatrician or a registered dietitian. Contains milk, nut and soy ingredients. Made on equipment that also processed peanuts and wheat. 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 What are some names for milk on same. There is a high degree of cross-reactivity food labels? between cow’s milk and the milk from other The following are some names for milk derived mammals such as goat and sheep. In studies, the risk products. Dairy, includes milk (whole, 2%, 1%, or of allergy (resulting in symptoms) to goat’s milk or non-fat/skim), dry milk solids, butter, cream, half and sheep’s milk in a person with cow’s milk allergy is half, sour cream, cottage cheese, cheese (any type), ice about 90%. cream, yogurt, kefir, eggnog, instant breakfast powders or liquids, and other milk based protein drinks. 1 Many non-dairy sources of calcium are not foods that Ingredients that contain milk are favorites of most children. For example, 1 cup of leafy Artificial butter Dairy Milk protein flavor hydrolysate greens contains as much calcium as 4 ounces of milk. A Diacetyl Protein child who needs 500 milligrams of calcium daily would Butter fat hydrolysate need to eat as much as 4 cups of leafy greens to meet the Butter milk Ghee Rennet casein need. The likelihood of a child eating that much is very Butter oil Lactaglobulin Tagatose small. You and your child will need to read labels Casein Lactalbumin Whey carefully to find a variety of calcium-fortified foods. Caseinates Lactoalbumin Whey hydrolysate (in all forms) phosphate You may be able to use milk alternatives as an Cheese Lactoferrin acceptable substitute if your child is over one-year-old. Cream Lactose Examples include: •• Soy milk •• Fortified nut milks “Non-dairy” foods may still contain milk proteins, so •• Fortified rice milk (almond or cashew milk) take time to read labels. Many packaged meals, •• Fortified grain or seed •• Fortified coconut milk vegetables, gravies, sauces, soups, and salad mixes milks (hemp milk, oat •• Fortified pea protein contain milk. Current U.S. food labeling regulations milk, flax milk) based milk allow for an item to be labeled as “non-dairy” on the package. A food can be labeled non-dairy even if it Any of these milk substitutes can be used, if tolerated. has casein in it, a milk protein. The ingredient Make sure they are a good source of calcium and statement on non-dairy products will list “casein” or additional nutrients. A substitute for a glass of milk “caseinates” and the word “milk” if it is an ingredient. will have 30% calcium and 8 grams of protein per 8 ounce serving. Review the nutrition information on Always read the label for milk and milk products. the package to check for the amount of nutrients. Will my child get enough nutrients by Calcium fortified juices will provide additional avoiding milk? calcium but are not a good source of other nutrients. Milk provides a good source of many nutrients In some cases, you may need to give your child dietary essential for your child’s growth and bone supplements. However, if your child is at an age when development. This is especially important during a specialized milk-free formula is a large part of the peak growth periods. daily diet, supplementation may not be necessary. Suggested alternate How do I substitute milk in recipes? Nutrient’s lost when sources avoiding milk (if not allergic) There are many milk alternatives based with nuts, Protein, Calcium, Increase other protein legumes, seeds, peas, and grains. Many are available Riboflavin, Phosphorus, foods: eat fish, poultry, in original (plain), unsweetened, vanilla, and Vitamins A, D, and B12 legumes, eggs (if safe for your child), fortified milk chocolate flavors. Generally, the unsweetened and substitutes; leafy greens, unflavored versions work best in recipes and can be nuts, calcium-fortified foods substituted 1-for-1 in recipes. How can I help my child get the When cooking, you can substitute non-dairy right nutrients? margarine or oils (in equal amounts) for butter. You will need to choose foods with care to replace the Soy-based, coconut-based, almond and cashew-based, essential nutrients lost by avoiding milk. Meats, and pea-based cheese, yogurt, sour cream, and cream poultry, eggs, fish, nuts and legumes can easily cheese products are available. Be sure to check the provide needed protein. However, to replace calcium, ingredient list as some products, especially cheese, your child may need to consume a lot of non-dairy may still have casein in them. food sources containing calcium. This may be more 2 than a young child is capable of eating. Below are tables of foods allowed and foods to avoid: Foods your child Foods your child Foods your child Foods your child can eat should NOT eat can eat should NOT eat (No milk) (Contain milk) (No milk) (Contain milk) Beverages and Formula Vegetables •• All carbonated drinks All milk or milk products •• All baby vegetables without •• All baby vegetables •• Fruit juices such as: milk products with milk •• Punch •• Buttermilk •• All fresh vegetables •• Breaded vegetables •• Tea •• Condensed milk •• Canned or frozen •• Buttered vegetables vegetables without •• Creamed vegetables Non-Dairy Beverages: •• Dry skim milk powder, milk solids, or milk proteins milk products •• Frozen french fries with milk •• Almond milk •• Evaporated milk •• Instant potatoes •• Cashew milk •• Goats milk •• Vegetable products •• Coconut milk or water •• Hot chocolate with milk •• Flax milk •• Kefir •• Hemp milk Breads, Cereals and Pasta •• Lactose-Free Milk •• Pea protein milk •• Breads and rolls made •• Commercial breads, rolls, •• Lowfat milk •• Rice milk without milk or dairy cereal, crackers made with •• Malted milk products. milk or dairy •• Soy milk ® •• Nido •• French bread •• English muffins Infant/Pediatric Formulas: •• Ovaltine •• Hot cereals (read label) •• Hypoallergenic Formula •• Skim milk •• Cold Cereals not •• Instant cream-of-wheat or •• Soy formulas •• Whole milk containing milk oatmeal with milk Infant/Pediatric formulas •• Crackers: •• Prepared Mixes: with milk •• Graham crackers •• Biscuits Non-Dairy Beverages: •• Oyster crackers •• Muffins •• Coffee creamers •• Pretzels •• Pancakes •• Saltines •• Waffles Dairy Products •• Pasta and Starches: •• Crackers containing milk: •• None •• Cheeses •• Noodles •• Club-type crackers •• Cottage cheese (wheat and rice based) •• Flavored graham crackers ® •• Cream •• Rice •• Zweiback crackers •• Cream solids •• Whole Grains •• Custard Soups •• Frozen yogurt •• Half-and-half •• Clear soups and consommés •• Any soups with milk •• Ice cream •• Commercial soups without •• Chowders milk (read label carefully) •• Nacho cheese •• Commercial creamed soups •• Homemade soups •• Natural or processed Nougat Fats •• Pudding •• Bacon •• Butter •• Sour cream (inc. imitation) •• Coconut butters or oil •• Cream •• Velveeta® cheese •• Margarine and dressings •• Cream cheese •• Whipping cream without milk •• Ghee •• Yogurt •• Vegetable oils •• Margarine and dressings Eggs, Meats, Fish and Poultry •• Vegetable shortening containing milk •• All plain eggs, beef, •• Creamed or breaded Desserts chicken, fish, ham, turkey, meats, fish or chicken •• Angel food cake •• Commercial cakes, cookies, lamb, veal and pork •• Hotdogs with milk solids •• Frozen fruit bars donuts, or mixes with milk •• Baby foods without milk •• Luncheon meats or cold •• Fruit and flavored water ices •• Custard products cuts with milk solids •• Hard candy •• Frozen yogurt •• Omelets with cheese or milk •• Homemade treats with •• Ice cream made with milk •• Sausages no milk •• Pie crust with butter or •• Souffle’s •• Gelatin margarine Fruits •• Most fruit roll-ups and •• Pudding other fruit-type snacks •• Sherbets •• All baby fruit without milk •• All baby fruits with milk •• Popsicle® products •• Canned or frozen fruit •• All fresh fruits with milk •• Canned and frozen fruits without milk products 3 What about foods outside of Milk Allergy Resources the home? •• Food Allergy Research and Education School/Daycare—Do the following: www.foodallergy.org •• Ask your child’s school/daycare about their allergy •• Kids with Food Allergies action plan. www.kidswithfoodallergies.org •• Tell the school/daycare about your child’s allergies. •• Utah Food Allergy Network www.utahfoodallergy.org •• Give the school written allergy information. •• American Academy of Allergy, Asthma, •• Provide them with emergency contact information. and Immunology •• Give them a photo of your child. www.aaaai.org

Everywhere—Teach your child the following: •• Academy of Nutrition and Dietetics www.eatright.org •• Which foods are safe and unsafe •• Eating out information from Safe Fare •• Not to trade food with others www.safefare.org •• Not to eat any food with unknown ingredients For additional information and questions please •• What their allergic symptoms are contact the Outpatient Dietitians at Primary •• How and when to tell an adult about Children’s Hospital at 801.662.1601. allergy-related problems •• How to read food labels Eating out can be a challenge with a milk allergy. Many foods have milk products added for binders or thickeners, or as a main ingredient. Here are some tips to remember when eating out: •• Inquire about all menu items and food preparation before ordering. •• Be aware of cross-contamination. For example: serving tongs for salad items, cooking utensils for multiple foods on the grill, etc. •• Find out if the meat is cooked on a grill that is also used for breaded items or dairy items (especially cheese). •• Ask if it can be cooked on a piece of aluminum foil or in a clean pan. •• Choose menu items that do not contain breading or sauces.

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