What is a milk allergy?
A milk allergy occurs when the body reacts to one or more of the proteins in cow’s milk.
How serious is a milk allergy?
Milk allergy reactions are different for each child, but they usually happen soon after your child consumes milk and most often involve skin and/or respiratory (breathing) systems. Symptoms of a milk allergy may include hives, lip and face swelling or difficulty breathing. This is different from non-IgE cow's milk allergy. A milk allergy can sometimes cause anaphylaxis, a severe and life-threatening allergic reaction.
How to treat a milk allergy
If your child has been diagnosed with a milk allergy, they must follow a strict cow’s milk protein (CMP)–free diet. This means avoiding all sources of CMPs from food, drink, medications, supplements or natural health products. Your child should also avoid foods that may have come into contact with other foods containing CMP or touched surfaces that have had CMP-containing foods on them.
It is very important to always read the product labels for any sources of CMPs for a strict CMP-free diet for milk allergy. This includes “contains” statements (or ingredient lists), as well as “may contain” statements, of any food or drink. All sources or potential sources of CMPs must be avoided on a strict CMP-free diet for milk allergy.
What the CMP-free diet is NOT:
- A dairy-free diet. The CMP-free diet excludes all sources of CMPs found in foods or drinks, not just dairy-based foods or drinks.
- A lactose-free diet. Lactose is a sugar found in dairy, so lactose-free products still contain CMPs, which are not allowed on a CMP-free diet.
The CMP-free diet for milk allergy
CMPs are found in dairy, as well as in many packaged and processed products. The obvious sources of CMPs are dairy-based foods or drinks, such as cheeses, yogurts, butter and milks. However, there are also many foods and drinks where CMPs are hidden as an ingredient.
When buying packaged foods, always check the list of ingredients in the store and again when you bring the product home. It is also a good idea to check the ingredients every time you buy the food in case the recipe has changed. You can also call the manufacturer to ask about any ingredient changes.
The following is a list of some names for milk or proteins in cow’s milk products. Use it when you are grocery shopping or calling food manufacturers.
- Casein or caseinate (also, ammonium/calcium/magnesium/potassium/sodium caseinate)
- Dried milk
- Hydrolyzed casein, hydrolyzed milk protein
- Lactate/lactose
- Lactoferrin/lactoglobulin/lactalbumin
- Milk protein/solids
- Modified milk ingredients
- Rennet
- Whey (de-lactosed, demineralized)
- Whey protein concentrate
Possible sources of milk
Milk is used in a range of packaged foods and drinks. Below is a list of some of the many food products that may contain milk or CMPs.
Other names for milk/dairy or sources of cow’s milk proteins (CMPs)
- Beta-lactoglobulin
- Casein, rennet casein
- Caseinate (ammonium caseinate, calcium caseinate, magnesium caseinate, potassium caseinate, and sodium caseinate)
- De-lactosed or de-mineralized whey
- Hydrolyzed casein
- Lactalbumin and lactalbumin phosphate
- Lactoferrin, lactoglobulin
- Whey and whey protein concentrate
Sources of cow’s milk/dairy
- Butter, buttermilk
- Cheese, curds
- Cream
- Gelato
- Ghee and butter fat
- Ice cream
- Kefir (fermented drink)
- Kumiss (fermented drink)
- Sorbets
- Sour cream
- Yogurt
Examples of foods, drinks and products that may contain milk/dairy CMPs
- Infant formula, infant cereals
- Artificial butter, butter flavour or butter oil
- Baked goods (including some types of bread) and baking mixes
- Battered and fried foods
- Broths and bouillons
- Caramel colouring or flavouring
- Casseroles, frozen prepared foods
- Cereals, crackers
- Chocolates
- Desserts (e.g., custards, puddings)
- Dips and salad dressings
- Egg and fat substitutes
- Fat replacers (e.g., Opta™ and Simplesse®)
- Glazes, gravies and sauces
- High-protein flours
- Malt-drink mixes
- Margarine
- Pâtés, sausages
- Pizza
- Plant-based products (e.g., vegetarian cheeses)
- Potato products (e.g., instant) or dishes
- Seasonings
- Soups, soup mixes, cream soups
*The above are not inclusive lists. Always read the product label for any source of milk/dairy or CMPs. Check the Health Canada and Canadian Food and Inspection Agency (CFIA) websites for any updates about milk/dairy or CMPs.
What do I do if my child has a milk allergy?
Your child should see an allergist (a doctor who specializes in diagnosing and treating allergies) who can discuss the milk allergy with you in more detail. Some children who have a milk allergy are able to safely eat baked goods containing milk. If your child has a milk allergy, you should consult with an allergist before giving your child baked goods containing milk.
Your child’s health-care provider may also prescribe a medication called an epinephrine autoinjector, which can be used to treat allergic reactions, in case your child accidentally eats a food containing milk.
What type of milk can my infant have if they are allergic to cow’s milk?
Breastfeeding is the best way to feed an infant. If your infant is already breastfed, this can continue even if they have been diagnosed with a milk allergy. However, the rest of your infant's diet should not include cow’s milk or sources of CMPs.
If your infant is not breastfed, they can take a soy-based infant formula. If they have an allergy to soy and to cow’s milk, a health-care provider or dietitian will recommend a hydrolyzed (broken-down) formula to meet your infant’s needs.
Always speak with your child’s health-care provider or dietitian about your infant’s food allergies and what option is best for you and your infant.
Reducing the risk of cross-contact (sometimes called cross-contamination)
Cross-contact occurs when CMP from a food or other source touches a “safe” food, drink or surface by accident. Cross-contact makes a food, drink or surface unsafe for your child with milk allergy.
Cross-contact can occur by CMP (or other food allergens) being transferred from utensils (e.g., wooden spoons, ladles), pots and pans, as well as preparation or other surfaces (e.g., kitchen countertops, picnic tables).
Be careful when eating out and always ask service staff about possible cross-contact during preparation and delivery of food or drink.
Avoid shopping at bulk food stores as these places are high risk for CMP cross-contact (e.g., from sharing one spoon between bins, milk powder dust transferred between bins). Bulk food containers pose a high risk of cross-contamination because they are often used for different products.
How can my child get the right amount of nutrients if they must avoid milk?
Dairy and dairy-based products provide your child with important nutrients, including calcium, vitamin D and protein.
Calcium
When following a CMP-free diet, it can be challenging to get enough calcium from non-dairy sources of food and drink. Good sources of calcium include calcium-fortified/enriched beverages, tofu with added calcium sulfate (if you have not been told to avoid soy protein), legumes, nuts and canned fish with bones.
| Food or drink | Serving size | Approximate calcium content |
|---|---|---|
| Almonds | 1/4 cup | 90 mg |
| Bok choy, boiled | 1 cup | 160 mg |
| Broccoli, boiled | 1 cup | 55 mg |
| Orange juice, calcium fortified | 1 cup | 300 mg |
| Salmon, canned, with bones | 4 oz | 175 mg |
| Sardines, canned, with bones | 4 medium | 180 mg |
| Soy beverage, fortified | 1 cup | 300 mg |
| Tahini (100% crushed sesame seeds) | 3 tbsp | 190 mg |
| White beans, boiled | 1 cup | 170 mg |
Supplement with calcium if your child is not meeting calcium needs from food or drink. Refer to the table below for daily calcium needs based on age. Use online calcium calculators or speak with your health-care provider about calcium supplements on a CMP-free diet.
There are many calcium supplements available. Choose the type (e.g., tablet, gummy, liquid) that your child can take by mouth. It can be any form of calcium (e.g., calcium carbonate, calcium citrate, calcium gluconate), as tolerated.
Vitamin D
The body needs vitamin D to absorb calcium, as well for bone and immune health. Avoiding CMPs may lower the amount of vitamin D in your child’s diet. Dietary sources of vitamin D include fortified dairy products, egg yolk, fish and fish liver oils, and livers. Vitamin D status is also affected by exposure to sunshine. In Canada, sun exposure is limited, especially during the months of October to April. It is strongly recommended that your child takes a vitamin D supplement to maintain optimal vitamin D status.
Recommended Dietary Allowances (RDAs) for calcium and vitamin D based on age
| Age | Calcium (mg)* | Vitamin D (IU)** |
|---|---|---|
| 0 – 6 months | 200 | 400 |
| 7 – 12 months | 260 | 600 |
| 1 – 3 years | 700 | 600 |
| 4 – 8 years | 1000 | 600 |
|
9 – 18 years Pregnant or lactating |
1300 1300 |
600 600 |
|
19 – 50 years Pregnant or lactating |
1000 1000 |
600 600 |
*mg = milligrams
**IU = international units
Protein
Milk-based food and drink are sources of protein that must be avoided on a CMP-free diet. This may affect your child’s ability to meet daily protein needs. Sources of protein that can be eaten on a CMP-free diet include egg, poultry (e.g., chicken, turkey), meat (e.g., beef, pork, wild game), fish, seafood, legumes (e.g., beans, chickpeas) and some grains (e.g., quinoa). The recommended minimum amount of protein is 1 gram of protein per kilogram of body weight per day, which can be met with many non-dairy food sources.
Ideas for CMP substitutions
- Fortified plant-based milk alternatives, such as almond, coconut, hemp, oat, pea or rice milks.
- Plant-based dairy alternatives, such as spreads and butter, cream, cheese and yogurt alternatives (read the label for hidden CMPs).
- Plant-based frozen treats (e.g., coconut- or rice-based treats; read the label for hidden CMPs).
- Snacks including fruits and vegetables with nuts, seeds, avocado and legume-based spreads such as hummus or white bean dips.
Tips for eating out
- Call ahead to inquire if the restaurant can accommodate CMP-free meals.
- Be mindful when eating out during peak hours when staff may not be as available to address your dietary concerns.
- Don’t be shy to speak directly with the manager about your dietary concerns.
- Choose stock-based soups instead of creamed soups.
- Order salads with oil and vinegar instead of salad dressing.
- Choose grilled or barbecued meat, poultry, fish or alternatives without breading, sauces or marinades.
When to see a dietitian for a milk allergy
If you have removed many foods from your child’s diet because of a milk allergy, it may be a good idea to speak to a registered dietitian. The dietitian can review the foods your child eats to see if they are getting enough nutrition for growth and development.
Will my child always have a milk allergy?
A milk allergy is one of the most common food allergies in infants, but most children outgrow it as they grow older.
An allergist can help you find out when to test your child and see whether they have outgrown their allergy. Consult them regularly to check if there have been any changes to your child's food allergy.
When to go the emergency room
If your child is having a severe allergic reaction to milk, call 911 or go to your nearest emergency department immediately. If your child’s doctor prescribed them an epinephrine autoinjector, administer this medication to your child right away. See Anaphylaxis: How to recognize and respond to a severe allergic reaction for more information.