Kids with milk allergies

Milk Allergy (for Parents) - Nemours KidsHealth

What Is Milk Allergy?

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
• hives
• 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.

Reviewed by: Larissa Hirsch, MD

Date reviewed: January 2021

Milk Allergy in Infants (for Parents)

What Is a Milk Allergy?

When a baby is allergic to milk, it means that his or her immune system, which normally fights infections, overreacts to proteins in cow's milk. Every time the child has milk, the body thinks these proteins are harmful invaders and works hard to fight them. This causes an allergic reaction in which the body releases chemicals like

histamine.

Cow's milk is in most baby formulas. Babies with a milk allergy often show their first symptoms days to weeks after they first get cow milk-based formula. Breastfed infants have a lower risk of having a milk allergy than formula-fed babies.

People of any age can have a milk allergy, but it's more common in young children. Many kids outgrow it, but some don't.

If your baby has a milk allergy, keep two epinephrine auto-injectors on hand in case of a severe reaction (called anaphylaxis). An epinephrine auto-injector is an easy-to-use prescription medicine that comes in a container about the size of a large pen. Your doctor will show you how to use it.

What Are the Signs & Symptoms of a Milk Allergy?

In children who show symptoms shortly after they have milk, an allergic reaction can cause:

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

The severity of allergic reactions to milk can vary. The same child can react differently with each exposure. This means that even though one reaction was mild, the next could be more severe and even life-threatening.

Children also can have:

• an intolerance to milk in which symptoms — such as loose stools, blood in the stool, refusal to eat, or irritability or colic — appear hours to days later
• lactose intolerance, which is when the body has trouble digesting milk

If you're not sure if your child has an intolerance versus an allergy, talk to your doctor.

If Your Child Has an Allergic Reaction

If your child has symptoms of an allergic reaction, follow the food allergy action plan your doctor gave you.

If your child has symptoms of a serious reaction (like swelling of the mouth or throat or difficulty breathing, or symptoms involving two different parts of the body, like hives with vomiting):

• Give the epinephrine auto-injector right away. Every second counts in an allergic reaction.
• Then, call 911 or take your child to the emergency room. Your child needs to be under medical supervision because, even if the worst seems to have passed, a second wave of serious symptoms can happen.

How Is a Milk Allergy Diagnosed?

If you think your infant is allergic to milk, call your baby's doctor. He or she will ask you questions and talk to you about what's going on. After the doctor examines your baby, some stool tests and blood tests might be ordered. The doctor may refer you to an allergist (a doctor who specializes in treating allergies).

The allergist might do skin testing. In skin testing, the doctor or nurse will place a tiny bit of milk protein on the skin, then make a small scratch on the skin. If your child reacts to the allergen, the skin will swell a little in that area like an insect bite.

If the allergist finds that your baby is at risk for a serious allergic reaction, epinephrine auto-injectors will be prescribed.

Avoiding a Milk Allergy Reaction

If You're Breastfeeding

If your breastfed infant has a milk allergy, talk to the allergist before changing your diet.

If You're Formula Feeding

If you're formula feeding, your doctor may advise you to switch to an extensively hydrolyzed formula or an amino acid-based formula in which the proteins are broken down into particles so that the formula is less likely to trigger an allergic reaction.

You also might see "partially hydrolyzed" formulas, but these aren't truly hypoallergenic and can lead to a significant allergic reaction.

If you're concerned about a milk allergy, it's always best to talk with your child's doctor and work together to choose a formula that's safe for your baby.

Do not try to make your own formula. Commercial formulas are approved by the U.S. Food and Drug Administration (FDA) and created through a very specialized process that cannot be duplicated at home. Other types of milk that might be safe for an older child with a milk allergy are not safe for infants.

If you have any questions or concerns, talk with your child's doctor.

Diet for milk allergy

03/22/2020

Cow's milk and products containing it are excluded from the diet. Although cow's milk and goat's milk are similar in antigenic composition, some patients with cow's milk allergy tolerate goat's milk. In order to avoid the use of ready-made products containing cow's milk, you should always study their composition on the packaging.

Some products containing milk:

• Skimmed milk powder
• Powdered milk
• Oil
• Whey
• Curd
• Lactose
• Margarine
• Casein
• Casein hydrolyzate
• Ice cream
• Cheese

Since the composition of any product is subject to change, it is necessary to study the packaging even of previously consumed products.

Dishes excluded from the diet:

1. Soups - Puree soups and other soups based on or containing milk.

2. High protein foods - Cheese, cottage cheese, sausages (e.g. sausages, smoked sausage) containing milk and milk components, beef, fish, poultry (breaded or with white sauce), egg dishes with the addition of dairy products.

3. Potatoes and other side dishes - Any food containing milk and its components (eg mashed potatoes, macaroni and cheese).

4. Vegetables - Any vegetable products with the addition of milk and its components (for example spinach puree).

5. Bakery products - Any bakery products with the addition of milk and its components:

• donuts
• pancakes
• pancakes
• wafers
• dry biscuits
• biscuit rolls
• biscuits

6. Cereal dishes — Dishes prepared with milk, prepared foods with the addition of milk or its components.

7. Fats - Butter, cream, salad dressings, mayonnaise and margarine containing milk or milk ingredients.

8. Sweet dishes — Any sweet dishes containing milk or its components, ready-made pies, cakes, biscuits, puddings, ice cream, sherbets, yoghurts, dry mixes.

9. Milk Whole cow's milk, skimmed milk, skimmed milk powder, sweetened or unsweetened condensed milk, yoghurt, cow's milk infant formula, cocoa with milk.

10. Beverages — Beverages with added milk:

• cocoa
• milkshakes
• alcoholic drinks with cream

11. Other products — Milk chocolate, cream sauce, whey, cottage cheese, products fried in butter, fried in breadcrumbs, cheese, dough, low quality chocolate. ⠀

Allergy to cow's milk protein in children

03/22/2020

Food allergy is a food-induced adverse (pathological) reaction based on immune mechanisms. In children under one year of age, the most common cause of food allergy is cow's milk protein (CMP).

A distinction is made between cow's milk protein allergy and cow's milk protein intolerance. In the first case immune mechanisms are involved, in the second - the baby simply does not have enough enzymes to digest cow's milk protein (for example, lactase deficiency).

There are only 36 cow's milk protein allergens, but 4 of them most often cause food allergies.

Casein is 80% BCM, it is heat stable (does not break down when boiled) and is not a species-specific protein. This means that if you are allergic to it, you may be allergic to the milk of other animal species.

β - lactoglobulin has the highest allergenic activity, species-specific, does not break down when boiled. This protein is not found in human milk.

α - lactalbumin is destroyed by boiling, species-specific.

Bovine serum albumin is not destroyed by boiling If an allergy to this cow's milk protein is detected, the child may also react to beef and veal meat.

It should be noted that mainly children who are formula-fed formulas based on cow's milk protein suffer from allergy to cow's milk protein.

This type of allergy can also develop in children who are breastfed - if the diet of a nursing mother contains products containing cow's milk protein (milk, cheese, cottage cheese, sour cream, butter, fermented milk products), especially in large quantities.

What symptoms suggest that the baby may be allergic to CMP:

• Skin manifestations (dry skin, dry nummular rashes, skin itching).
• Gastrointestinal manifestations (bloating, regurgitation, vomiting, loose stools, possibly mucus and blood-streaked stools).
• Respiratory manifestations (itchy eyes, cough, nasal congestion and even urticaria and Quincke's edema). These symptoms are rare in toddlers, but still possible.

I must say that if the first manifestations of food allergy in a baby appeared after switching to artificial feeding with a “regular” adapted formula based on cow's milk, then this is a reason to suspect cow's milk proteins as an allergen.

Further correct history taking : the doctor will definitely find out if anyone in your family suffers from allergic diseases (bronchial asthma, allergic rhinitis, atopic dermatitis, hay fever). If the family has these diseases, the risk of developing allergies in the baby increases.

At the discretion of the doctor, it is possible to take blood from a child for the presence of immunoglobulin E (IgE) antibodies to cow's milk proteins, which were mentioned above. In the presence of IgE antibodies to CMP in the baby's blood, almost 100% confirms that he has an allergy. Paradoxically, the absence of these antibodies does not rule out an allergy to cow's milk proteins, but only indicates that the allergy proceeds through a different type of allergic reaction.

And the simplest, most important and affordable method is the diagnostic diet with the exclusion of products from the child's diet (or from the mother's diet during breastfeeding) containing CMP. The duration of this diet is from 1-2 to 4 weeks. If during these periods there is no improvement in the condition of the baby, then an allergy to CMP is unlikely.

If the child's condition improves, you may need challenge test . This means the introduction of dairy products into the child's diet again. And if the manifestations of allergies return, this will prove an allergy to BCM. This test is carried out under strict medical supervision.

In children who are fed exclusively with breast milk, it is necessary to exclude products containing CMP from the diet of mothers.