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Milk Allergy


What is a milk allergy?

A milk allergy is a condition that develops because your child's immune system overreacts to milk proteins. His immune system sees the proteins as harmful and attacks them. The reaction can happen minutes to hours after your child has a milk product. Milk allergies are most common during the first year of a child's life. Your child may outgrow the allergy by the time he is 2 to 5 years old. Less commonly, he may have it until he is an adolescent. Rarely, a milk allergy can continue into adulthood. A family history of allergies, eczema, or milk allergy can increase your child's risk. A milk allergy increases his risk for seasonal allergies, or allergies to other foods, such as eggs, peanuts, or soy.

What are the signs and symptoms of a milk allergy?

  • A rash, hives, or itching around the mouth and chin
  • Nausea, vomiting, diarrhea, or blood in the bowel movements
  • A runny or stuffy nose, cough, wheezing, or trouble breathing
  • Itchy or watery eyes, swelling, or a hoarse voice
  • Feeling lightheaded, or feeling that he may faint

How is a milk allergy diagnosed?

Tell your child's healthcare provider if anyone in your child's family has a history of allergies or a milk allergy. Tell him when your child first started having a reaction to milk. Describe the reaction and how long it lasts. Your child may need additional testing if he developed anaphylaxis after he was exposed to a trigger and then exercised. This is called exercise-induced anaphylaxis. A trigger can be any food or a specific food your child is allergic to. Your child may need any of the following:

  • A skin prick test is used to check for an allergic reaction. Your child's healthcare provider will scratch your child's skin and add a small amount of milk protein. He will watch for signs of an allergic reaction, such as hives or swelling.
    Skin Prick Test
  • A sample of your child's blood may be checked for a reaction to milk protein.
  • An elimination test may be used if your child does not have an immediate allergic reaction to milk protein. Your child will not eat or drink any milk products for a few weeks. He will then be given a milk product. His healthcare provider will watch for a reaction. Your child may need to have this test repeated every 6 to 12 months to see if he might be able to start having milk.

Which foods does my child need to avoid?

Even a small taste of a milk product can cause an allergic reaction. Do not let your child have any of the following:

  • Cow's milk, goat's milk, or sheep's milk
  • Cheese, cottage cheese, powdered milk, or butter
  • Sour cream, yogurt, or buttermilk
  • Ice cream, whipped cream, or half-and-half
  • Pudding, custard, or milk chocolate
  • Microwave or movie popcorn that contains diacetyl for butter flavor
  • Soy products, if he is also allergic to soy

How is a milk allergy treated?

The main treatment for a milk allergy is not to have any milk products. This is called an elimination diet. Your child's healthcare provider or dietitian can help you create a meal plan that does not include milk products.

  • Medicines may be given to treat milk symptoms of an allergic reaction or to stop wheezing. Medicine may also be given to reduce swelling. Medicine called epinephrine may be prescribed in case of a severe allergic reaction.
  • If your baby is breast fed, his mother may need to stop having milk and milk products. As he is weaned off breastfeeding, do not give him milk until his healthcare provider says it is okay. He may need to be watched for an allergic reaction when he starts to get milk.
  • If your baby is formula fed, he will need a formula that does not contain milk protein. Your baby's healthcare provider can recommend an allergy-free formula that is right for your baby.
  • If your baby is older than 1 year, treatment will first include not having milk products. His healthcare provider may then give him baked foods that contain milk. This is because heat changes the milk proteins and lowers the risk for an allergic reaction. If your child does not have a reaction, he will be given foods such as butter or margarine. He will then be given cooked cheese, milk chocolate, or yogurt. The last step is to give him cow's milk and cheese that is not cooked. Do not give milk, milk products, or baked foods to your child without permission from your child's healthcare provider. Your child can have an allergic reaction quickly, even if you only give him a small amount.

What steps do I need to take for signs or symptoms of anaphylaxis?

Your child's healthcare provider will tell you if your child is at risk for anaphylaxis. He will prescribe a medicine called epinephrine to use at the first sign of anaphylaxis. Signs include trouble breathing or swallowing, swelling in your child's mouth or throat, a change in your voice, or wheezing.

  • Immediately give 1 shot of epinephrine only into the outer thigh muscle. Hold the shot in place for up to 10 seconds before you remove it. This helps make sure all of the epinephrine is delivered.
  • Call 911 and go to the emergency department, even if the shot improved symptoms. Bring the used epinephrine shot with you.

What can I do to manage or prevent a milk allergy?

  • Read all food labels. Read the label each time you buy the food to make sure the ingredients have not changed. Look for milk protein in the list of ingredients. Milk protein may be listed as casein or whey. Also check for diacetyl, ghee, lactose, lactalbumin, lactoglobulin, lactoferrin, and tagatose. Ask your child's healthcare provider for a complete list of ingredients to check for when you buy packaged foods.
  • Talk to servers or managers at restaurants when you eat out. Tell the server or manager about the milk allergy before you order. Ask about ingredients in the dish you want to order for your child. Ask if milk is added to sauces or soups. Ask for food to be prepared without butter or sour cream.
  • Prevent cross-contamination. Do not use kitchen items that have touched milk products. For example, do not use a knife to cut a food after it touched a milk product. This is called cross-contamination, and it can still cause an allergic reaction. Keep all utensils, cutting boards, and dishes that touched milk separate from other equipment. Use hot, soapy water to wash all kitchen items that touch food. Wash items after each time they touch food as you cook.
  • Breastfeed your baby for the first year. Breast milk is the best food for your baby. Breastfeeding can help prevent allergies, and can help your baby's immune system develop. If possible, give your baby only breast milk for the first 4 to 6 months.

What safety precautions do I need to take if my child is at risk for anaphylaxis?

  • Tell others about your child's allergy. Tell family members, friends, and your child's school officials, teachers, and babysitters. Your child's school or daycare center can help make sure your child is not exposed to milk protein. This includes making sure your child does not eat baked foods brought into the classroom to celebrate a holiday or birthday. Ask if your child should keep epinephrine with him at all times. Some schools keep epinephrine in a medical office. Make sure others know what to do in case of an anaphylactic reaction.
  • Keep 2 shots of epinephrine available for your child at all times. Your child may need a second shot if the first dose does not help or if his symptoms return. Your child's healthcare provider can show you and family members how to give the shot. Check the expiration date every month and replace it before it expires.
  • Create an action plan. Your child's healthcare provider can help you create a written plan that explains the allergy and an emergency plan to treat a reaction. The plan explains when to give a second epinephrine shot if symptoms return or do not improve after the first. Give copies of the action plan and emergency instructions to family members, school and sports staff, and daycare providers. Show them how to give a shot of epinephrine. Update the plan as the allergy changes.
  • Tell your child to be careful when he exercises. If your child had exercise-induced anaphylaxis, tell him not to exercise right after he eats. He must stop exercising right away if he starts to develop any signs or symptoms of anaphylaxis. He may first feel tired, warm, or have itchy skin. Hives, swelling, and severe breathing problems may develop if he continues to exercise.
  • Have your child carry medical alert identification. Have your child wear jewelry or carry a card that says he has a milk allergy. Ask your child's healthcare provider where to get these items.
  • Use good hygiene. Do not let your child share utensils or food. Wash your child's hands before and after meals.

Call 911 for signs or symptoms of anaphylaxis,

such as trouble breathing, swelling in your child's mouth or throat, or wheezing. Your child may also have itching, a rash, hives, or feel like he is going to faint.

When should I seek immediate care?

  • Your child has itching or hives that spread all over his body.
  • Your child's skin or nails are blue or pale.
  • Your child has bloody diarrhea.

When should I contact my child's healthcare provider?

  • Your child has new or worsening rashes, hives, or itching.
  • Your child has an upset stomach or are vomiting.
  • Your child has stomach cramps or diarrhea.
  • You have questions or concerns about your child's condition or care.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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