Cows’ milk allergy – affects around 2-5% of (2-5 in every 100) infants and young children who usually start to have symptoms in their first few months. This causes many health problems and is frequently not diagnosed, or takes many months to be diagnosed.
Most children outgrow milk allergy by five years of age so only about 1 in 1000 older children and adults have true milk allergy.
Milk and dairy foods are an important part of our diet, providing many nutrients including proteins, minerals and vitamins essential for growth, bone and dental health. It is therefore important that if you think that you or your baby may be allergic to cows’ milk, you speak to a GP or Health Visitor about it.
Cows’ milk and dairy foods are essential in babies and young children. Any child with a potential food allergy must be seen by an Allergy Specialist for an accurate diagnosis and to ensure the child’s diet remains adequate and the allergy is managed appropriately. See our factsheet Does my child have a Cows’ Milk Allergyfor more information.
If a child or adult needs to avoid cows’ milk, remember that it may be present in many foods, such as:
- Milk Powder
- Milk drinks
- All types of cheese
- Ice cream
Food labels that list any of the ingredients below also contain some cows’ milk or products in them.
- Hydrolysed casein
- Skimmed milk
- Skimmed milk powder
- Milk solids
- Non-fat milk
- Whey syrup sweetener
- Milk sugar solids
The following are examples of processed foods which may contain milk:
- Breakfast cereals
- Baby foods
- Processed meats, e.g. sausages
- Pasta and pizzas
- Instant mashed potato
- Sauces and gravies
- Baked goods, e.g. rolls
- Pancakes, batters
- Ready made meals
- Puddings and custards
- Cakes, biscuits, crackers
Note: This list includes just some of the foods to be avoided in a milk free diet. Before any changes are made to you or your child’s diet, seek advice from a dietitian.
Remember, check the labels first.
If you or your child are allergic to the proteins in cows’ milk, neither goat nor sheep milk will be suitable as a replacement. Your body will recognise the milk proteins as being physically similar and react in the same way as to cows’ milk. Milk intolerance is also common and many patients who are intolerant but not truly allergic to cows’ milk may tolerate goats’ milk or sheep’s milk better than cows’ milk, due to factors other than milk protein. If in doubt, you should check with your medical advisor.
- Soya milks available in shops and supermarkets are unsuitable for babies under 12 months.
- In children over 12 months, soya milks can be used during weaning, both as a drink and in recipes to replace cows’ milk. Soya milks specially developed for younger children are available, but are not recommended in babies under 6 months of age.
Cows’ milk is an important source of calcium. If my baby must avoid cows’ milk, will he get enough calcium?
Soya baby milks are fortified with calcium, and one pint will provide about 60% of the daily requirement for calcium for babies under one year.The balance of the calcium must be obtained from milk free foods at weaning. Occasionally, calcium supplements may be necessary if a baby is not taking a sufficient amount of soya baby milk and calcium rich solids. If you are concerned about your baby’s calcium intake, ask your dietitian or doctor for advice.
We prefer a vegetarian diet. Can we give our baby a soy formula instead of a formula based on cows milk?
Yes, although soya formula is mainly given to babies with cows’ milk intolerance, it is free from animal products. So, parents who prefer to give their babies a vegetarian diet can use it.
A small number of children will react to soya formula and thus will need to be prescribed a non-milk, non-soya formula for feeding. If you suspect this, please contact your general practitioner or specialist.
If you or your child is milk allergic then specialist advice is required because although some children do “outgrow” their allergy not all will. If one has had a serious reaction, then potentially another could occur. If in doubt contact your specialist or GP. Pure lactose does not contain any milk protein and therefore will not produce any allergic reaction.
This is a relatively common condition, up to one in ten Eurasian people will suffer symptoms suggestive of lactose intolerance, although it is present in the majority of some African and Asian populations. This is not an allergic condition, but an inability to digest lactose (milk sugar) because the body produces low levels oflactase, the enzyme responsible for digesting lactose. It can affect both children and adults, and the common symptoms are diarrhoea, bloating, discomfort. Lactose intolerance may occur temporarily following a bout of gastroenteritis, with diarrhoea being the main symptom. Lactose is present in cow’s milk, goat’s milk and sheep’s milk in similar quantities As with all intolerances the only solution is avoidance of the offending food until one can once again tolerate it, which may be weeks, months or longer.
For some people there is a dose related response, that is one may be able to tolerate milk in tea, but a glass of milk would cause symptoms. There is a test available for the diagnosis of lactose intolerance, called a lactose challenge, and for small babies and children is especially advisable. If there is no need to exclude foods from a diet then life is a great deal simpler. Your general practitioner (GP) can refer you to a gastroenterologist, who would give an accurate diagnosis.
In adults an exclusion diet would probably be adequate, and this can be easily attempted at home. If your diet is already restricted or you have a family history of osteoporosis (brittle bones) a dietitian should be consulted. Your GP can refer you to a state registered dietitian on the National Health Service. If there is no history of gastroenteritis causing your symptoms, then it may be necessary for milk to be permanently excluded from the diet, provided it is a well balanced diet this should not have any significant effects on your health. A list of other foods high in calcium has been provided.
If, having excluded dairy products from your diet for 3-4 weeks, with no improvement in your symptoms, it is likely there is some other cause of your symptoms, so you can then reintroduce dairy products and observe your condition. If you are contemplating a permanent exclusion diet, you should be referred to a dietitian for advice.
It is recommended that older people have a calcium intake of 1500 mg per day. The daily recommended calcium intake according to age, as recommended by the National Osteoporosis Society, is as follows:
|Age||Daily Calcium Intake|
|Pregnant and Nursing Mothers||1200mg|
|Males 20 – 60 yrs||1000mg|
|Females 20 – 45 yrs||1000mg|
|Females over 45 yrs||1500mg|
|Males over 60 yrs||1500mg|
The following are foods that have a high calcium content:
|Food||Calcium content per 100g of Food|
|Soya milk||13 mg (often has calcium added)|
|Chick peas (raw)||160 mg|
|Soya beans (raw)||240 mg|
|Red kidney beans||100 mg|
|Curley kale (boiled)||150 mg (absorbed as well as milk)|
|Okra (cooked / raw)||160mg / 220mg|
|Spring greens (cooked / raw)||75mg / 210mg|
Herbs and spices contain useful amounts, but obviously only small quantities are used.