Allergy and Immunology

COWS MILK ALLERGY

Cows milk is one of the most common causes of food allergic reactions in children.
Fortunately most children will outgrow their cows milk allergy.

HOW CAN YOU TELL WHEN MY CHILD HAS OUTGROWN THEIR COWS MILK
ALLERGY?
The doctors will determine whether your child has grown out of their allergy by a
combination of allergy testing and food challenge with milk. If your child has a
type of allergy that can be diagnosed with allergy testing this may be used to
monitor your child’s allergies. A positive allergy test does not always mean your
child will have symptoms when they have milk or milk products, therefore a
challenge may be the only way to determine if your child has grown out of their
allergy. Challenges may need to be done in a hospital by experienced medical
staff. Do not do challenges at home unless instructed to do so by your doctor.

HOW DO YOU TREAT COWS MILK ALLERGY?

There is currently no treatment for food allergy. If your child has a confirmed cows
milk allergy avoiding milk and all milk containing foods is the only way to prevent
symptoms.

HOW IS COWS MILK ALLERGY DIFFERENT TO LACTOSE INTOLERANCE?

Lactose intolerance is when the body has difficulty digesting lactose, the natural
SUGAR found in milk. Cows milk allergy is when the immune system reacts to the
PROTEIN in milk. Lactose free products still contain cows milk protein and are not
suitable for people with cows milk allergy.

HOW CAN MY CHILD AVOID COWS MILK?

Cows milk is found widely in the foods we eat therefore it is important to read and
understand food labels to be able to choose foods that are safe for your child.
Other animal milks (goat and sheep) contain similar proteins to cows milk and
should also be avoided. Heating and processing can change the proteins in foods
making them less allergenic. Your child may be able to tolerate baked or processed
forms of milk without reactions. Your doctor will advise you what forms of milk can
be included.

The following foods and ingredients DO NOT contain cows milk protein
and can be eaten:
 Cocoa butter
 Cream of tartar
 Lactic acid- some lactic acid starter culture may however contain milk, so
check labels carefully.
 Lactose in medications- Lactose is the sugar contained in cows milk. The
pure sugar form is used in medications. The chance of a person with milk
allergy reacting to pure lactose in medications is very low.

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  A2 milk  Ice cream
 Butter  Infant formula (cows milk
 Buttermilk based including HA)
 Casein and caseinates  Lactalbumin
 Cheese  Lactoglobulin
 Cheese powder  Lactose free milk
 Cheesybite spread  Milk – low fat, skim, A2,
 Cheese spreads UHT
Foods and  Condensed milk  Milk derivative
 Cottage cheese  Milk protein
ingredients that
 Cream  Milk solids
contain cows
 Cream cheese  Nonfat dairy or milk solids
milk protein  Curds  Probiotic drinks
 Custard  Ricotta cheese
 Dairy solids  Skim milk solids
 Evaporated milk  Sustagen, Pediasure and
 Ghee, butter oil or butter fat other high protein drink
 Goat and sheep’s milk powders
 Feta cheese  Sour cream
 Hydrolysates (casein, milk  Whey
protein, whey)  Yoghurt

 Baked goods –biscuits,  Margarine

cakes, pastries  Milk drink flavouring such
 Breads as Milo and malted milk
 Breakfast cereals powder.
 Canned spaghetti  Nougat
 Caramel, fudge,  Pasta sauces
Foods and butterscotch  Potato products – mash,
 Chocolate salads and instant potato
ingredients likely
 Commercial baby foods  Processed meats-sausages,
to contain cows
 Confectionary sandwich meats,
milk protein  Crumbed and battered hamburgers
products  Sorbet and Gelati
 Dips  Salad dressings
 Gravy powders  Soups
 Fruit Juice drinks- high  Soy cheese
protein  Snack foods – crisps,
 Infant feeding rusks crackers
 Instant mashed potato

LABEL READING

Ingredients List
All packaged foods must have an ingredients list. You must check this ingredients
list for any ingredients that may contain milk. It is law that all common food
allergens (peanut, tree nut, seafood, fish, milk, eggs, soybeans and wheat) be
clearly identified, however small the amount.

Example: Instead of simply casein the ingredients list should read casein (milk)
or milk casein.

ALWAYS Check the ingredients list every time you buy the food as the ingredients
of the product may change.
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“May contain traces of milk” statements
These statements are used by manufacturers to indicate that the product may be
contaminated with milk through processing and packaging. At present these
statements are voluntary and there are no clear guidelines for companies
regarding how and when to use them. The wording of the statements makes it
very difficult to determine the level of risk and a product that does not contain the
statement may be no safer than a product that does. The chances of having a
significant allergic reaction through contamination during processing is extremely
unlikely. For children at risk of severe allergic reactions companies can be
contacted directly to explore food processing, packaging and cleaning procedures.

Products labelled as “May be present” have undergone more robust

assessment (VITAL) and should be avoided by those with severe reactions
to milk.

COWS MILK PRODUCT ALTERNATIVES

Cows milk and products made from cows milk such as yoghurt and cheese are
important sources of energy, protein, fat, calcium and vitamin A and D. Especially
for infants and young children, it is important to replace cows milk with a suitable
alternative and in adequate amounts to ensure optimal nutrition and growth.

Instead of: Use

Removing cows milk and cows milk based products from
the maternal diet may sometimes be required. Check
this with your doctor or dietitian. Alternative milks such
as soy, rice or oat milk may be used for your baby in
Breastfed infants
cooking and or on cereals. Infant formula will be
required as a breast milk substitute until at least 12
months of age. Maternal calcium supplementation may
be required.
Suitable Alternatives
0-6mths
Specialised infant formula prescribed by your doctor will
be required. These include:
Extensively hydrolysed: Alfare, Pepti Junior, Allerpro*
and Novalac Allergy*
Amino Acid based: Alfamino, Elecare and Neocate.
*available without doctor prescription

Cows milk based 6-12mths

infant formula Soy formula, if tolerated can be used from 6 months of
age.

Not suitable
Lactose free formula
HA formula
Anti reflux (AR) formula
A2 formula
Comfort formula
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 Suitable Alternatives
Soy is the preferred option.
Rice, oat or other plant milks are low in protein and fat
and should only be used with guidance from a dietitian
Cows milk
until after 2 years of age.
(children over 1-2yrs
Choose brands with added calcium (120mg/100ml).
of age)
Not suitable
Goat and sheep’s milks contain similar proteins to cows
milk and are not suitable. A2 milk is not suitable.
Soy yoghurt (highly allergic children may still react due
Yoghurt
to a milk based starter used to make the yogurt)
Cheese and Sour Soy based cheese (check as some brands contain
Cream casein-milk protein)
Icecream Soy ice cream, sorbet, milk free gelato
Cream and Soy cream, soy cooking milk, soy condensed milk and
condensed milk rice cream
Butter and Milk free margarine
margarine
Chocolate Soy or Rice based chocolate

If you are having trouble finding products in your supermarket try online allergy or
vegetarian stores such as: www.crueltyfreeshop.com.au or
www.veganperfection.com.au.

ALLERGEN MANAGEMENT AT HOME

Have a plan regarding storage and cooking of foods in your home as cross
contamination can occur during storage, cooking and serving of foods.

ALLERGEN MANAGEMENT WHILST EATING OUT

 Parties and eating at cafes and restaurants can pose a challenge for families
with a child with a food allergy.
 If your child has an Epipen prescribed have it with them at all times.
 Plan ahead and discuss your child’s allergies in advance
 If you are not sure that the food is suitable do not give it to your child to
eat.

ALLERGEN MANAGAEMENT AT CHILDCARE AND SCHOOL

 Ensure your child has an up to date Allergy Action Plan.
 Teach your child not to share food or drinks.
 Excursions and camps will need advanced planning and communication with
the childcare centre or school.
 Remind staff about craft activities that may use old food containers and
ensure they are clean.
Refer to the ASCIA (Australasian Society of Clinical Immunology and Allergy)
website for further resources for Schools and Childcare www.allergy.org.au

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For further information refer to:

ASCIA (The Australian Society of Clinical Immunology and Allergy) is the peak
professional body of Clinical Immunologists and Allergists in Australia and New
Zealand.

Their website contains a wide range of information including Guidelines for

prevention of food anaphylactic reactions in schools, preschools and childcare
centres and Action plans - www.allergy.org.au

Allergy & Anaphylaxis Australia: a non-profit organisation that provides

information, training and support. Membership provides you with access to local
support groups and seminars, quarterly newsletters and discounts on resources.
Website contains outlines on each states policy on managing food allergies in
schools, preschools and childcare facilities - www.allergyfacts.org.au

FSANZ (Food Standards Australia and New Zealand): for information on food
labeling - www.foodstandards.gov.au

Disclaimer
The food and ingredient lists included in this resource are not exhaustive
and may change, individuals with food allergy should always check food
labels each time a product is purchased.

This resource is intended to accompany a medical consultation regarding

the management of a diagnosed food allergy.

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