Milk Allergy

Cow milk allergy varies from person to person, and allergic reactions can be unpredictable. Symptoms of a milk allergy reaction can range from mild, such as hives, to severe, such as anaphylaxis.

If you have a milk allergy, keep an epinephrine delivery device with you at all times. Epinephrine is the first-line treatment for anaphylaxis.

To prevent a reaction, it is very important that you avoid cow’s milk and cow’s milk-containing food products. Always read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.

If you are allergic to cow’s milk, your doctor may recommend you also avoid milk from other domestic animals. For example, goat's milk protein is very similar to cow's milk protein and may cause a reaction in people who have a milk allergy.

Milk is one of the eight major allergens that must be listed in plain language on packaged foods sold in the U.S., as required by federal law, either within the ingredient list or in a separate “Contains” statement on the package. This makes it easy to see if milk is present in a food item. 

As a general tip, ingredients are listed on the package in order of their prevalence in the product. For those avoiding baked milk, make sure milk (or an milk-containing product) is listed as the 3rd ingredient or later in the list. When in doubt, it’s best to avoid. Avoid foods that contain milk or any of these ingredients:

• Butter, butter fat, butter oil, butter acid, butter ester(s)
• Buttermilk
• Casein
• Casein hydrolysate
• Caseinates (in all forms)
• Cheese
• Cottage cheese
• Cream
• Curds
• Custard
• Ghee
• Half-and-half
• Lactalbumin, lactalbumin phosphate
• Lactic acid starter culture
• Lactoferrin
• Lactoglobulin
• Lactose
• Lactulose
• Milk (in all forms including condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, low-fat, malted, milkfat, non-fat, powder, protein, skimmed, solids, whole)
• Milk protein hydrolysate
• Pudding
• Recaldent®
• Rennet casein
• Simplesse®
• Sour cream, sour cream solids
• Sour milk solids
• Tagatose
• Whey (in all forms)
• Whey protein hydrolysate
• Yogurt

Other Possible Sources of Milk:

• Artificial butter flavor
• Baked goods and desserts
• Breakfast foods (e.g. cereals, pancakes, waffles)
• Caramel candies
• Chocolate
• Lactic acid starter culture and other bacterial cultures
• Luncheon meat, hot dogs and sausages, which may use the milk protein casein as a binder. Also, deli meat slicers are often used for both meat and cheese products, leading to cross-contact.
• Margarine
• Nisin
• Non-dairy products, as many contain casein
• Nougat
• Pantry Staples (e.g. breads, pasta, tortillas)
• Shellfish is sometimes dipped in milk to reduce the fishy odor. Ask questions when buying shellfish.
• Sherbert
• Snack foods (e.g. chips, crackers, pretzels)
• Tuna fish, as some brands contain casein
• Some specialty beverages (e.g. smoothies, lattes) made with milk substitutes (i.e., soy-, nut- or rice-based dairy products) are manufactured on equipment shared with milk.
• Many restaurants put butter on grilled steaks to add extra flavor. You can’t see the butter after it melts.
• Some medications (e.g., psyllium, Advair diskus, Flovent diskus, some probiotics) contain milk protein.

Allergens are not always present in these food and products, but milk protein can appear in surprising places. Again, read food labels and ask questions if you’re ever unsure about an item’s ingredients.

Milk in Kosher Foods

Kosher Dairy: A “D” or the word “dairy” following the circled K or U on a product label means the product contains or is contaminated with milk protein. Avoid these products if you have a milk allergy.

Kosher Pareve: A food product labeled “pareve” is considered milk-free under kosher dietary law. However, a product may be considered pareve even if it contains a very small amount of milk protein—possibly enough to cause an allergic reaction in certain people. Do not assume that these products will always be safe. 

Do These Ingredients Contain Milk?

People allergic to milk often have questions about the following ingredients. These ingredients do not contain milk protein and are safe to eat.

• Calcium lactate
• Calcium stearoyl lactylate
• Cocoa butter
• Cream of tartar
• Lactic acid (however, lactic acid starter culture may contain milk)
• Oleoresin
• Sodium lactate
• Sodium stearoyl lactylate

Is the use of non-animal casein or whey ingredients in products safe for those with milk allergy? What are the labeling requirements?

Products with man-made casein or whey ingredients are not safe for individuals with milk allergy as they still contain milk protein.  

The Food Allergy Labeling Consumer Protection Act (FALCPA) requires plain-English labeling of casein and whey as “milk,” regardless of whether extracted from cow’s milk or man-made, either in the ingredient list or with a “Contains: Milk” statement immediately following the list of ingredients.

Most children, up to 75%, eventually outgrow a milk allergy.⁵ The allergy is most likely to continue in children who have high levels of cow’s milk antibodies in their blood.

Blood tests that measure these antibodies can help your allergist determine whether or not a child is likely to outgrow a milk allergy.

Ingestion of baked forms of cow milk may help lead to tolerance or resolution of the allergy with time. Be sure to speak to your practitioner about a formal baked milk challenge before trialing at home.