Print Print this Page

Milk Allergy Avoidance

The Asthma Center, Allergic Disease Associates, P.C.
Professional Arts Building
205 North Broad Street, Ste 300
Philadelphia, PA 19107

215-569-1111
http://www.asthmacenter.com/

There is no current cure for milk allergies. Therefore, the only way to avoid symptoms of a milk allergic reaction is to practice strict dietary avoidance. Because sensitive individuals have reacted to very minute fractions of milk, avoidance requires a thorough knowledge of food labels to avoid eating ordinarily obscure or hidden milk proteins. In general, milk sensitive individuals should avoid eating or drinking a food unless they are absolutely sure of the ingredients in the product. These individuals should avoid products that do not provide an ingredient list. Milk-restricted diets are challenging and also pose a significant nutritional risk, particularly in young children. Milk-restricted diets may have the potential of producing diets that are deficient in calcium, vitamin A, vitamin D, riboflavin, pantothenic acid, phosphorus, protein and calories. Milk substitutes, such as soy, rice, and potato “milks” offer levels of calcium, vitamin A, and vitamin D similar to those found in cow’s milk. Other sources of calcium include calcium fortified fruit juices, drinks, and cereal products.

Recommendations for calcium intake were recently separated into dietary reference intakes (DRIs) by the US government. For children: 500mg/day in children 1-3; 800mg/day in children 4-8; 1300 mg/day in children 9-18; 1300 mg/day in pregnant or lactating teens. Recommendations for adults have also changed and the following intakes are recommended: 1000-1200 mg/day for women ages 19-30; 1200 mg/day for pregnant or lactating women ages 19-50; 1000 mg/day for men 19-50 and women 19-50 years; 1200 mg/day for women and men over 50 years of age. Milk substitutes typically offer levels similar to 2% milk but are poor sources of protein. A registered dietician may be helpful in providing additional adequate nutritional and dietary analysis. In addition, software is available online from the Food and Nutrition Information Center www.nal.usda.gov/fnic for diet analysis as well. Individual intake can be evaluated for nutritional deficiencies and an individualized plan developed to optimize intake of nutrients into the milk-free diet.

Hidden Sources of Milk Allergens
Milk and milk proteins are often used as food stabilizers and flavorings. As a food additive, milk proteins are allowed to be labeled as non-dairy or to be concealed under the generic term of natural flavoring. Examples include coffee whiteners, imitation cheese, butter flavoring and frozen desserts. Other hidden sources of milk listed as natural flavoring may be found in canned tuna fish, commercial breads, pancakes, cereals, fruit snacks, reduced fat lunch meats, sausages, cheese-milk mixes, salad dressings and baby foods. It is recommended that boxed fruit juices also be avoided in milk-sensitive individuals because of the potential cross-contamination of milk-containing beverages packaged on the same equipment. The possibility of allergic reaction to milk through kissing has also been reported and is usually not thought of by people with milk allergies. Teenagers and young adults may be particularly at risk during dating to this hidden contact source. Individuals of any age, though, should be aware of this vulnerability. Pet food may also contain protein from milk. For children and adults extremely sensitive to milk, even trace amounts of milk exposure from saliva may cause a reaction.

Ingredient Terms that Indicate or May Indicate the Presence of Milk
The following is a partial list of terms commonly used on food labels to indicate the presence of milk. Individuals with milk allergy should avoid all foods containing these ingredients. The list should be distributed to any caregivers, relatives, or food service workers who will be providing food to the milk-allergic individual.

Ingredients that INDICATE the Presence of Milk

  • Artificial butter flavor
  • Butter, butter fat, butter oil
  • Buttermilk
  • Casein
  • Caseinates (listed as ammonium, magnesium, potassium or sodium caseinate)
  • Cheese Cottage
  • Cheese
  • Cream
  • Curds
  • Ghee
  • Half and Half
  • Hydrolysates (listed as casein, milk protein, whey, or whey protein hydrolysate)
  • Lactalbumin, lactalbumin phosphate
  • Lactoglobulin
  • Lactose
  • Milk (derivative, powder, protein, solids, malted, condensed, evaporated, dry, whole, low-fat, skimmed, and goat’s milk)
  • Nougat
  • Pudding
  • Rennet cassein
  • Sour Cream, sour cream solids
  • Whey (in all forms, including sweet, delactosed, and protein concentrate)
  • Yogurt

Ingredients that MAY indicate the Presence of Milk

  • Flavorings (including caramel, Bavarian cream, coconut cream, brown sugar, butter, and natural flavorings)
  • Chocolate
  • Luncheon Meats, hot dogs, sausages
  • High Protein flour
  • Margarine
  • Simplesse (The NutraSweet Company, Chicago, IL)

Helpful Kosher Symbols
Kosher symbols can also help identify unsafe foods for milk-allergic patients. Products identified as kosher have a symbol stated as “Kosher,” “U” or “K.” “Parve” is a kosher term and label that indicate the food does not have milk or milk proteins in it and can be safely used in milk allergic individuals. A “DE” indicates that the product is manufactured on equipment that is also used to manufacture dairy-containing foods. Neither of these foods is recommended for milk allergic patients.

The Food Allergy and Anaphylaxis Network
The Food Allergy and Anaphylaxis Network (FAAN) is a very helpful lay organization based in Fairfax, Virginia that also publishes a number of resources for individuals with food allergies including a bi-monthly newsletter called Food Allergy News. Milk-free diets, recipes, cookbooks and videos are also available. FAAN also provides to members a convenient, laminated wallet-sized chart that delineates how to read a food label for a milk-free diet. Their phone number is 1-800-929-4040, and their website is http://www.foodallergy.org

What Consumers Can do to Help Identify Allergens
If a consumer finds that a product causes a reaction, besides discussing it with your physician at the Asthma Center, please notify the manufacturer and notify the local FDA consumer complaint coordinator (The following provides a list of phone numbers in the US)
http://www.fda.gov/opacom/backgrounders/complain.html

In addition, consumers should continue to provide input about concerns and suggestions for allergen labeling issues by emailing comments to: fdadockets@oc.fda.gov and noting Docket OOP-1322.

Printed with permission from The Asthma Center, copyright 2008