Milk allergy occurs when the body’s immune system responds defensively to one or more cow milk proteins, triggering an allergic reaction. In the US, it is one of the most common food allergies affecting about three percent of children under three years (1).
Children allergic to milk could experience several symptoms after ingesting milk or milk-containing foods. These symptoms usually are mild and manageable with the elimination of milk and milk products from the diet. Fortunately, most children outgrow milk allergy before they turn 16.
Parents should focus on prompt management and child guidance to manage the condition effectively. This post shares about milk allergy in children, its symptoms, diagnosis, treatment, and prevention.
What Are The Causes Of Milk Allergy In Children?
There is no exact cause of milk allergy. Genetics and environmental factors may play a role in its manifestation. Physiologically, in those with milk allergy, the body identifies milk protein as an allergen and produces IgE antibodies. These antibodies bind to allergic cells (mast cells and basophils) in the body, and release chemicals called histamines that bring symptoms of an allergic reaction (2). Each time the child consumes milk or milk products, the body displays an allergic reaction (3).
What Are The Symptoms Of Milk Allergy In Children?
Milk allergy symptoms may appear within two hours or several hours after the milk ingestion. If you suspect your child has a milk allergy, look for the following symptoms (1).
- Red itchy rashor skin hives
- Swelling around the mouth, face, or around the eyes
- Runny or blocked nose; symptoms similar to hay fever
- Vomiting, abdominal cramps, or diarrhea
- Slow and poor weight gain
- In rare cases, cow milk allergy can cause anaphylaxis. Anaphylaxis is a life-threatening immune-response that impairs breathing and leads to a state of shock.
The intensity of symptoms varies from child-to-child. Also, milk allergy symptoms often seem similar to lactose intolerance. Therefore, if your child shows any symptoms, consult a pediatrician promptly for an accurate diagnosis.
How Is Milk Allergy Diagnosed In Children?
There is no specific test that can detect cow milk allergy. Generally, the doctor will collect the family, medical, and diet history of your child along with a detailed discussion of the child’s symptoms. Based on these details, they are likely to advise the following tests (1) (4) (5).
- Elimination test: This simple test includes eliminating milk from the diet and then reintroducing it to see if it causes a reaction. If the pediatrician suspects milk allergy, they will recommend an allergist for further evaluation to confirm the diagnosis.
- Blood test: This test estimates the amount of total or specific immunoglobulin E (IgE) antibodies responsible for triggering an allergic reaction when a body is exposed to an allergen. However, this test does not help evaluate cow milk allergy with precision.
- Skin prick test: In this test, a liquid containing milk or milk protein extract is placed on the forearm or the back of the hand. The skin is then pricked with a small, sterile probe, allowing the liquid to enter the skin. The development of a raised, reddish bump, within 15 to 20 minutes indicates an allergy.
- Oral food challenge: In the test, your child will have to eat milk-based food in small but increasing quantities. If the child develops an allergy, it indicates a positive case of milk allergy. The test should only be performed in an allergist’s office with all emergency measures ready at hand due to its potential risk of causing a severe allergic reaction.
- Component test: This test can help an allergist determine the specific milk protein allergen for your child. It can help accurately determine the milk component that triggered the allergy.
Based on the diagnosis, your allergist will prescribe a treatment plan consisting of different treatment modalities.
What Is The Treatment For Milk Allergy In Children?
The treatment of milk allergy aims at managing the triggers and symptoms. If your child is diagnosed with milk allergy, the treatment will include the following.
- Remove cow’s milk and its products from your child’s diet for a while. You are likely to be referred to a pediatric nutritionist who could devise a well-balanced milk-free diet plan with healthy cow’s milk substitutes.
- Use oral antihistamines to subside mild allergic symptoms, such as swelling, hives, runny nose, and abdominal pain.
- Stay prepared with the use of epinephrine auto-injector in case of a severe allergic reaction. Train your child on how to use the device. Encourage them to carry the injections with them at all times.
Your child will undergo pediatric assessment every six to 12 months to know if they have outgrown the allergy.
What To Feed To Children With Milk Allergy?
A child on a dairy-free diet may be losing essential nutrients. However, you can offer a well-balanced dairy-free diet to mitigate the risk (6). Below are some foods that can nutritionally substitute dairy.
- Plant-based milk alternatives: A child may not be able to have milk due to milk allergy, but they can consume fortified soy milk, rice milk, oat milk or flax milk, almond or cashew milk, and coconut milk if they are not allergic to any of these foods.
- Meat, poultry, and fish: Lean meat, poultry, and fish are excellent sources of high-quality protein and micronutrients, such as calcium, vitamin A, D, B12, iron, zinc, and potassium (7). You can offer these foods to your child as a part of a well-balanced diet.
- Calcium-rich veggies and fruits: Kale, amaranth, broccoli, okra, and spinach are some calcium-rich veggies that can add color, flavor, texture, and valuable nutrients to your child’s diet (8). Similarly, rhubarb, blackberries, and kiwi fruit can be a healthy substitute for dairy products (9).
- Pulses, legumes, and nuts: These foods offer protein, healthy fats, and essential micronutrients, such as iron and zinc (7). You can feed them to your child as a part of a well-balanced diet.
- Fortified foods: Fortified foods, such as fortified cereals and health drinks, can be added to a child’s diet. You can speak to a pediatrician who can recommend a fortified cereal or health drink based on your child’s age.
Eating a well-balanced diet ensures that a child gets all the necessary nutrients in optimum amounts.
What Are The Complications Of Milk Allergy In Children?
Children with milk allergy may have a higher risk of experiencing the following complications.
- Insufficient supply of vital nutrients that can hinder the growth and development of a child. In such cases, along with a well-balanced diet, nutritional supplementation may be necessary for some time to ensure the child’s uninterrupted growth and development.
- Allergies to other foods, such as peanuts, eggs, and soy, may occur. Research shows that children with milk allergy are more likely to develop other food allergies (5). The child may also have a higher risk of developing allergies against airborne particles, such as pollen.
Poor nutrition, due to the absence of milk in the diet, can be mitigated through alternative food items. Parents of children with milk allergy should be alert to the presence of other allergies.
How To Prevent Milk Allergy In Children?
You cannot prevent milk allergy, but allergic reactions attributed to milk allergy can be prevented by avoiding milk and milk products. Below are some steps that you should educate your child to manage milk allergy effectively (6) (11) (12).
- Avoid all kinds of milk, such as whole, skim, low-fat, evaporated, condensed, and powdered milk.
- Eliminate milk products, such as clarified butter, butter, butterfat, butter oil, cream, cheese, cottage cheese, yogurt, and
- Avoid foods prepared from milk and its products, such as hot cocoa, candies, chocolates, eggnog, milkshakes, French toast, custard, ice cream, salad dressing, and pudding.
- Check food labels carefully while buying packaged foods. The “non-dairy” label on a product means it does not contain butter, cream, or milk. But the product may have other milk-containing ingredients.
- A “lactose-free” label does not mean the product is dairy-free. Such products may still contain some milk proteins. Baked goods, such as cookies, and cereal products, such as bread and pancakes, are examples of such products.
- Some processed or pre-cooked products may also contain milk as artificial butter flavors, such as margarine and non-dairy creamers. Luncheon meat, hot dog, and sausages contain milk as a meat binder.
- Avoid products containing whey protein, casein, protein hydrolysates, lactose, or milk solids in their ingredient list.
- Children allergic to cow milk may be allergic to milk of other animals (13). In such cases, the doctor may ask your child to avoid animal milk entirely.
- Some medicines, such as antibiotics, probiotics, and even vaccines, may contain casein, a milk protein. Inform your doctor about your child’s milk allergy before they write a prescription (14).
- If you use Kosher foods, avoid using foods labeled with a “D” or “DE” adjacent to Kosher symbols. It indicates that the product may contain traces of milk or is manufactured on machinery that handles milk or milk products.
Milk allergy in children can be bothersome for parents and children. However, following the proper dietary recommendations can help tackle the condition safely. Encourage your child to consume a well-balanced diet consisting of various dairy alternatives. Train them to read food labels and inquire about food ingredients at restaurants to avoid accidental intake of dairy products.
2. Milk Allergy; Food Allergy Research & Education
3. Histamine: The Stuff Allergies are Made of; Medline Plus; U.S. National Library of Medicine
4. Milk Allergies; Children’s Hospital of Philadelphia
5. Cow Milk Allergy; NCBI
6. Milk Allergy Diet; Children’s Hospital of The King’s Daughters
7. Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts; University of Massachusetts Amherst
8. Get calcium and vitamin D by growing and eating vegetables and fruit; Michigan State University
9. Calcium Content of Foods; UCSF
10. Nutrition tools; Bright Futures; AAP
11. Milk Allergy Diet; Children’s Hospital of Philadelphia
12. Milk Allergy Diet for Children; Stanford Children’s Health
13. Cow’s milk allergy; State Government of Victoria, Australia
14. Potential food allergens in medications; The Journal of Allergy and Clinical Immunology
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