Milk allergy

Symptoms caused by milk allergy can vary, so it is important that you see a health professional for a diagnosis. This fact sheet will help you to follow a healthy, balanced milk-free diet.

In this fact sheet:


You may need to avoid cow’s milk and food made with cow’s milk because you can’t tolerate the cow’s milk proteins or because you are intolerant to lactose (the sugar in milk), or both. If you are avoiding cow’s milk, you should also avoid other animal milks/products such as goat, sheep and buffalo.

It is important that you understand how strict your cow’s milk avoidance needs to be. Some people can only tolerate a small amount of fresh cow’s milk, others only cooked or processed cow’s milk, and some react to tiny amounts of cow’s milk in foods. Speak to your dietitian for further advice.

Always check the label

It is easy to identify the obvious cow’s milk products such as milk, cheese or yoghurt, but cow’s milk is often added to prepared manufactured foods. It is therefore important to always read food ingredient labels carefully.

EU food labelling laws require that labels must clearly state whether cow’s milk (as well as other common allergens) are ingredients in a food product. These laws apply to all packaged and manufactured foods and drinks sold throughout the EU, foods sold loose (e.g. from a bakery, butcher or café) and food packed for direct sale (e.g. sandwich bars, market stall). If you travel outside the EU, be aware that labelling laws are different and may not always list milk, so check ingredients carefully.

Allergens must be emphasised (e.g. in bold or highlighted) and listed in one place; usually the ingredients label. ‘May contain’ statements are often used on food packaging to state that a food may be contaminated with one of the common allergens including cow’s milk. There is no law about using these statements. It is important to discuss with your dietitian the safest approach to these foods.

Example_food_label_containing_cows_milk

Check labels for these ingredients

buttermilk casein (curds), caseinates
cows milk (fresh, UHT) calcium or sodium caseinate
condensed milk hydrolysed casein
cream/artificial cream hydrolysed whey protein
evaporated milk lactoglobulin
butter, butter oil lactoalbumin
ghee lactose*
margarine milk powder, skimmed milk powder
cheese milk protein
fromage frais milk sugar
ice-cream milk solids, non -fat milk solids
yoghurt modified milk
whey, whey solids, hydrolysed whey

*Lactose - you will need to discuss with your Dietitian to what
extent you need to avoid lactose

Food Maestro and Spoon Guru apps are free from product finders and bar code scanners, to help you identify which foods are safe to eat and make your diet more interesting and nutritious. You can filter products by ingredients you want to avoid, find products you want to include, discover allergen information about each food, create personal shopping lists and access suitable recipes.

Choose milk free milk and yogurt alternatives that are fortified with calcium. Most contain as much calcium as you would find in cow’s milk (120mg per 100mls).

For young children, choose milks with higher fat and protein content such as junior soya milks and higher fat oat milk. Try to find milk free versions of the products they were having before to maintain their energy, protein and calcium intakes.

Alternative milk free foods

  • Milks - oat, soya, flaxseed, sesame, rice**, pea, coconut, quinoa, hemp, potato and nut* (e.g. almond, hazelnut, cashew)
  • Spreads - milk free and vegan spreads
  • Cheese - hard, soft, melting and parmesan varieties of milk free cheeses based on soya, pea, cashew, almond, rice or coconut
  • Yoghurts and desserts - soya, pea, coconut, oat, almond*
  • Ice creams and frozen desserts - soya, rice, coconut, almond* and cashew*
  • Creams/ crème fraiche - soya, oat, rice, coconut and almond*

* Avoid nut-based milk alternatives if you have/are at risk of a nut allergy
** Rice milk should not be used in children under 4.5 years, due to potential inorganic arsenic content

Lactose intolerance

Lactose intolerance is often confused with milk allergy. It happens when the sugar in milk (called lactose) cannot be digested. If you are lactose intolerant, lactose free milk, cheese, ice cream and yoghurt products are available from supermarkets, health food shops and online. These have all the nutritional benefits of cow’s milk, but just without the lactose. Some cheeses are naturally low in lactose so are often suitable e.g. Edam, Cheddar, cream cheese.

Please note: these products are not suitable for cow’s milk allergy because the protein content is unchanged.

Vitamins and minerals

Choose alternatives to milk, yoghurt and custard that are fortified with calcium. Many now contain as much calcium as you would find in cow’s milk (120mg per 100mls). Try to have around three portions a day. You may need to take a calcium supplement to meet your calcium requirements. Your dietitian can advise you further on this.

Recommendations have changed to suggest that everyone would benefit from having 10mcg vitamin D daily, including breast fed babies and infants who are not managing a pint of formula (600ml) a day. Try to have foods rich in iodine such as fish and eggs.

A few milk substitutes (junior soya milk and certain oat milks) contain iodine as well as calcium. Your dietitian can advise you further on this.

See the BDA Food Fact Sheets on these topics for more information: Calcium, iodine, vitamin D, milk allergy in children.

Milk free products can be substituted in recipes but here are some helpful hints

  1. Don’t add soya milk to coffee as it tends to curdle (go lumpy) but it is fine in tea.
  2. Use plain soya or coconut based yoghurts, coconut milk or oat cream/ crème friache when making curries, raita, stroganoffs, creamy sauces and dips.
  3. Egg white replacer can be used to make a dairy free and soya free whipping cream. This is available on prescription or can be ordered from any chemist.
  4. Grate hard cheeses on the fine part of the grater
  5. Use a milk free melting cheese on pizza, cheese on toast and on lasagne.
  6. Use a non-melting hard cheese to make cheese sauces. Using a microwave will stop it sticking to the bottom of the saucepan (which also works for milk free custard and porridge).
  7. Use milk free soft or spreading cheese or dairy free sour cream in dips, cheesecakes and other savoury and sweet sauces.

Summary

It is important to find out how strict your cow’s milk avoidance needs to be. Under EU law, if milk is an ingredient it must be clearly labelled, but always check as ingredients change; take extra care with loose foods without labels on them. Choose milk free alternatives that have added calcium and iodine and will help add variety and nutrition to your diet.

Further information and Useful links:

NHS Food Allergy 

Goodness Direct

Vegan

Kosher 

Download this information as a PDF

Information sources for this fact sheet.


This Food Factsheet is a public service of The British Dietetic Association (BDA) intended for information only. It is not a substitute for proper medical diagnosis or dietary advice given by a dietitian. If you need to see a dietitian, visit your GP for a referral or a private dietitian.

To check your dietitian is registered check HCPC.

Written by Tanya Wright, Dr Lisa Waddell and Liane Reeves, Dietitians on behalf of the Food Allergy Specialist Group of the BDA.

© BDA June 2018. Review date June 2018.