Cow's Milk Allergy
Cow's milk is one of the most common cause of food allergies in children. Overall, it appears that the majority of
people with cow's milk allergy will outgrow their food allergy, but it can take many years. According to a study
published in 2007 in the Journal of Allergy and Clinical Immunology, milk allergy resolved in 19% of children at
age 4, in 42% by 8 years of age, in 64% by age 12, and in 79% by 16 years of age. It is thus important to re-
appraise food allergies periodically with a board certified allergist to safely determine if the allergy has gone away.
Lactose intolerance is not due to an allergy to cow's milk, but results from difficulties in digesting milk proteins.
Soy milk and Rice milk are usually well tolerated in cow's milk allergic individuals. The majority (90%) of cow's
milk allergic individuals will also have an allergy to goat's milk.
90% of infants with cow's milk allergy will tolerate specially formulated cow's milk formula that are "extensively
hydrolysed". This means that the milk particles are broken down into small pieces that the body may not recognize
as cow's milk. Extensively hydrolyzed formulas include Pregestimil, Nutramigen and Alimentum.
If extensively hydrolyzed formulas are not tolerated, you can use "elemental amino acid" formulas, where the cow's
milk proteins are broken into even smaller particles. Elemental formulas include Neocate and EleCare.They are
usually very well tolerated, but are very expensive.
For baking: You can substitute cow's milk with water, soy milk, rice milk, or almond milk. You can substitute butter
with milk free margarine, vegetable shortening, or soy butter.
Cow's Milk Avoidance
Avoid foods that contain:
- Artificial butter flavor
- Butter fat
- Butter oil
- Condensed milk
- Cottage cheese
- Goat’s milk
- Half and Half
- Milk (whole, low fat, non-fat, skimmed)
- Milk derivative
- Milk powder
- Milk protein
- Rennet Casein
- Sour cream
- Sour cream solid
- Sour milk
These foods may contain cow's milk:
- Bavarian cream
- Brown sugar
- Caramel flavoring
- Caned tuna
- Coconut cream
- Cream sauce
- Cream soup
- High protein flour
- High protein powder
- Ice cream
- Instant mashed potatoes
- Luncheon meat, hot dogs, sausages
- Packet soups
- Whipped cream
Watch out for contamination from:
- Deli meat slicers used for both meat and cheeses
- Pareve labeled foods. Food products labeled as pareve may, under Jewish law, contain trace amounts of
cow's milk. There are at least 3 case reports of children with cow's milk allergy who developed allergic
reactions after eating pareve labeled foods.
Cow's milk substitutes:
Each option below equals 1 cup of cow's milk:
- 1 cup of soy milk
- 1 cup of rice milk + 1 egg yolk
- 1 cup of water + 1 egg yolk
- 1 cup of coconut milk
- 1 cup of fruit juice
Each of the following equals 1 stick (8 tablespoons) of butter:
- 8 tablespoons (1 stick) of Fleischmann's unsalted margarine
- 8 tablespoons of vegetable or olive oil
- 6 tablespoons of unsweetened apple sauce + 2 tablespoons of one of these: olive oil, vegetable oil,
fleischmann's unsalted margarine
Make sure to check out the coping with food allergies page for school and traveling tips, and useful links including
sites that sell allergy safe foods, medic alert bracelets. There's even a link to a website that will translate food allergy
words in just about any language you can imagine!
Skripak JM et al. The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol 2007;120:
updated 6 Jan 2009
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