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
  • Butter fat
  • Butter oil
  • Buttermilk
  • Casein
  • Caseinates
  • Cheese
  • Cream
  • Condensed milk
  • Cottage cheese
  • Curds
  • Custard
  • Ghee
  • Goat’s milk
  • Half and Half
  • Lactalbumin
  • Lactoglobulin
  • Lactose
  • Lactulose
  • Milk (whole, low fat, non-fat, skimmed)
  • Milk derivative
  • Milk powder
  • Milk protein
  • Nougat
  • Pudding
  • Rennet Casein
  • Sour cream
  • Sour cream solid
  • Sour milk
  • Whey
  • Yogurt

These foods may contain cow's  milk:

  • Bavarian cream
  • Biscuit
  • Brown sugar
  • Caramel flavoring
  • Cake
  • Caned tuna
  • Coconut cream
  • Cookies
  • Cream sauce
  • Cream soup
  • High protein flour
  • High protein powder
  • Ice cream
  • Instant mashed potatoes
  • Luncheon meat, hot dogs, sausages
  • Margarine
  • Muffins
  • Packet soups
  • Pies
  • Puddings
  • Sausages
  • Sherbet
  • 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

Butter replacement:
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;120:1172-7.

updated 6 Jan 2009
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Cow's milk allergy