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The three types of milk allergy/intolerance, and how to get diagnosed
The three types of milk allergy/intolerance, and how to get diagnosed:
1. Cow’s milk (and other animal milk) allergy – a severe and immediate reaction This is a serious allergy (you will often hear it referred to as IgE mediated) in which your immune system (or your child’s) sees the proteins in cow’s milk as ‘evil’ or toxic. It therefore ‘goes into battle’ to expel what it sees as a toxin from the body. Typical Symptoms:
The reaction will happen very quickly, usually within seconds, or at most minutes, of eating the allergen. Your immune system may release lots of histamine, which will cause the soft tissues in your face, mouth and throat to swell up. This is particularly relevant if you are also asthmatic. For severe allergies like this, you will be prescribed an adrenaline auto-injector device (also called ‘adrenaline pens’ or known by various brand names like Emerade, Epipen or Jext). These allow you to inject yourself with adrenaline; this will bring your blood pressure back to normal and reduce the swelling. It is possible to be allergic to only to cow’s milk and not to any other animal milk but because the proteins in cow’s, goat’s and sheep milk are very similar, this is very unlikely. You or your child can have skin prick and blood tests which will establish whether or not you are likely to have this kind of allergy. Your GP will either perform them him/herself or refer you on to an allergy clinic/allergist. Remember: If you or your child are cow’s milk allergic you must rigorously avoid all milk and milk products. If your child is an infant and you are not breastfeeding you should talk to your healthcare professional about amino acid based formula feeds, such as Neocate.
2. Cow’s milk intolerance This is very much more common than the ‘true’ allergy described above. It does not activate the immune system so is never fatal, but it can make you or your child very ill. An intolerance like this is also described as “non-IgE mediated”; whereas severe allergies are IgE-mediated. The reaction will not be as quick as with a cow’s milk allergy and may sometimes take hours or even days for you or your child to experience symptoms. It is thought that at least 2.5% of small children may suffer from cow’s milk intolerance but it is very under-diagnosed. An Allergy UK survey in 2015 found that it took an average of eight visits to the GP and 17 weeks to get a diagnosis. Typical Symptoms:
If your baby or small child suffers from any combination of these, you should certainly suspect a cow’s milk intolerance and talk to your doctor. Skin prick tests are not good at diagnosing the presence or absence of cow’s milk intolerance so, if they prove negative and you still think you or your child are intolerant you need to do a ‘challenge test’. This involves taking all milk products out of the diet for two weeks and seeing if symptoms improve. If they do, then you need to re-introduce cow’s milk products and, if symptoms recur within one to two days, you know that you or your child are cow’s milk intolerant. However, children or adults who suffer from cow’s milk intolerance may be able to tolerate goat or sheep milk and, occasionally, A2 milk. Babies with cow’s milk intolerance can be prescribed hydrolysed cow’s milk formula—in which the proteins have been broken down to be more digestible—or goat’s milk formula.
Your baby’s healthcare professional will be able to advise on which type of formula will be most suitable.
3. Lactose intolerance What are the symptoms of lactose intolerance? Typical Symptoms:
These symptoms usually develop within a few hours of consuming food or drink that contains lactose (lactose is the sugar that is to be found in all animal milks, including human milk). We need an enzyme called lactase in order to digest this lactose sugar. Babies normally make this enzyme but because all animals except humans stop drinking milk once they are weaned, most also stop producing lactase once they are weaned. But because the human body is enormously flexible, if humans continue to drink milk, their bodies will often, but not always, continue to produce at least some lactase. But they may not produce enough to allow them to digest all of the lactose that they eat if they eat a lot of milk based products. This does not usually apply to babies as they are, obviously, programmed to drink milk and therefore to produce lactase. However, if the baby has a stomach upset or diarrhoea, the lactase may be washed out of their system and they may become temporarily lactose intolerant. Lactose intolerance is relatively easy to diagnose with a breath test so ask your doctor about this. If the intolerance is only temporary, then removing milk products from the diet for a day or two will be enough to allow the lactase to re-establish itself in the child’s system. Your child will then be able to eat and drink milk products as before. If it is permanent, then you will need to:
Whatever sort of cow’s milk sensitivity you think you have, you need to visit your doctor or physician and discuss it with him or her. However, remember that certainly in the UK, a diagnosis of cow’s milk intolerance can be hard to get so be prepared for them not, initially at least, to be that sympathetic to your case.
What do you need to do after diagnosis?
Foods to Avoid Always read the ingredients list before buying anything! It is now much easier in the UK and Europe to recognize cow’s milk in a packaged food as, in the ingredients list, ‘milk’ will be highlighted in bold. Similarly, if you’re eating in a café or restaurant, don’t forget to tell your server of your dietary needs and check with them what ingredients are in whatever you order. Remember that foods made from or containing cow’s milk include:
Ingredients which are derived from cow’s milk:
Special advice if you or your child have an IgE mediated allergy:
Who do I need to tell? The family and other close friends Tell everyone in the family—and not just your immediate family but grandparents, uncles, aunts and cousins—especially if there are lots of children. You do not want to cause panic but you do need everyone to know that the condition is serious and that they must be vigilant (especially if the child is small) and ensure that the child does not come into contact with any milk-containing foods. It may be helpful to recommend specific snacks and foods that grandparents can have in stock for your child. You may like to remind family around times like Easter, that your child will need dairy-free treats. Tell any close friends, and their children, with whom you or your child may spend time. Child-minders or nurseries It is very important that you talk to the nursery or child-minder if your child goes to either. Child-minders may not be prepared to accept the responsibility of seriously allergic child but nurseries should be able manage the situation. A care plan will be of great help but you still need to discuss the child’s needs in detail with them. You also need to know that they know how to use an auto-injector and are prepared to do so if needed—and that they have a proper emergency procedure. Schools Make sure that you talk to the school about your child’s allergy and, if there is a school nurse, that you talk to him/her. Again, a pre-existing care plan will be very helpful. Auto-injector pens: Bullying:
Other care-givers If you ever leave your child in the care of another organisation (e.g. a piano teacher, a Scout pack or Sunday School), it’s also vital that they know your child’s allergy needs, and that they know what to do in the event of an emergency. Your and your children’s friends Your friends and your children’s friends are the best guardians of your safety. Without making a big deal of it, try to make sure that your children tell their friends about their allergy and the importance, if they have been prescribed one, of always having their auto-injector with them. If your children are small you must also make sure that their friends’ parents know about your child’s allergy. It is important that while your children remain safe they can, as far as is possible, they lead a ‘normal’ life—which includes visiting friends’ houses. Telling their friends becomes even more important if they are teenagers. Check here for the Anaphylaxis Campaign’s hugely successful video on this very subject and check into the AC’s site and into this section of the FM site for more help on managing serious allergy for teenagers and students. Very important: for those with a serious allergy. Make sure that everyone has your phone number and knows that, if they think you or your child might be having a serious reaction, they should always call 999 and tell the operator that someone is suffering from anaphylaxis (pronounced ana-fill-axis). The emergency services would much rather be called out unnecessarily than get there too late! N.B. Although, unlike cow’s milk allergy, cow’s milk and lactose intolerance are not potentially fatal, they can still be very serious and you or your child will do much better if you are rigorous in your exclusion of cow’s milk from your diet.
What do I tell my child? This will depend very much on the age of the child. If very young: If they have an IgE mediated allergy: Whatever kind of allergy/intolerance they have: Once they go to school: If they have an IgE mediated allergy:
Whatever kind of allergy/intolerance they have:
Teenagers: You cannot ‘tell’ teenagers anything very much, but you can ’encourage’ them…. so:
What do I do if I, or my child, accidentally eats something containing cow’s milk?
If you or your child has a cow’s milk or lactose-intolerance: You will just have to live through the symptoms or reaction.
What else can I do to keep myself or my child safe?
Follow the links below to find:
No one really knows what has caused the massive rise in the incidence food allergy and intolerance over the last 50 years. But there are many theories.
If you would like to investigate some of these theories for yourself we have a whole section of the FoodsMatter site devoted to possible causes of food allergy.
Is there any cure or will you or your child grow out of a cow’s milk allergy or intolerance? If your baby is cow’s milk allergic or intolerant there is a good chance that they will grow out of it. Experts suggest that while approximately 80% of cow’s milk sensitive babies are still sensitive aged two, by the time they are 16-years-old that percentage has dropped to around 20%. However, your child is much more likely to grow out of their cow’s milk sensitivity if it is treated in infancy. If not treated, the child may go on to develop other food allergies as they grow. This is known as the ‘allergic march’. For those who do not grow out of their allergy, some interesting work has been going on in research laboratories in both the UK and USA on desensitisation or immunotherapy. In immunotherapy you give an allergy sufferer a tiny amount of their allergen and gradually increase the dose thus ‘educating’ their immune system not to see it as an enemy. NB. Never try this at home! It can be very dangerous, and is normally conducted at hospitals where resuscitation equipment is available. For more on immunotherapy see Linda Gamlin's article here. Although desensitisation may never allow cow’s milk allergy sufferers to drink milk freely, it would hopefully reduce their sensitivity to the point that they would be able to tolerate traces of cow’s milk in other foods without ill effect – allowing for a massive improvement in their general quality of life. This treatment is not yet widely available but may well become so over the next five years. For lots more really useful information, see the cow’s milk allergy, management of cow’s milk allergy and lactose intolerance sections of the FoodsMatter site. Those with serious allergies should also check in to the Anaphylaxis Campaign site in the UK, the FARE site in the US or Allergy & Anaphylaxis Australia in Australia or New Zealand.
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The first thing that you need to do is to establish exactly what you or your child are suffering from as there are at least three ways in which you can react adversely to milk products. You also need to know whether you or your child is reacting to all animal milks or just to cow’s milk.
