I think that I (or my child) may have a milk allergy – what do I need to do?

Michelle Berriedale-Johnson explains in the video and in the article below in which you will find all the links that she refers to.


The three types of milk allergy/intolerance, and how to get diagnosed
What do you need to do after diagnosis?
Foods to Avoid
Special advice if you or your child have an IgE mediated allergy
Who do I need to tell?
What do I tell my child?
What do I do if I, or my child, accidentally eats something containing cow’s milk?
Why has this happened?
Is there any cure or will you or your child grow out of a cow’s milk allergy or intolerance?

BBQ 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.

The three types of milk allergy/intolerance, and how to get diagnosed:

  • Severe allergy to cow’s milk and other animal milk
  • Cow’s milk intolerance
  • Lactose intolerance


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:

  • Vomiting
  • Diarrhoea
  • Breathing difficulties
  • Skin reactions or swelling

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.

The proteins to which you are allergic are not changed by cooking or by pasteurization, so if you are truly allergic to cow’s milk you will still be allergic to cooked and to unpasteurised cow’s milk—and you will also be allergic to A2 milk.

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:

  • Colic
  • Eczema or other skin reactions
  • Abdominal pain
  • Constipation
  • Breathing difficulties
  • General failure to thrive

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.
Brands include

  • Nutramingen (hydrolysed formula based on casein)
  • Pepti (hydrolysed formula based on whey)
  • Neocate (amino acid 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:

  • Abdominal pain
  • Flatulence
  • Bloated Stomach
  • Nausea (not necessarily vomiting)

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:

  • Remove all milk products from the diet.
  • Buy lactose-reduced or lactose-free dairy products. In the UK Arla Foods sell a range of Lactofree milks, butters and cheeses.
  • Use a lactase enzyme supplement. These will not always work if the lactose intolerance is severe but are certainly worth trying. (You can buy lactase supplement here in the UK and here in the US.)


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?

  • Whichever of the above conditions you are diagnosed with the management of the condition is basically the same – avoidance.
  • If you or your child have been diagnosed with an IgE mediated allergy, then you must avoid all milk and milk products. (If you have been diagnosed with cow’s milk-intolerance or lactose-intolerance, the more you avoid these products, the sooner you will see results).
  • Whether you are seriously allergic to milk, or lactose-intolerant, or cow’s milk-intolerant, you need to go through your kitchen and your house and get rid of any products that include cow’s milk or any other animal milks (unless you have already established that you or your child can tolerate goat’s or sheep’s milk).
  • Depending on the size, age and shape of your family you may decide that some members of the family should continue to use cow’s milk products but, it is very much safer not to have them in the house at all.
  • Moreover, there are now so many good alternative milks (soya, coconut, oat, rice, almond, hazelnut etc.) that it is far less of a penance to give up cow’s milk than it used to be. Some of these are also fortified so are good for growing children.


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:

  • Buttermilk
  • Butter
  • Cheese including cottage and curd
  • Cream, Crème fraiche
  • Fromage Frais
  • Ghee
  • Ice cream

Ingredients which are derived from cow’s milk:

  • Whey
  • Casein
  • Lactose


Special advice if you or your child have an IgE mediated allergy:

  • Make sure that you get as much guidance from your doctor or allergist as you can and either download a 'care plan' or ask your allergist for one. (You can download one from the BSACI site here.) The plan contains instructions on what to do if someone is suffering from anaphylaxis and has been designed to be used by people with no medical training. You can pass this care plan on to people who may need it in an emergency (e.g. your employer, close friends).
  • You will be prescribed an adrenaline/epinephrine Auto-injector pen (Epipen, Jext, Emerade) but you need to be sure that you know how to use it. You can get ‘trainer pens’ from all the suppliers. It is very important that you practice and know what to do. In the unlikely event that someone does have a serious reaction, it will be much easier not to panic and to use the pen properly if you have already practiced with the trainer pen. You should be prescribed two pens; it’s vital to keep them both with you at all times.
  • Depending on the age of your child, they should also practice with the pen, even if they do not use it themselves, so that they know what should happen.
  • Make sure that you or your child always carry their auto-injector pen at all times.
  • Join the Anaphylaxis Campaign in the UK, FARE in the US, and/or a local support group. The Anaphylaxis Campaign has an excellent helpline and both have lots of local support groups.


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.


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:
If your child has a serious allergy then, as in the nursery you need to know that they know how to use an auto-injector, are prepared to do so if needed and that they have a proper emergency procedure.
You also need to know how the school will deal with your child’s injector pen when he/she is at school. What happens when they play sport or go on an outing? Does the school have a generic pen and who amongst the staff may have been trained, or be prepared, to use it?

Ask about the school’s policy on bullying as food allergy can be an excuse for bullies to pick on their victims.

  • Get the school involved:
    Once you have learnt more about milk allergy (see below) encourage the school to involve the other children in the management of your child’s allergy.
  • There is a brilliant free school video pack created by Allergy Adventures which will teach not only the children but the teachers about the management of food allergy in a really fun and exciting way—all tied into curriculum subjects.
  • Karen Waggott, whose son Jamie has a severe nut allergy, has put together an excellent management plan for schools. For the background to the plan click here; for a summary of the plan, click here; for the full plan click here.
  • For another mum, Nathalie’s way to prepare her son’s school, see here.
  • For more suggestions on how to manage allergy at school see here.

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:
They need to know that if they eat something and then ‘feel funny’ – tickly throat or lips, short of breath – they must tell an adult immediately.

Whatever kind of allergy/intolerance they have:
They need to know that they must not eat any milk products and that, unless they know the person offering them food very well (parents or close family members), they should always ask if the food contains any milk before they eat it.

Once they go to school:

If they have an IgE mediated allergy:

  • They need to know that if they eat something and then ‘feel funny’ – tickly throat or lips, short of breath – they must tell an adult immediately.
  • They need to know that they must always carry their Epipen/adrenaline auto-injector or know who has got it and where to find it. (Some schools may prefer it to be kept in a safe place rather than the child keeping it on them as it could get lost or damaged.)

Whatever kind of allergy/intolerance they have:

  • They need to know that they should never swap foods with their friends or eat anything that their friends offer them.
  • They should learn to recognise the word ‘milk’ even if they cannot read so that they can check foods themselves wherever they are before they eat it.
    If they are not sure about a food they should always ask an adult to check it for them.
    If they are worried about a food they should never eat it.
  • They need to know that they never need to be ashamed of their allergy. Lots of other children have problems with foods—coeliac children cannot eat any bread or cakes, for example, and diabetic children need to inject themselves. So while having a food allergy or intolerance is serious and they must be careful, it in no way stops them having a fun and exciting life.


You cannot ‘tell’ teenagers anything very much, but you can ’encourage’ them….  so:

  • If they have a serious allergy, encourage them to get involved with a support group such as the Anaphylaxis Campaign or FARE.
  • Encourage them to learn and read up about their allergy.
  • Encourage them to tell their friends and explain to them what having a milk allergy means.
  • Encourage them always to carry their adrenaline auto-injector. (See #Take the kit)
  • Encourage them to learn to, and enjoy, cooking – the safest way for them to eat!
  • Encourage them to be firm and assertive when they go out. By law any eaterie has to be able to tell their customers whether any of the 14 major allergens are in their food and milk and milk products is one of the 14. So, they have a right to know. (See the Freefrom Eating Out Awards for award winning allergen-aware eateries and CanIEatThere? for listed ‘freefrom’ eateries all round the UK.)
  • Remind them that while no one wants to stop them having a good time, drinking too much and experimenting with drugs can impair one’s judgement and make one take silly risks. This is where good friends who are aware of your allergy can be very useful.


What do I do if I, or my child, accidentally eats something containing cow’s milk?

  • If you have a serious allergy:
    If you or your child has a serious allergy and you think that you have eaten milk, watch very carefully and at the least sign of a reaction (feeling sick, tingly mouth, difficulty in breathing, wheezing or anything else out of the ordinary) call 999 and tell them that you think someone is suffering from an anaphylactic (“ana-fill-ack-tick”) reaction.
  • Be very clear when you give instructions to the emergency services how to find you. Getting lost wastes crucial time. Always provide them with a postcode or zip code to key into their SATNAV and have someone ready at the door to take them to where the person is.
  • If you have an adrenaline auto-injector (Epinen, Emerade etc) then use it, being careful to read the instructions carefully. (The pens are very easy to use but it really pays off to have ‘trained’ with a trainer pen as using it is then so much less scary.) Even if the reaction is not a bad one, you will not do any harm in using the pen; it is perfectly safe to inject adrenaline/epinephrine even if you do not need it.
  • Even if you have used the pen and you/your child feels better, always go with the ambulance as sometimes you can get a delayed reaction.

If you or your child has a cow’s milk or lactose-intolerance:
If you, or your child, eats something containing cow’s milk (when cow’s milk or lactose-intolerant) then there is very little you can do – except possibly take a lactase enzyme if you are lactose intolerant.

You will just have to live through the symptoms or reaction.


What else can I do to keep myself or my child safe?

  • If you or your child have a serious allergy and are asthmatic, make sure that your asthma is well controlled. Asthma and serious allergy are closely linked and it is thought that many of the deaths apparently from asthma might in fact have been allergic reactions. Keeping your asthma well under control greatly reduces the risks.
  • If you don’t already know how, learn to cook and teach your child to cook! The safest – and the healthiest – way for an allergic or intolerant person to eat is to cook for themselves!
  • We have over 800 recipes in our freefrom recipes section, all of which are free from cow’s milk and most from all animal milks. They are coded for what they are free from.
  • We also have huge directories of freefrom foods  available in the UK – and you can check out our FreeFrom Food Awards site for award-winning milk-free products.
  • Learn more about cow’s milk allergy: on the FoodsMatter site we have hundreds of articles and research reports about cow’s milk allergy and intolerance and lactose intolerance.

Follow the links below to find:

Why has this happened?

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.

  • Some blame the overuse of antibiotics which has drastically upset the balance of the bacterial population of our guts.
  • Some blame food processing, junk food and the use of food additives.
  • Some blame monocultures and industrial farming which has starved the soil of nutrients.
  • Some blame excessive hygiene which has meant that the immune system has become confused.
  • Some blame the huge growth in the use of chemicals in the home and our personal care products.
  • Some blame too many vaccinations, too young.
  • Some blame the fact that we have eliminated parasites from our systems (see the helminthic section on our website).
  • Some blame the massive growth in the amount of man-made electromagnetic radiation to which we subject ourselves.

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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