Factsheet - Allergy - Milk
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Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.
How common is milk allergy?
Milk allergy is one of the most common food allergies in childhood affecting about 1-2% of preschool children. Milk allergy is much less common in school age children (less than 0.1%). It is often due to IgE allergy antibodies against milk proteins and the reactions caused by these antibodies are called immediate allergic reactions. These antibodies can be detected with an allergy test such as a skin prick test. Not all children with a positive milk allergy antibody test develop reactions on having milk or foods containing milk. If your child has a positive allergy test but has never had milk, your doctor will determine the chance of developing a reaction if there is exposure to milk, usually by doing a 'milk challenge' in hospital.
What are the symptoms of milk allergy?
The majority of immediate allergic reactions to milk are mild and consist of hives around the mouth or more generalised hives on other parts of the body. Some children may develop hives from skin contact with milk. These are usually restricted to the area of skin that came into contact with the milk and do not always mean your child will develop worse symptoms from drinking milk. Your doctor will help to sort this out. A less common symptom is abdominal pain and vomiting which occurs soon after exposure to milk. More sensitive children can develop coughing, wheezing, difficulty breathing or hoarseness of the voice due to an allergic reaction occurring in the airway. In the most severe cases collapse and loss of consciousness and can occur. Milk or milk containing foods are less likely to cause severe reactions as compared to peanut. Very rarely very sensitive individuals have died from a severe allergic reaction to milk.
Milk can also cause delayed reactions which are not due to IgE allergy antibodies. These delayed reactions can have symptoms such as worsening of eczema, diarrhoea and vomiting.
How is milk allergy diagnosed?
In most cases the clue to milk allergy is the start of symptoms soon after exposure to milk or milk containing foods. Another common clue is the occurrence of redness and hives soon after milk or containing foods such as ice cream or yoghurt touch the skin. The presence of allergy IgE antibodies to milk can be confirmed by an allergy skin prick test or a blood test (called a RAST test). It is important to realise that not every child with a positive allergy test will develop symptoms on exposure to milk and the interpretation of the test should be discussed with your doctor.
The delayed reactions can only be definitely diagnosed by a process of removal of milk containing foods from the diet and rechallenge if the symptoms resolve. Allergy skin tests and blood tests are not necessarily helpful in diagnosing these reactions. You should not challenge your child with milk unless this has been discussed with your doctor.
What about baby formula?
The most commonly used formulae are made from cows' milk proteins and will cause reactions in cows' milk sensitive children .Some formulae are made from soy and do not contain milk. There are special formulae made for milk allergic children which have been treated to break down the cows' milk to non allergy producing fragments.
How do I avoid exposing my child to milk?
Milk or milk products may be found in foods we don't always expect them to be in. It is important to use common sense and read food labels carefully. The following food labels indicate the food is made from or likely to contain milk proteins. Obtain a milk free diet sheet to help you avoid milk.
Is low fat or skim milk less likely to cause an allergic reaction?
No. The allergy producing part of the milk is in the protein not the fat part of the milk.
Is goat or sheep milk a good alternative?
No. There is a lot of overlap in the allergy causing parts of goat and sheep milk and cows' milk .Cows' milk allergic children are more likely to react to these milks than other cows milk substitutes that do not contain any animal milk protein.
Is lactose intolerance the same as milk allergy?
No. Lactose intolerance occurs because the milk sugar called lactose cannot be completely digested in the bowel. The usual symptom is diarrhoea. A formula without any lactose (eg De-Lact) used to treat lactose intolerance can still cause milk allergy.
What about foods with a label that says "may contain traces of milk"?
Some foods may carry a warning on the label "may contain traces of milk". This usually indicates that the food is made in a facility that also makes a food containing milk. Discuss what to do about these foods with your doctor.
Can my child grow out of milk allergy?
Most infants and young children will grow out of their milk allergy. Children with the delayed reactions are more likely to outgrow their milk allergy at an earlier age than children with milk allergy due to IgE allergy antibodies. Approximately 90% of children with delayed and 50% with immediate reactions will grow out of their allergy by 3 years of age. Those children who have had more severe immediate reactions with breathing problems may be less likely to outgrow their allergy than children with milder reactions. Your doctor can determine whether your child has outgrown immediate milk allergy by monitoring the allergy tests every 12 months or so.
Is my child likely to have a severe reaction from casual contact with milk product on benches, other children's hands or by smelling milks?
No. Severe reactions from casual contact are extremely rare.
Can I prevent milk allergy in my future children?
There are no steps which can guarantee a child will not develop milk allergy. There is no evidence that avoiding cow's milk in pregnancy prevents milk allergy in the baby. The evidence is unclear whether avoidance of cows milk by the mother while breastfeeding will alter the development of milk allergy in the baby.
What is an Epipen?
Epipen is an emergency device which injects a dose of adrenaline into the muscle. It is used to treat severe reactions to milk. The drug adrenaline reverses the severe allergic reaction and can be lifesaving.
Should my child carry an Epipen?
Children who have had a serious immediate reaction to milk with involvement of the breathing passages should have an Epipen. Children do not need to have an Epipen for delayed reactions. The need for children with less serious immediate reactions and babies to have an Epipen depends on a number of factors which should be discussed with your doctor. If you have an Epipen it is very important that you understand how to use it and that you have a written anaphylaxis action plan provided by your doctor.
- Most children will outgrow their milk allergy by the age of 5 years.
- Learn to recognize the different types of food labels which indicate that the food contains cows' milk products.
Where can I find more information on the Internet?
- The Australian Society of Clinical Immunology and Allergy (ASCIA) website contains useful information on food allergy written by Australian specialists (www.allergy.org.au).
Written by the Department of Allergy, Immunology and Infectious diseases The Children's Hospital at Westmead.
|The Children's Hospital at Westmead
Tel: (02) 9845 3585
Fax: (02) 9845 3562
|Sydney Children's Hospital, Randwick
Tel: (02) 9382 1688
Fax: (02) 9382 1451
|Kaleidoscope, Hunter Children's Health Network
Tel: (02) 4921 3670
Fax: (02) 4921 3599
& Kaleidoscope, Hunter Children's Health Network - 2005-2009.