General Information
Reactions to food are common and can be divided into two categories, those caused by food allergy and all other reactions
Food allergies develop when the body’s immune system has an abnormal reaction to one or more proteins in a food that can lead to serious allergic reactions
Other food reactions are not caused by the immune system but can cause unpleasant symptoms (examples include lactose intolerance, heartburn, food poisoning, and sensitivities)
Cow’s milk protein allergy is one of the most common food allergies
Cow’s Milk Protein Avoidance
Tell anyone with regular contact with you or your child about the allergy and avoidance of cow’s milk protein
Read labels every time you buy something. Manufacturers can change products at any time
Be aware of cross contamination (transfer of cow’s milk protein to a food that does not normally have cow’s milk protein as an ingredient)
Nursing mothers may have to limit their own cow’s milk protein intake
Formula fed infants require specialized extensively hydrolyzed formulas such as Nutramigen, Pregestimil and Alimentum or amino acid formulas such as Neocate
Avoid foods that contain cow’s milk protein in all forms including - Skim, 1%, 2%, whole, lactose-free:
Milk from other animals (ex: goat)
Condensed, dry, evaporated, powder, malted, derivative
Food ingredients that indicate or may indicate the presence of cow’s milk protein:
Ammonium caseinate
High protein flour
Milk fat/solids
Artificial butter flavor
Hydrolysed casein
Milk ingredients
Butter solids/fats
Hydrolysed milk protein
Modified milk ingredients
Calcium caseinate
Lactalbumin
Natural flavoring
Caramel colour/flavoring
Lactalbumin phosphate
Potassum caseinate
Casein
Lactoferrin
Rennet casein
Delactosed whey
Lactoglobulin
Simplesse (fat replacer)
Demineralized whey
Lactose
Sodium caseinate
Dried milk
Lactulose
Sour cream/milk solids
Dry milk solids
Magnesium caseinate
Whey
Flavoring
Milk derivative
Whey protein hydrolysate
Some foods that contain or may contain cow’s milk protein
Baked goods (cake, bread)
Deli meat
Margarine
Butter/buttermilk
Egg substitute
Pizza
Candy (caramel)
Frozen yogurt
Pudding
Cheese
Gravy
Salad dressing
Chocolate
Ghee
Sausage
Cream
Half and half
Seasonings
Cream soup
Hot dogs
Sherbet
Curds
Ice cream
Sour cream
Custard
Kefir
Yogurt
Allergic Reactions
Symptoms often occur within minutes up to 2 hours of exposure to milk protein
Outside Symptoms
Face: Redness, itchy eyes / nose, swelling of eyes, runny nose, sneezing
Skin: Itching, redness, hives, swelling
Inside Symptoms
Face: Swelling lips and tongue, itchy mouth
Throat: Itching, tightness, hoarse voice, cough
Lungs: trouble swallowing, trouble speaking, Trouble breathing, shortness of breath
Stomach: coughing, wheezing (whistle noise) Vomiting, nausea, stomach pain, diarrhea
General: Dizzy, unsteady, drowsy, fainting
Not every reaction will look the same, a person can have different symptoms each time
Symptoms range from mild to life-threatening, there is no way to predict if the reaction will be
mild or severe
Anaphylaxis is a severe life threatening reaction with more than one body system affected (skin, breathing, stomach, general) and can occur WITHOUT skin symptoms such as hives
Treatment of Reactions
Antihistamines such as Benadryl will NOT stop severe reactions
An epinephrine auto-injector such as Allerject or EpiPen MUST be available at all times
If you are visiting an area without access to a hospital you should have 2 auto-injectors available
A medical identification device such a Medical Alert bracelet should be worn to outline the food allergy and that an epinephrine auto-injector is carried
Give epinephrine in the outer thigh if there are any of the following symptoms (listed in the table on the previous page)
General symptoms
Severe outside symptoms
Any inside symptoms
If you are in doubt, give the epinephrine
After epinephrine is given
Lie down / lie your child down
Call local emergency service and tell them someone is having an allergic reaction
If the reaction continues or worsens, give a second dose of epinephrine in 5 - 15 minutes (there is only 1 dose of epinephrine in each auto-injector, a second dose requires a new auto-injector)
- Go to the nearest emergency room even if the symptoms are gone because the reaction can worsen or come back
- Stay in the hospital for at least 4 - 6 hours of observation
Outcomes for Cow’s Milk Protein Allergic Patients
About 80 - 90% outgrow the milk allergy
Repeat skin testing and blood work every 1 - 2 years will help determine if the allergy is outgrown
An oral food challenge (eating milk products in small steps ONLY in the doctors office) will be offered if your doctor feels it is safe
Cow’s milk protein products should NEVER be tried outside of a doctors office to see if the allergy is outgrown
Some patients are able to tolerate baked forms of milk. This will be advised by your doctor. NEVER try baked milk products for the first time outside a doctors office
Additional information: www.anaphylaxis.ca or www.foodallergy.org