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