People who don't have a milk allergy may think it's easy
to avoid eating foods that are made with milk or milk products. You
just say "no" to ice cream and pizza, right? (Yeah, like
that's
easy.)
But so many foods are made with milk and milk products these
days that people with milk allergies have to pay attention to
what's in just about everything they eat. And a milk allergy is
not the same as lactose intolerance - some people with food
allergies can become suddenly and severely ill if they eat or even
come in contact with the food they're allergic to.
Some foods that contain milk are obvious, like pizza. But
others, like baked goods, may not be so obvious. Plus, teens need
calcium and vitamin D, which milk has lots of, because their bones
are still growing. So what should a person who's allergic to
milk do? Read on to find out.
What Happens When a Person Has a Milk Allergy?
People who are allergic to cow's milk react to one or more
of the proteins in it. Curd, the substance that forms chunks in
sour milk, contains 80% of milk's proteins, including several
called
caseins
(pronounced:
kay
-seenz). Whey (pronounced:
way
), the watery part of milk, holds the other 20%. A person may be
allergic to proteins in either or both parts of milk.
When a person who is allergic to milk eats a food that contains
milk products, the body's immune system mistakenly sees the
milk proteins as dangerous "invaders." The immune system
responds by creating specific antibodies, which are designed to
fight off the "invader." These antibodies - called
immunoglobulin E
(IgE) - trigger the release of certain chemicals into the body, one
of which is
histamine
(pronounced:
hiss
-tuh-meen).
So when a person with a milk allergy eats a food that contains
milk, the immune system unleashes an army of chemicals to protect
the body. The release of these chemicals can affect the respiratory
system, gastrointestinal tract, skin, and the cardiovascular system
- causing allergy symptoms like wheezing, nausea, headache,
stomachache, and itchy hives.
Milk allergy is like most food allergy reactions: It usually
happens within minutes to hours after eating foods that contain
milk proteins. Most reactions last less than a day and may affect
any of three body systems:
- the skin
- in the form of red, bumpy rashes (hives), eczema, or redness
and swelling around the mouth
- the gastrointestinal tract
- in the form of belly cramps, diarrhea, nausea, or vomiting
- the respiratory tract
- symptoms can range from a runny nose, itchy, watery eyes, and
sneezing to the triggering of asthma with coughing and
wheezing
Most people have some of the reactions listed above, but a few
people may have a very strong reaction called
anaphylaxis
(pronounced: ah-nuh-fuh-
lak
-sis). This severe allergic reaction causes swelling of the mouth,
throat, and airways leading to the lungs, resulting in an inability
to breathe. In addition, there is a dangerous drop in blood
pressure, which can make someone dizzy or pass out, and may quickly
lead to shock.
People often confuse milk allergy with lactose intolerance
because people can have the same kinds of things happening to them
(like stomach pains or bloating, for example) with both conditions.
But the conditions are not related. Milk allergy is a problem
involving the immune system, but lactose intolerance involves the
digestive system. For someone who is lactose intolerant, the
digestive system doesn't produce enough of the enzyme needed to
break down the sugar in milk.
How Can Doctors Tell If a Person Has a Milk Allergy?
If your doctor suspects you might have a milk allergy, he or she
will probably refer you to an allergist or allergy specialist for
further testing. The allergy specialist will ask you questions.
These may cover things like how often you have the reaction, the
time it takes between eating a particular food and the start of the
symptoms, and whether any family members have allergies or
conditions like eczema and asthma.
The allergy specialist may perform a skin test on you. This test
involves placing liquid extracts of milk protein on a person's
forearm or back, pricking the skin a tiny bit, and waiting to see
if a reddish, raised spot forms, indicating an allergic
reaction.
You may need to stop taking anti-allergy medications (such as
over-the-counter antihistamines) 2 to 3 days before the skin test
because they can interfere with the results. Most cold medications
as well as some antidepressants may also affect skin testing. Check
with the allergist's office if you are unsure about what
medications need to be stopped and for how long.
Some doctors may also take a blood sample and send it to a lab
where it will be mixed with some of the suspected allergen and
checked for IgE antibodies.
These types of tests are used for diagnosing what doctors call a
fast-onset type of milk allergy. But for people whose allergic
reactions to milk develop more slowly, skin and blood tests are not
as helpful.
In these cases doctors try to diagnose the person using a food
challenge. The person is told not to eat or drink anything made
with milk for a period of time - usually a few weeks. Then, during
the challenge, the person eats foods containing milk under a
doctor's close supervision. If symptoms come back after eating milk
products, it's a pretty sure bet the person has a milk
allergy.
How Is It Treated?
To treat a milk allergy, the person who is allergic needs to
completely avoid any foods that contain milk or milk products.
Avoiding milk involves more than just leaving the cheese off
your cheese fries. If you are allergic to milk, you need to read
food labels carefully and not eat anything that you're not sure
about. It's a good idea to work with a registered dietitian to
develop an eating plan that provides all the nutrients you need
while avoiding things you can't eat. Check out our section on
Living With a Milk Allergy (below) for more tips.
If you have a severe milk allergy - or any kind of serious
allergy - your doctor may want you to carry a shot of
epinephrine
(pronounced: eh-puh-
neh
-frin) with you in case of an emergency. Epinephrine comes in an
easy-to-carry container about the size of a large marker. It's easy
to use - your doctor will show you how.
If you accidentally eat something with milk in it and start
having serious allergic symptoms, like swelling inside your mouth,
chest pain, or difficulty breathing, you can give yourself the shot
right away to counteract the reaction while you're waiting for
medical help. Always call for emergency help (911) when using
epinephrine. You should make sure your school and even good
friends' houses have injectable epinephrine on hand, too.
Keeping epinephrine on hand at all times should be just part of
your action plan for living with a milk allergy. It's also a
good idea to carry an over-the-counter antihistamine as this can
help alleviate allergy symptoms in some people. Antihistamines
should be used in addition to the epinephrine and not as a
replacement for the shot.
If you've had to take an epinephrine shot because of an
allergic reaction, then you should go immediately to a medical
facility or hospital emergency room so they can give you additional
treatment if you need it. Up to one third of anaphylactic reactions
can have a second wave of symptoms several hours following the
initial attack. Therefore, you might need to be observed in a
clinic or hospital for 4 to 8 hours following the reaction.
Living With a Milk Allergy
It may be challenging to eliminate milk from your diet, but
it's not impossible. Because most people don't get enough
calcium in their diets even if they do drink milk, many other foods
are now enriched with calcium, such as juices, cereals, and rice
and soy beverages. But before you eat or drink anything calcium
enriched, make sure it's also dairy free.
Milk and milk products can lurk in strange places, such as
processed meats. Chocolate is another product that may contain
dairy - so be sure to check the label before you eat it.
As of January 2006, manufacturers of foods sold in the United
States must list on their labels whether a food contains any of the
most common allergens. This means that you should be able to find
statements like these somewhere on the label: "contains milk
ingredients," "made with milk ingredients," or "processed in a
facility that also processes milk products."
This new labeling requirement makes it a little easier than
reading the ingredients list - instead needing to know that the
ingredient "hydrolyzed casein" comes from milk protein, you should
be able to tell at a glance which foods to avoid. But the
government is allowing companies to use labels that were made
before 2006, which means it's still a good idea to get to know the
"code words" for milk products when you see them in the ingredients
of a food.
Vegan foods are made without animal products, such as eggs or
milk. You can buy vegan products at health food stores. Be careful
to read the labels of soy cheeses, though. They may say
"milk-free," but they could contain milk protein.
For your sweet tooth, soy- or rice-based frozen desserts,
sorbets, and puddings are good substitutes for ice cream, as are
ice pops. For baking, milk substitutes work as well as milk and
some come out better. Dairy-free margarine works as well as butter
for recipes and spreading on your bagel.
Try to avoid fried foods or foods with batter on them. Even if
the batter doesn't contain milk products, the oil used to fry
the foods may have been used to fry something that contains
milk.
People are usually understanding when it comes to food allergies
- nobody wants to risk your health. When eating out, order the
simplest foods and ask the waitstaff detailed questions about menu
items. At a friend's house, explain your situation and
don't be embarrassed to ask questions if you're staying for
a meal.
Having a milk allergy doesn't mean you can't still enjoy
eating. In fact, some people think that some of the milk
substitutes - like vanilla soy milk - taste better than regular
cow's milk. As with any specialized diet, you'll probably
find avoiding milk gives you the opportunity to explore and
discover some great foods that you'd never have found
otherwise!
Updated and reviewed by:
D. Pauline Williams, MPA, RD, CD
Date reviewed: April 2006
Originally reviewed by:
Susan Konek, MA, RD, CSP
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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