Mayo Clinic Milk Allergy re-post

Milk allergy, one of the most common food allergies in children, is an abnormal response by the body’s immune system to milk and products containing milk. Cow’s milk is the usual cause, but milk from sheep, goats, buffalo and other mammals also can cause a reaction.

An allergic reaction usually occurs minutes to hours after consuming milk. Signs and symptoms of milk allergy range from mild to severe and can include wheezing, vomiting, hives and digestive problems. Sometimes, milk allergy can cause anaphylaxis — a severe, life-threatening reaction.

Avoidance is the primary treatment for milk allergy. Fortunately, most children outgrow a milk allergy. Those who don’t outgrow it may need to continue to avoid milk products.

Milk allergy symptoms, which differ from person to person, occur a few minutes to a few hours after drinking milk or eating milk products.

Immediately after consuming milk, signs and symptoms of a milk allergy might include:

  • Hives
  • Wheezing
  • Vomiting

Signs and symptoms that may take more time to develop include:

  • Loose stools, which may contain blood
  • Diarrhea
  • Abdominal cramps
  • Coughing or wheezing
  • Runny nose
  • Watery eyes
  • Itchy skin rash, often around the mouth
  • Colic, in babies

Milk allergy or milk intolerance?

A true milk allergy differs from milk protein intolerance or lactose intolerance. Unlike a milk allergy, intolerance doesn’t involve the immune system. Milk intolerance causes different symptoms and requires different treatment from a true milk allergy.

Common signs and symptoms of milk protein intolerance or lactose intolerance include digestive problems, such as bloating, gas or diarrhea, after consuming milk or products containing milk.

Anaphylaxis

Milk allergy can cause anaphylaxis, a life-threatening reaction that can narrow the airways and block breathing. Milk is the third most common food, after peanuts and tree nuts, to cause anaphylaxis.

If you or your child has a reaction to milk, tell your doctor, no matter how mild the reaction. Tests can help confirm a milk allergy, so you can avoid future and potentially worse reactions.

Anaphylaxis is a medical emergency and requires treatment with an epinephrine (adrenaline) shot and a trip to the emergency room. Signs and symptoms start soon after consuming milk and can include:

  • Constriction of airways, including a swollen throat that makes it difficult to breathe
  • Facial flushing
  • Itching
  • Shock, with a marked drop in blood pressure

When to see doctor

See your doctor or an allergist if you or your child experiences milk allergy symptoms shortly after consuming milk. If possible, see your doctor during the allergic reaction to help the doctor make a diagnosis. Seek emergency treatment if you or your child develops signs or symptoms of anaphylaxis.

All true food allergies are caused by an immune system malfunction. Your immune system identifies certain milk proteins as harmful, triggering the production of immunoglobulin E (IgE) antibodies to neutralize the protein (allergen). The next time you come in contact with these proteins, IgE antibodies recognize them and signal your immune system to release histamine and other chemicals, causing a range of allergic signs and symptoms.

There are two main proteins in cow’s milk that can cause an allergic reaction:

  • Casein, found in the solid part (curd) of milk that curdles
  • Whey, found in the liquid part of milk that remains after milk curdles

You or your child may be allergic to only one milk protein or both. These proteins may be hard to avoid because they’re also in some processed foods. And, most people who react to cow’s milk will react to sheep’s, goat’s and buffalo’s milk. Less commonly, people allergic to cow’s milk are also allergic to soy milk.

Food protein-induced enterocolitis syndrome (FPIES)

A food allergen can also cause what’s sometimes called a delayed food allergy. Although any food can be a trigger, milk is one of the most common. The reaction, commonly vomiting and diarrhea, usually occurs within hours after eating the trigger rather than minutes.

Unlike some food allergies, FPIES usually resolves over time. As with typical milk allergies, preventing an FPIES reaction involves avoiding milk and milk products.

Certain factors may increase the risk of developing a milk allergy:

  • Other allergies. Many children allergic to milk also have other allergies. Milk allergy is often the first to develop.
  • Atopic dermatitis. Children who have atopic dermatitis — a common, chronic inflammation of the skin — are much more likely to develop a food allergy.
  • Family history. A person’s risk of a food allergy increases if one or both parents have a food allergy or another type of allergy — such as hay fever, asthma, hives or eczema.
  • Age. Milk allergy is more common in children. As they age, their digestive system matures, and their bodies are less likely to react to milk.

Children who are allergic to milk are more likely to develop certain other health problems, including:

  • Allergies to other foods — such as eggs, soy, peanuts or even beef
  • Hay fever — a common reaction to pet dander, dust mites, grass pollen and other substances

You’re likely to start by seeing your family doctor, a general practitioner or your child’s pediatrician. However, you may then be referred to a doctor who specializes in allergic disorders (allergist-immunologist).

Here’s some information to help you get ready for your appointment and to know what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there’s anything you need to do in advance. For example, if you’re going to have allergy testing done, your doctor will want you or your child to stop taking antihistamine medications for a certain time period before the test.
  • Write down any symptoms you or your child has experienced, including any that may seem unrelated to milk allergy.
  • Make a list of any medications, vitamins and supplements you or your child is taking.
  • Write down questions to ask your doctor.

Preparing a list of questions can help you make the most of your time with your doctor. For a milk allergy, some basic questions to ask your doctor include:

  • Do you think this is a milk allergy or lactose intolerance?
  • Are there tests to diagnose milk allergy? Do these tests require preparation?
  • Is it possible to outgrow this allergy?
  • Are there treatments?
  • Is it necessary to avoid milk and milk products?
  • What foods are likely to contain milk products?
  • Is it necessary to stay away from others who are drinking milk?
  • What do I need to tell people at my child’s school about this allergy?
  • How can milk allergy best be managed with other conditions?
  • Are there brochures or other printed materials that I can take? What websites do you recommend?
  • Do I need to carry an epinephrine pen at all times?

Don’t hesitate to ask any other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • When did you or your child first react to milk?
  • Can you describe the reaction?
  • Does this happen every time you or your child drinks milk or eats something made with milk?
  • How soon after consuming milk or milk products do symptoms begin?
  • How severe are the symptoms?
  • Does anything seem to improve the symptoms, such as allergy medication or milk avoidance?
  • What, if anything, appears to worsen the symptoms?
  • Have you or your child tried any of the products made for people with lactose intolerance? If yes, did those help?
  • Is anyone else in your family allergic to milk?

What you can do in the meantime

If you’re having mild allergy symptoms from eating something that contained milk, taking an antihistamine medication may lessen your discomfort. Watch for more-severe symptoms that might require medical attention. If you or your child has symptoms of anaphylaxis, seek emergency medical care.

When food causes an allergic reaction, it isn’t always easy to pinpoint what food is to blame. To evaluate whether you or your child has a milk allergy, your doctor may:

  • Ask detailed questions about signs and symptoms
  • Perform a physical exam
  • Have you keep a detailed diary of the foods you or your child eats
  • Have you eliminate milk from your diet or your child’s diet (elimination diet) — and then have you add back the food to see if it causes a reaction

He or she may also recommend one or both of the following tests:

  • Skin test. In this test, your skin is pricked and exposed to small amounts of the proteins found in milk. If you’re allergic, you develop a raised bump (hive) at the test location on your skin. Allergy specialists usually are best equipped to perform and interpret allergy skin tests. This type of test isn’t always accurate for detecting milk allergy.
  • Blood test. A blood test can measure your immune system’s response to milk by measuring the amount of immunoglobulin E (IgE) antibodies in your blood. This test isn’t always accurate in identifying a milk allergy.

If your examination and test results can’t confirm a milk allergy, your doctor might administer an oral challenge, in which you are fed different foods that may or may not contain milk in increasing amounts to see if you react to the ones that contain milk. Allergy tests are best administered by an allergist who’s trained to manage serious reactions.

If your doctor suspects your symptoms are caused by something other than a food allergy, you may need other tests to identify — or rule out — other medical problems.

The only way to prevent an allergic reaction is to avoid milk and milk proteins. This can be difficult because milk is a common ingredient in many foods. Also, some people with a milk allergy can tolerate milk in some forms, such as milk that’s heated in baked goods, or some processed foods, such as yogurt. Talk to your doctor about what to avoid.

Despite your best efforts, if you or your child accidentally consumes milk, medications such as antihistamines may reduce mild signs and symptoms of an allergic reaction. Taken after exposure to milk, an antihistamine may help relieve discomfort.

If you or your child has a serious allergic reaction (anaphylaxis), you may need an emergency injection of epinephrine (adrenaline) and a trip to the emergency room. If you’re at risk of having a severe reaction, you or your child may need to carry injectable epinephrine (such as EpiPen, Auvi-Q, others) at all times. Have your doctor or pharmacist demonstrate how to use this device so that you’re prepared for an emergency.

There’s no sure way to prevent a food allergy, but you can prevent reactions by avoiding the food that causes them. If you know you or your child is allergic to milk, avoid milk and milk products.

Read food labels carefully. Look for casein, a milk derivative, which can be found in some unexpected places, such as in some canned tuna or nondairy products. Question ingredients when ordering in restaurants.

Sources of milk products

Obvious sources of allergy-causing milk proteins are found in dairy products, including:

  • Whole milk, low-fat milk, skim milk, buttermilk
  • Butter
  • Yogurt
  • Ice cream, gelato
  • Cheese and anything that contains cheese
  • Half-and-half

Milk can be harder to identify when it’s used as an ingredient in processed foods, including baked goods, processed meats and breakfast cereals. Hidden sources of milk include:

  • Whey
  • Casein
  • Ingredients spelled with the prefix “lact” — such as lactose and lactate
  • Candies, such as chocolate, nougat and caramel
  • Protein powders
  • Artificial butter flavor
  • Artificial cheese flavor
  • Hydrosolate

Even if a food is labeled “milk-free” or “nondairy,” it may contain allergy-causing milk proteins — so you have to read the label carefully. When in doubt, contact the manufacturer to be sure a product doesn’t contain milk ingredients.

When eating out, ask how foods have been prepared. Does your steak have melted butter on it? Was your seafood dipped in milk before cooking?

If you’re at risk of a serious allergic reaction, talk with your doctor about carrying and using emergency epinephrine (adrenaline). If you have already had a severe reaction, wear a medical alert bracelet or necklace that lets others know you have a food allergy.

Milk alternatives for infants

Some research suggests that breast-feeding during the first four to six months of a baby’s life instead of giving a standard cow’s milk formula can help prevent milk allergy. In children who are allergic to milk, breast-feeding and use of hypoallergenic formula can prevent allergic reactions.

  • Breast-feeding is the best source of nutrition for your child. Breast-feeding for at least the first four to six months of life if possible is recommended, especially if your infant is at high risk of developing a milk allergy.
  • Hypoallergenic formulas are produced by using enzymes to break down (hydrolyze) milk proteins, such as casein or whey. Further processing can include heat and filtering. Depending on the level of processing, products are classified as either partially or extensively hydrolyzed. Or they may also be called elemental formulas.

    Some hypoallergenic formulas aren’t milk based, but instead contain amino acids. Besides extensively hydrolyzed products, amino-acid-based formulas are the least likely to cause an allergic reaction.

  • Soy-based formulas are based on soy protein instead of milk. Soy formulas are fortified to be nutritionally complete — but, unfortunately, some children with a milk allergy also develop an allergy to soy.

If you’re breast-feeding and your child has a milk allergy, cow’s milk proteins passed through your breast milk may cause an allergic reaction. Then you may need to exclude all products that contain milk from your diet. Talk to your doctor if you know — or suspect — your child has a milk allergy and develops allergy signs and symptoms after breast-feeding.

If you or your child is on a milk-free diet, your doctor or dietitian can help you plan nutritionally balanced meals. You or your child may need to take supplements to replace calcium and nutrients found in milk, such as vitamin D and riboflavin.

Having a serious allergy or being the parent of a child with a potentially life-threatening allergy can be stressful. Talking to others in similar situations can be helpful. Besides offering support and encouragement, they may also provide useful coping tips, such as how to deal effectively with school officials to ensure your child’s medical needs are met. Ask your doctor if there are any support groups in your area, or contact the Asthma and Allergy Foundation of America.

Aug. 07, 2014

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What’s the difference between milk allergy and milk intolerance?

What’s the difference between milk allergy and milk intolerance?

Adam Fox

Consultant paediatric allergist.

Cow’s milk allergy and cow’s milk intolerance (lactose intolerance), are entirely unrelated.

  • Milk allergy is when your baby’s immune system reacts to proteins in milk. It is the most common childhood allergy, affecting between two per cent and seven per cent of babies. Babies who have eczema are more likely to suffer from milk allergy.
  • Lactose intolerance is when your baby has difficulty digesting lactose, which is the natural sugar found in milk. In babies, lactose intolerance usually happens after a tummy infection (viral gastroenteritis). It can last for about four weeks before the gut recovers and starts to break down lactose again.

Milk allergy in babies

Your baby can take in milk protein through your breastmilk if you have drunk or eaten dairy produce, or she may react to cow’s milk-based formula milk. Milk contains two types of protein:

  • casein, which is the curd formed when milk turns sour
  • whey, which is the watery part left when the curd is removed

Your baby may be allergic to one or both of these proteins.

If your baby is allergic, she could have an immediate reaction after drinking or eating something with a dairy ingredient. Her face will flush and a rash will appear, and she’s likely to have watery eyes and a stuffy nose. It’s also possible she’ll feel sick or have diarrhoea, and rarely, a more serious reaction called anaphylaxis.

Your doctor can find out whether your baby has an allergy by talking through your baby’s suspected reaction with you and taking a blood sample from her. Your doctor may only need to do a heel-prick test to get enough blood for testing.

Most allergic reactions to milk are immediate, but delayed allergic reactions are common, too. Your baby may have eczema, reflux, diarrhoea or constipation, and she may not put on enough weight (failure to thrive). Remember that babies often have symptoms like these, and an allergy is only one possible explanation.

Symptoms of milk allergy are similar to colic, a phase that many small babies go through. However, if your baby is persistently crying, one explanation may be milk allergy, so it’s worth taking your baby to the doctor to find out.

It can be tricky to find out whether your baby is having a delayed allergic reaction, because they involve parts of the immune system that take longer to respond.

Your doctor and a dietitian will work with you on a diet that removes milk from your meals if you’re breastfeeding, or your baby’s meals if she’s started solids. This can be a long process. The dietitian will review your baby’s symptoms and gradually try her with increasing amounts of milk to see if her symptoms recur. Always see your doctor or a dietitian before cutting food groups out of your baby’s diet.

If your baby is allergic to milk and is formula-fed, talk to your doctor before changing formula. It may not be the answer simply to switch to a soya-based product, because many babies with milk allergies can react to this, too.

Your doctor is likely to recommend that you give your baby a special hypoallergenic formula in this situation. This will be in the form of an amino acid-based or fully hydrolysed formula milk, which you can get on prescription.

Rest assured that your baby is likely to grow out of her milk allergy. If your baby has delayed allergic reactions to milk, she will probably outgrow it by the time she’s three years old. If she has an immediate allergic reaction, the allergy may last into her teenage years. By the time she’s grown-up, she’s very unlikely to be allergic. Milk allergy is uncommon in adults, with less than one per cent being affected.

However, about half of babies and children who react to milk will develop an allergy to something else when they are older. Unfortunately, between half and 80 per cent of children who react to milk will develop asthma.

Lactose intolerance in babies

Intolerance reactions do not involve the immune system. If your baby has lactose intolerance, it is likely that she will lack the enzyme lactase, which is needed to break down lactose.

It’s exceptionally rare for babies in the UK to be born with lactose intolerance. It is more common in parts of the world where adults don’t typically drink or cook with cow’s milk, for example, in Asia, Africa, and South America.

Your baby may develop lactose intolerance for a short period after she has had a tummy bug. If your baby is formula-fed, your doctor may advise you to give her lactose-free formula milk for a short time.

http://www.babycentre.co.uk/x555830/whats-the-difference-between-milk-allergy-and-milk-intolerance#ixzz3RDpgYFVJ

Dairy Allergy

Milk Allergy

Allergy to cow’s milk is the most common food allergy in infants and young children. Symptoms of a milk allergy reaction can range from mild, such as hives, to severe, such as anaphylaxis. Therefore it is advised that people with milk allergy have quick access to an epinephrine auto-injector (such as an EpiPen®, Auvi-Q™ or Adrenaclick®) at all times.  To prevent a reaction, strict avoidance of cow’s milk and cow’s milk products is essential. Always read ingredient labels to identify cow’s milk ingredients.

Approximately 2.5 percent of children younger than three years of age are allergic to milk. Nearly all infants who develop an allergy to milk do so in their first year of life. Most children eventually outgrow a milk allergy. The allergy is most likely to persist in children who have high levels of cow’s milk antibodies in their blood. Blood tests that measure these antibodies can help your allergist determine whether or not a child is likely to outgrow a milk allergy.

Sensitivity to cow’s milk varies from person to person. Some people have a severe reaction after ingesting a tiny amount of milk. Others have only a mild reaction after ingesting a moderate amount of milk. Reactions to milk can be severe and life-threatening (read more about anaphylaxis).

Differences between Milk Allergy and Lactose Intolerance

Milk allergy should not be confused with lactose intolerance. A food allergy is an overreaction of the immune system to a specific food protein. When the food protein is ingested, in can trigger an allergic reaction that may include a range of symptoms from mild symptoms (rashes, hives, itching, swelling, etc.) to severe symptoms (trouble breathing, wheezing, loss of consciousness, etc.). A food allergy can be potentially fatal.

Unlike food allergies, food intolerances do not involve the immune system.  People who are lactose intolerant are missing the enzyme lactase, which breaks down lactose, a sugar found in milk and dairy products. As a result, lactose-intolerant patients are unable to digest these foods, and may experience symptoms such as nausea, cramps, gas, bloating and diarrhea. While lactose intolerance can cause great discomfort, it is not life-threatening.

Read more about food intolerances>

Formula for Infants with a Milk Allergy

It is recommended that formula-fed infants who are allergic to milk use an extensively hydrolyzed, casein-based formula. This type of formula contains protein that has been extensively broken down so it is different than milk protein and not as likely to cause an allergic reaction. Examples of casein-hydrolysate formulas are Alimentum® and Nutramigen®. If the child is not allergic to soy, his or her doctor may recommend a soy-based formula.

A milk-free formula is an excellent source of necessary nutrients, so many doctors recommend continuing its use well past the age of one year for children on restricted diets due to food allergy. Discuss your options with your doctor or dietitian to be sure that the child’s nutritional requirements are all being met.

Avoiding Milk

The federal Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that all packaged food products sold in the U.S. that contain milk as an ingredient must list the word “Milk” on the label.

Read all product labels carefully before purchasing and consuming any item. Ingredients in packaged food products may change without warning, so check ingredient statements carefully every time you shop. If you have questions, call the manufacturer.

As of this time, the use of advisory labels (such as “May Contain”) on packaged foods is voluntary, and there are no guidelines for their use. However, the FDA has begun to develop a long-term strategy to help manufacturers use these statements in a clear and consistent manner, so that consumers with food allergies and their caregivers can be informed as to the potential presence of the eight major allergens.

Read more about food labels>

Avoid foods that contain milk or any of these ingredients:

  • Butter, butter fat, butter oil, butter acid, butter ester(s)
  • Buttermilk
  • Casein
  • Casein hydrolysate
  • Caseinates (in all forms)
  • Cheese
  • Cottage cheese
  • Cream
  • Curds
  • Custard
  • Diacetyl
  • Ghee
  • Half-and-half
  • Lactalbumin, lactalbumin phosphate
  • Llactoferrin
  • Lactose
  • Lactulose
  • Milk (in all forms, including condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, lowfat, malted, milkfat, nonfat, powder, protein, skimmed, solids, whole)
  • Milk protein hydrolysate
  • Pudding
  • Recaldent(R)
  • Rennet casein
  • Sour cream, sour cream solids
  • Sour milk solids
  • Tagatose
  • Whey (in all forms)
  • Whey protein hydrolysate
  • Yogurt

Milk is sometimes found in the following:

  • Artificial butter flavor
  • Baked goods
  • Caramel candies
  • Chocolate
  • Lactic acid starter culture and other bacterial cultures
  • Luncheon meat, hot dogs, sausages
  • Margarine
  • Nisin
  • Nondairy products
  • Nougat

Some Unexpected Sources of Milk*

  • Deli meat slicers are frequently used for both meat and cheese products.
  • Some brands of canned tuna fish contain casein, a milk protein.
  • Many non-dairy products contain casein (a milk derivative), listed on the ingredient labels.
  • Some specialty products made with milk substitutes (i.e., soy-, nut- or rice-based dairy products) are manufactured on equipment shared with milk.
  • Some meats may contain casein as a binder. Check all labels carefully.
  • Shellfish is sometimes dipped in milk to reduce the fishy odor. Ask questions about the risk of milk contact when purchasing shellfish.
  • Many restaurants put butter on steaks after they have been grilled to add extra flavor. The butter is not visible after it melts.
  • Some medications contain milk protein.

*Note: This list highlights examples of where milk has been unexpectedly found (e.g., on a food label for a specific product, in a restaurant meal, in creative cookery). This list does not imply that milk is always present in these foods; it is intended to serve as a reminder to always read the label and ask questions about ingredients before eating a food that you have not prepared yourself.

Keep in mind the following:

  • Individuals who are allergic to cow’s milk are often advised to also avoid milk from other domestic animals. For example, goat’s milk protein is similar to cow’s milk protein and may, therefore, cause a reaction in individuals who have a milk allergy.
  • Kosher Dairy:  A “D” or the word “dairy” following the circled K or U on a product label indicates the presence of milk protein or a risk that the product is contaminated with milk protein. These products should be avoided.
  • Kosher Pareve:  A product labeled “pareve” is considered milk-free under kosher dietary law. However, a food product may be considered pareve even if it contains a very small amount of milk protein – potentially enough to cause an allergic reaction in susceptible individuals. Do not assume that pareve-labeled products will always be safe. Read more about kosher labeling>

Do These Ingredients Contain Milk?

People allergic to milk often have questions about the following ingredients. These ingredients do not contain milk protein and need not be restricted by someone avoiding milk:

  • Calcium lactate
  • Calcium stearoyl lactylate
  • Cocoa butter
  • Cream of tartar
  • Lactic acid (however, lactic acid starter culture may contain milk)
  • Oleoresin
  • Sodium lactate
  • Sodium stearoyl lactylate