Cow’s milk is listed as a priority allergen in Canada. This page focuses on facts specific to milk allergy, available resources, and special considerations related to this allergen. We will also explain the difference between IgE-mediated and non-IgE mediated milk allergy as well as nutritional concerns related to a milk-free diet will be addressed.
Statistics and data on cow’s milk allergy
- Milk is the food most often associated with food allergy in infants and young children.
- Allergy to cow’s milk develops most often in the first year of life.
- This allergy affects 2% to 4% of young children[i],[ii].
- Up to 80% of children allergic to cow’s milk become tolerant by age 3 or 4 [iii].
- Allergy to cow’s milk is rare in adults, affecting less than 0.5% of the adult population according to some studies[iv].
- There are 2 types of allergies to cow’s milk IgE-mediated and non-IgE mediated
IgE-mediated allergy to milk
IgE allergy stimulates immune system’s production of type E immunoglobulins (IgE).
IgE antibodies react to cow’s milk proteins, leading to the production of histamine, this triggers an allergic reaction. In some cases, the reaction can lead to anaphylaxis. Skin prick tests and blood tests are used to measure IgE concentration and diagnose IgE-mediated allergies. Diagnosis of an IgE-mediated allergy is conducted through skin tests and blood tests to measure IgE concentration.
Non-IgE mediated allergy to milk
This type of allergy does not lead to the production of IgE antibodies. Symptoms can be delayed, and may appear hours after consuming cow’s milk. Generally symptoms affect the gastrointestinal tract, and can include diarrhea and/or vomiting. Diagnosis is based on observed resolution of symptoms following exclusion of cow’s milk from the diet.
Cow’s milk : REFERENCE GUIDE
|Cross-allergies with cow’s milk
|Note: Soy milk allergy may be concomitant to cow’s milk allergy and will generally be non-IgE mediated. Because medical advice is required to make the diagnosis, soy should not be systematically excluded from the diet of people with a medicated non-IgE allergy to milk.
|Terms that may indicate the presence of cow’s milk
||Lactalbumin and lactalbumin phosphate
||Whey and whey protein concentrate
|Caseinate (ammonium caseinate, sodium caseinate, calcium caseinate, magnesium caseinate, potassium caseinate)
||Lactose-free or demineralized whey
|Casein, rennet casein
||Modified milk substance
|Health Canada’s food allergen labelling regulations established in 2012 prohibit use of these terms. Manufacturers must clearly indicate the presence of milk in their product using the words “Contains” or “May contain.” However, it is important to keep these terms in mind when travelling, as regulations vary from one country to another. In some cases, it may also be useful to know them when we are offered artisanal products.
|Foods that are likely sources of cow’s milk
|Paste and fried foods
||Desserts (e.g., puddings, yogurts, ice creams and Puddings)
||Ragouts, frozen preparations
|Artificial butter flavouring or butter oil
||High protein flour
||Stocks and sauces
||Soy cheese (with casein)
|Broths and consommés
||Glazing on bakery products
||Soups and preparations for soup, soups, and creams
||Malt beverage mixes
||Fat substitute, comm OptaTM and Simplicity*
|Caramel colour or flavour
||Instant potatoes, mashed potatoes or Dauphinoises
|Coffee colouring agent
||Bakery and pastry products, including certain types of bread, and preparations for these products
||Salad dips and sauces
|Cereals, biscuits and salted biscuits
||Pies and sausages
|Foods that are possible sources of cow’s milk
|Frozen/Dehydrated Foods and Meals
||Frankfurt sausages, deli meats, and processed meats
||Seasoned chips (e. g. z with sour cream and with onions)
|Candy, fruit and cereal bars, especially those containing caramel or chocolate
||Wax on certain fruits and vegetables
||Canned tuna, mixed with other ingredients or seasoned
|French fries (e.g. those prepared from mixtures of potatoes or mashed potatoes or seasoned)
||Non-dairy coffee colouring agents
|Possible non-food sources of cow’s milk
||Drugs and supplements
|Note: To find out if common products contain cow’s milk protein, it is important to read the labels carefully and contact the manufacturer. Food allergen labelling regulations apply only to packaged foods, they do not apply to non-food products.
* The lists of foods and ingredients presented in the table are not exhaustive and are given for information only.
Sicherer, S. (2001). Clinical implications of cross-reactive food allergens. Journal of Allergy and Clinical Immunology, 108 (6), 881-890. DOI 10.1067/mai. 2001.118515
|Substituting cow’s milk
||Cow’s milk: soy beverage, milk beverage, enriched rice beverage, almond milk, coconut milk, and fruit juice.
|Yogurt: soy yogurt, soft tofu, and coconut milk yogurt.
|Butter: non-dairy margarine, olive oil, canola oil, melted coconut oil, vegetable shortening, cocoa butter (a vegetable fat also available in powder form).
|Cocoa butter: vegetable fat often offered in powder.
|Cream of tartar is also used to fix and stabilize or as a leavening agent.
Nutritional concerns related to milk allergy
Milk is an important source of protein, carbohydrates, essential fatty acids, calcium, phosphorus, and vitamins A and D. People allergic to cow’s milk will need to find suitable alternatives to help meet their daily requirements.
Milk, whether maternal or commercial, is the staple food of infant feeding. Breastfeeding mothers may have to exclude milk-containing foods from their diet if their baby reacts to the presence of cow’s milk protein passed through breastmilk. This exclusion diet should be initiated following a doctor’s recommendation.
Infants who are not breastfed will require hypoallergenic formula to meet their nutritional requirements. These include extensively hydrolyzed formulas, or amino acid based formulas. For additional information, please refer to the section Babies and Young Children.
Note: Non-dairy beverages made from soy, rice and oat are not nutritionally adequate, so not recommended for infants or children under 24 months of age. These products should not replace breastmilk nor a hypoallergenic infant formula.
Children and adults
As a child transitions from a milk-based diet to solid foods, it is important to ensure a nutritionally adequate diet. Watch our French capsule for more information: L’allergie alimentaire pose-t-elle un risque pour l’état nutritionnel de l’enfant?
. In cases where dairy products are avoided, special attention should be paid to calcium and vitamin D intakes to ensure that dietary requirements are met by eating non-diary alternatives.
Note: Individuals with cow’s milk allergy may benefit from consulting a nutritionist to ensure that nutritional needs are met.
- Examples of non-dairy, calcium-rich foods include: tofu, black beans, lentils, chickpeas, fortified orange juice, broccoli, kale, hummus, almonds, and canned fish with bones.
- Examples of food sources of vitamin D include: eggs, salmon, herring, sardines, and fish oils.
Dairy-free recipes and resources
[i] Association des allergologues et immunologues du Québec. (2016). Allergies au lait
. Repéré à http://www.allerg.qc.ca/Information_allergique/3_3c_lait.html
[ii] Santé Canada. (2016). Lait — allergène alimentaire https://www.canada.ca/fr/sante-canada/services/aliments-nutrition/rapports-publications/salubrite-aliments/lait-allergene-alimentaire-prioritaire.html
[iii] World Allergy Organization. (2012). Cow’s milk allergy in children. Repéré à http://www.worldallergy.org/professional/allergic_diseases_center/cows_milk_allergy_in_children/
[iv] Fiocchi, A. (2010). Diagnosis and Rational for Action against Cow’s Milk Alergy (DRACMA): A summary report. Journal of Allergy and Clinical Immunology, 126(6), 1119-1128. DOI 10.1016/j.jaci.2010.10.0