Parents are used to hearing different responses from people when sharing that their child has a food allergy. Milk allergy is a case in point. Milk allergy is common in children—about 5 out of 100 children have it. Even so, people’s reactions can range from not taking the allergy seriously to wanting to give well-intentioned advice. Both can be harmful, especially when the advice is based on myths or out-of-date information.
What is Milk Allergy?
Milk allergy is an abnormal response caused by the immune system in which IgE antibodies are made to one or more of the proteins found in milk. Whenever milk or milk products are eaten, these antibodies cause histamine and other inflammatory messengers to be sent to the skin, the respiratory tract (for breathing), the gastrointestinal system (for digestion) and/or the cardiovascular system (for blood flow). This can quickly lead to signs and symptoms like hives, swelling, wheezing, coughing, vomiting, faintness, weakness or passing out. An allergic reaction can be very serious. Children at risk of a severe reaction need immediate medical attention to prevent a life-threatening allergic reaction.
Milk Allergy vs. Lactose Intolerance
Milk allergy is different than lactose intolerance. Lactose intolerance is caused by having low levels of the enzyme called lactase that is responsible for digesting lactose. Signs and symptoms of lactose intolerance are limited to the digestive tract. They may include excess abdominal gas, cramping, bloating and diarrhea. Unlike milk allergy, lactose intolerance is uncommon in children.
Diagnosing and Managing Milk Allergy
Milk allergy should be diagnosed by a medical doctor. Children who are at risk of a severe allergic reaction should see a pediatric allergist. They should be given a prescription for an epinephrine auto-injector, and their parents should be offered all the training and support needed to feel confident about when and how to use it.
The good news is that milk allergy is often outgrown. For this reason, children should be seen regularly by their doctor, who will look for signs that they are outgrowing their milk allergy. The sooner a family knows their child has outgrown the allergy, the sooner the child can benefit from a less restricted diet.
Generally, milk allergy management includes avoiding milk, milk products and milk ingredients in processed and prepared foods. Many people believe that other animal milks, in place of cow milk are safe for children with milk allergy, but this is not true. Children with cow milk allergy are likely to have an allergic reaction when they drink sheep or goat milk as well.
However, many children with milk allergy are able to have milk when it is baked into foods like wheat-flour based muffins and pancakes. Parents should talk to a pediatric allergist before giving baked goods that contain milk. If tolerated, these foods can make living with milk allergy easier for the whole family.
Milk Alternatives for Meeting Nutritional Needs
Most children with milk allergy are able to eat and drink soy products. Parents who are unsure should check with their child’s doctor.
Parents of a child with milk allergy need to pay extra attention to their child’s nutrition—mainly, the child’s needs for calcium, vitamin D, protein and energy (calories). Milk substitutes such as fortified rice, almond, coconut, and hemp beverages are not nutritionally equal to milk. They are usually not good sources of protein, and they are lower in fat. Using one of these substitutes, particularly in children less than two years of age, can put them at higher risk for under-nutrition and poor growth. These beverages may be given after two years of age as long as parents make sure their child eats additional protein-rich foods every day. One way to help achieve this would be to offer a child foods from the Meat and Alternatives food group four to six times each day.
For children between one and two years of age, breast milk continues to be a great source of nutrition but does not meet a child’s needs for calcium and vitamin D. Soy infant formula or hypoallergenic or elemental infant formulas may be offered to complement breast milk. Depending on the amount of formula taken, a calcium supplement may be needed. A vitamin D supplement is usually recommended for all children with milk allergy. Fortified soy beverages are good choices starting at two years of age (they are generally too low in fat for younger children).
For more information
Supporting a child with milk allergy is a team effort that starts with their parents and their family doctor. This team should include a registered dietitian and often a pediatric allergist, too. Contact HealthLink BC by calling 8-1-1 and ask to be transferred to Dietitian Services for help managing milk or other food allergies. You can also send an e-mail.
Author’s Bio: Linda Kirste is the Allergy Nutrition Service dietitian with Dietitian & Physical Activity Services at HealthLink BC. She has over 10 years of experience helping families manage their child’s food allergies. “It feels like choices are taken away by food allergy,” says Linda. “I like to help parents feel more confident that their child isn’t missing out.”