Milk is a common food allergen but most allergies to milk are the non IgE type of allergy and are annoying but not life threatening. IgE allergic reactions are quite different and can be severe and life threatening (see Food Allergy handout). IgE types of food allergies cause immediate and potentially very severe life threatening reactions when even small amounts of the food are ingested. Managing this type of reaction requires awareness of sources of milk, having adrenalin (usually in the form of an EpiPen) available, and use of Medic Alert bracelets.

Most people with IgE allergies to cow's milk do not react to beef but 1 out of 10 do. Eating well cooked beef usually results in less severe allergic reactions or may eliminate the reaction. There are good studies on cross reactions between milk from different species. If you have IgE allergy to cow's milk you are very likely to react to goat's milk (92%), to ewe's milk, and to buffalo milk, but not to camel milk or mare's milk (4%). Unfortunately, most available animal milks cause problems for those with IgE allergy to cow's milk. I have no idea where one might find camel milk in Oregon.

Some people with IgE allergy to milk react to casein and whey but many do not. Milk solids, casein, and whey may not cause reactions if they are a minor ingredient and if cooked or highly processed. Cow's milk may be tolerated in other foods if cooked well but this varies greatly from person to person and it is best to avoid all sources of cow's milk. We will have to discuss this for your particular situation and this may require challenges in the office with some of these products.

The FOOD ALLERGY NETWORK has additional and frequently updated information about reactions to milk and other foods.

Food Allergy Network

10400 Eaton Place, Suite 107

Fairfax, VA 22030-3179

703.691.3179  Fax 703.691.2713

http://foodallergy.org

You should carry an EpiPen and know how to use it. Caregivers also need to be instructed. Children can carry an EpiPen at school with a note from our office. EpiPens may be given through clothing. If the EpiPen is used, you need to be seen and observed in an emergency room. Reactions have recurred even 2-3 hours after the initial reaction seemed to be improving.

If you have an anaphylactic reaction to milk, spit the food out of your mouth, rinse and spit with water or other liquid, and use the EpiPen. USE THE EPIPEN AT THE EARLIEST SIGN OF A REACTION. You should also consider going to an emergency room unless the reaction was very mild. Even then there is a risk it could recur. Do not go to a restroom or other private place to use the EpiPen. Notify someone you are having an allergic reaction, tell them you are giving yourself a shot, and ask them to call 911. Wearing your Medic Alert bracelet is important and lets emergency personnel know what is happening if you are unable to communicate with them.

Patients at risk of anaphylaxis to foods or other materials should avoid beta blocker medications (used for heart, blood pressure, and glaucoma problems) as these will block the effect of the EpiPen.

With these precautions of avoidance, Medic Alert bracelet and availability of EpiPen milk allergy is a manageable problem. Although there have been rare exceptions fatal reactions almost never occur when an EpiPen is available and used early in the event of a reaction. New treatments for milk and similar food allergies may be available within the next few years.

HOW TO READ A LABEL FOR A MILK FREE DIET.

AVOID FOODS WITH THESE INGREDIENTS:

Artificial butter flavor

Butter, butter fat, butter oil

Buttermilk

Casein

Caseinates (ammonium, calcium, magnesium, potassium, sodium)

Cheese

Cream

Cottage cheese

Curds

Custard

Ghee

Half & Half

Hydrolysates (casein, milk protein, protein, whey, whey protein)

Lactalbumin, lactalbumin phosphate

Lactoglobulin

Lactose

Lactulose

Milk (derivative, powder, protein, solids, malted, condensed, evaporated, dry, whole, low-fat, non-fat, skimmed, and goat’s milk)

Nougat

Pudding

Rennet casein

Sour cream, sour cream solids

Sour milk solids

Whey (in all forms including sweet, delactosed, protein concentrate)

Yogurt

“D” on a label next to “K” or “U” indicates presence of milk protein

MAY CONTAIN MILK PROTEIN:

Flavorings including: caramel, Bavarian cream, coconut cream, brown sugar, butter, natural chocolate

Luncheon meat, hotdogs, sausages

High protein flour

Margarine

Simplesse

You may need to supplement your diet with calcium. Recommended adequate daily intake of calcium is:

Children 1-3 years old 500 mg.

Children 4-10 years old 800 mg.

Children 10-18 years old 1300 mg.

Adults 1000-1500 mg.

There are many calcium fortified foods on the market today including fortified milk substitutes, breads, cereals, and juices. Beans, broccoli, kale, collard greens, sardines, and salmon are also rich in calcium.

Calcium casienate is a milk ingredient (see above) and is not a safe source of calcium.

Calcium carbonate, calcium lactate, calcium phosphate, calcium proprionate, and others do not contain milk products & should be safe.