DEPARTMENT OF ALLERGY & IMMUNOLOGY

ROYAL CHILDREN’S HOSPITAL, MELBOURNE

COWS MILK ALLERGY

Cow’s milk is one of the most common causes of food allergic reactions in children. At this
time there is no treatment for food allergy. If your child is allergic to cows milk, strict
avoidance of milk and all milk containing foods is the only way to prevent symptoms.

Cow’s Milk Alternatives

Milk is an excellent source of protein and calcium, therefore it is important to replace it with a
suitable alternative to ensure adequate nutrition and growth. The most appropriate
alternative will depend on your child’s age.

Infant formula is usually based on cow’s milk. Children under 1 year of age will require an
alternative infant formula. Discuss the options with your doctor or dietitian.

Partially Hydrolysed Infant Formulae Not suitable for infants with established cows
Nan HA, Karicare Sensikare, S26 HA milk allergy.
Soy Infant Formulae Reasonable first alternative for infants over
Infasoy, Isomil, Karicare Soy 6mths of age
Up to 40% of children who are allergic to
cows milk will also be allergic to soy
products.
Extensively Hydrolysed and Amino Acid Specialised Hypoallergenic formula only
Based Infant Formulae available on prescription from your doctor
PeptiJunior, Alfare, Elecare, Neocate and
Neocate Advance
Sheep and Goats milk Not suitable for infants under 12 months
Not a suitable alternative to cows milk
because they contain a similar protein to that
found in cows milk and could result in similar
symptoms.
Soy Milk Not suitable for infants under 12 months
Suitable for older children (1-2yrs) if soy is
tolerated.
Ensure you are using a brand with added
calcium.
Rice Milk Not suitable for infants under 2 years
Usually well tolerated if reactions to cows
milk and soy.
Low in fat and protein and need to use with
caution in children under 2 years of age or
children with slow growth.
Ensure you are using a brand with calcium
added.

The Department of Allergy and Immunology

Royal Children’s Hospital, Flemington Rd, Parkville 3052
Telephone: 61 (0)3 9345 5701 Facsimile: 61 (0)3 9345 4848
Email: [email protected]
 Will my child grow out of their allergy?

For the majority of children their cows milk allergy will resolve by 3-5 years of age. The
doctors will determine whether your child has grown out of their allergy by a combination of
skin testing and food challenge with milk. Skin tests may be repeated every 1-2 years. A
positive skin test to milk does not always mean your child will have symptoms when they
have milk or milk products, therefore a challenge may be the only way to determine if your
child has grown out of their milk allergy. Challenges may need to be done in a hospital by
experienced medical staff. Do not do challenges at home unless discussed with your doctor.

What about calcium?

If your child drinks less than 600ml/day of calcium fortified soy or rice milk, a calcium
supplement may be required. A suitable supplement is Sandocal (1/2 effervescent
tablet/day) providing 500mg.

AVOIDING MILK
Milk Free Foods containing milk or
likely to contain milk
Fruit and Vegetables All fresh dried and canned fruits Commercial potato salad,
and vegetables mashed potato, instant potato
Fruit and vegetable juices

Breads, Cereals and Wheat, oats, rice and other grains Some muesli, chocolate
Grains Plain breakfast cereals such as flavoured cereals
Weetbix, Cornflakes, Rice
Bubbles, Weeties etc
Plain baby rice cereal Baby rusks
Commercial mixed baby
cereals and muesli

Most breads are milk free Bread containing milk products

or cheese.
Commercial garlic bread

Pasta, spaghetti, noodles, cous Filled pasta eg spinach and

cous ricotta
Canned spaghetti and
macaroni cheese

Dairy Soy infant formula, soy milk Cow’s milk, reduced fat milk,
(calcium fortified) skim milk, sheep and goats
Specialised infant formula milk and regular and partially
hydrolysed infant formula
Lactose free milk
Condensed milk, evaporated
milk, buttermilk

Most soy yoghurt (a milk based Yoghurt, fruche, custard,

starter culture may be used which yoghurt drinks, fermented milk
highly sensitive children may drinks
react to) All cheeses including cheddar,
Soy Custard ricotta, cream and cottage
Most vegetarian or soy
cheeses
Ice cream, cream and sour
cream

The Department of Allergy and Immunology

Royal Children’s Hospital, Flemington Rd, Parkville 3052
Telephone: 61 (0)3 9345 5701 Facsimile: 61 (0)3 9345 4848
Email: [email protected]
 Check labels of sorbet, gelatin
and ice confection

Meat, chicken and All fresh and frozen meat, chicken Check labels of crumbed and
fish and other and fish battered products
protein foods Canned fish in brine, oil or water Check labels of patties,
Canned or dried beans and burgers, sausages and
legumes. meatloaf
Tofu Check labels of processed
meats and sandwich meats

Eggs Omelette, quiche, scrambled

egg

Plain baked beans Flavoured baked beans

Fresh nuts, nut pastes and

peanut butter

Cakes and Biscuits Homemade cakes, biscuits, Commercial cakes, biscuits,

muffins, slices and pancakes slices and pastries unless
using milk free margarine and soy labelled milk free
or rice milk Waffles, pancakes and pikelets

Most plain dry biscuits such as Check labels of flavoured dry

Salada, water crackers, rice biscuits
crackers

Sauces Vinegar based salad dressings Check labels of creamy salad

such as French, Italian and dressings such as coleslaw,
Balsamic Caesar and mayonnaise
Homemade and commercial Béarnaise sauce
gravies Tartare sauce
Tomato sauce Hollandaise sauce
Soy sauce Béchamel, white or cheese
sauce

Soups Homemade soup without milk Creamed soups

products

Jams and Spreads Vegemite, honey, jams, Nuttela, cheese spread

marmalade, peanut butter, golden
syrup

Lollies and Chips Plain potato and corn chips Check labels of flavoured chips
Popcorn and snacks

Hard boiled lollies, liquorice, Check labels of soft jube/jelly

chewing gum style confectionary, caramels,
fudge, butterscotch

Soy and dark chocolate White and milk chocolate

Drinks Fruit and vegetable juices Milk shakes and flavoured milk
Soft drinks and cordials drinks
Flavoured toppings Chocolate drink powders
Cocoa (Quik, Milo, Ovaltine)

The Department of Allergy and Immunology

Royal Children’s Hospital, Flemington Rd, Parkville 3052
Telephone: 61 (0)3 9345 5701 Facsimile: 61 (0)3 9345 4848
Email: [email protected]
 Malted milk powders
Coffee creamers, whiteners
and Coffee mixes
Sustagen and other high
protein drink powders

Fats and Oils Cooking oils Ghee, butterfat

Milk free margarines such as Margarine and butter

Nuttelex, Becel

Other Tomato salsa dip, Hommus dip Check labels of commercial

Stock cubes dips
Herbs and spices Pizza
Yoghurt sauce on souvlaki,
raita dip with Indian meals

LABEL READING

Ingredients List
All packaged foods must have an ingredients list. You must check this ingredients list for any
ingredients that may contain milk. Since 2002, it has been law that all potential food
allergens (peanut, tree nut, seafood, fish, milk, eggs, soybeans and wheat) must be clearly
identified, however small the amount.
Example: instead of simply casein the ingredients list should read casein (milk) or milk
casein.
ALWAYS check the ingredients list every time you buy the food as the ingredients of the
product may change.

“May contain traces of milk” statements

These statements are used by manufacturers to indicate that the product may be
contaminated with milk through processing and packaging. At present these statements
are voluntary and there are no clear guidelines for companies regarding how and when to
use them. The wording of the statements makes it very difficult to determine the level of
risk and a product that does not contain the statement may be no safer than a product
that does. The chances of having a significant allergic reaction through contamination
during processing is extremely unlikely. Most families choose to ignore these statements
as the only safe alternative is to avoid all commercial food products in your child’s diet.

LACTOSE IN MEDICATIONS

Lactose is the sugar contained in cow’s milk. The pure sugar form is used in medications.
The chance of a person with milk allergy reacting to pure lactose in medications is very low.

FOOD PREPARATION

Highly allergic children can have a mild reaction from foods contaminated with milk or from
cooking surfaces and utensils contaminated with milk or milk containing foods.

November 2007

The Department of Allergy and Immunology

Royal Children’s Hospital, Flemington Rd, Parkville 3052
Telephone: 61 (0)3 9345 5701 Facsimile: 61 (0)3 9345 4848
Email: [email protected]