- Lactose Intolerance vs. Dairy Allergy
- Milk Allergy
- What Happens With a Milk Allergy?
- How Can Doctors Tell It's a Milk Allergy?
- How Is It Treated?
- Living With a Milk Allergy
- What Is Casein? Foods With Casein, Casein Allergies, and More
- Milk Allergy: Symptoms, Treatment & Prevention
- What are the symptoms of a milk allergy?
- Milk | Food Allergy Research & Education
Lactose Intolerance vs. Dairy Allergy
Lactose intolerance and dairy allergy sound a lot a. Many people think they’re the same thing. But, how they’re caused (and how they affect your body) are very different.
Lactose intolerance involves the digestive system: If you have it, your body doesn’t make lactase, the enzyme needed to digest lactose. That’s the sugar in milk.
Instead of digesting normally in your stomach and small intestine, undigested lactose moves into your colon, where it’s broken down by bacteria and causes bloating and gas.
It can be uncomfortable, but it’s not dangerous.
Lactose intolerance is common in adults – about 30 million Americans have it by age 20. It’s more common in people with Asian, African or Native American heritage and less common in people with a northern or western European background.
Dairy allergy involves the immune system: If you have it, your body reacts to the proteins in milk and other dairy products as if they’re dangerous invaders. It releases substances that cause allergy symptoms. This allergic reaction can be mild (rashes) to severe (trouble breathing, loss of consciousness).
Dairy allergy is one of most common allergies, especially in children. As many as 2 in every 100 children under 4 years old are allergic to milk. It’s even more common in babies.
Some symptoms of lactose intolerance and dairy allergy may be the same:
- Nausea; sometimes vomiting
- Abdominal cramps
But dairy allergy can also cause a reaction in other parts of your body, including the skin and lungs:
- Swelling, often in the lips and face
- Tightness in throat
- Trouble swallowing
There may be blood in the stool (poop) too, especially in babies.
Anaphylaxis is a serious, life-threatening allergic reaction and often begins minutes after you eat a food you’re allergic to, but sometimes it can happen hours later. It usually involves more than one symptom in more than one part of your body at the same time.
If you have a severe allergy or if you’ve ever had anaphylaxis in the past, talk to your doctor about carrying an injectable epinephrine (Adrenaclick, Auvi-Q, EpiPen, a generic auto-injector, Symjepi) to slow down or stop the allergic reaction.
You’re more ly to develop dairy allergy if:
- You have other allergies
- You have eczema
- One or both of your parents has a food or other allergy, hay fever, eczema or asthma
- You’re young. Milk allergy is more common in children. As you get older, your digestive system is less ly to react to milk, but you're lier to have lactose intolerance.
First your doctor will take your medical history to understand your symptoms and how your body reacts to dairy foods. Then you’ll be tested to confirm whether it’s lactose intolerance or a dairy allergy.
Lactose tolerance test: You’ll drink a liquid that contains a lot of lactose. About 2 hours later, the amount of glucose (sugar) in your bloodstream will be measured. If your glucose level doesn’t rise, you’re not digesting the lactose in the drink.
Hydrogen breath test: You’ll drink a liquid that contains a lot of lactose. Then, the hydrogen in your breath will be measured at regular intervals. If you’re not digesting lactose, it will be broken down in your colon, releasing hydrogen that can be detected in your breath.
Stool acidity test: Babies and children who can’t be tested otherwise can have their stool tested for lactic acid caused by the breakdown of undigested lactose in the colon.
Skin prick test: A small drop of liquid containing the dairy allergen is placed under your skin on your forearm or back. If a raised bump surrounded by itchy red skin appears, a dairy allergy is ly.
Your doctor might have you take a blood test too, which measures the amount of certain antibodies in your blood.
Both tests can have “false positives.” You can test positive for an allergy even though you really don’t have it. Your allergist will explain the results.
If an allergy is still suspected but not confirmed, your doctor may have you take an oral challenge. You’ll be fed different foods that may or may not contain milk in increasing amounts to see if you react to food that contains milk.
Lactose intolerance is easily managed, mostly by limiting the amount of dairy food and drink you consume. You can also try lactose-reduced ice cream and milk, or take lactase enzyme supplements when you eat dairy products to help your body digest lactose.
If you have dairy allergy, you’ll need to avoid all dairy foods and other foods that contain dairy products.
Staying safe means reading food labels to see if milk or ingredients containing milk are included. Milk proteins are found in many foods you wouldn’t expect. Some canned tuna, energy drinks and even chewing gum contain them. And don’t eat lactose-reduced foods if you have dairy allergy. They still contain the milk proteins that can cause allergic reactions.
American Academy of Allergy Asthma & Immunology: “Anaphylaxis,” “Anaphylaxis Quiz.”
Food Allergy Research & Education: “Milk Allergy,” “About Anaphylaxis,” “Blood Tests.”
Mayo Clinic: “Lactose intolerance,” “Milk allergy.”
MedlinePlus: “Lactose intolerance.”
UptoDate: “Milk allergy: Clinical features and diagnosis.”
© 2019 WebMD, LLC. All rights reserved. Lactose Intolerance Or IBS?
Henglein and Steets/Cultura/Getty
Milk allergy is the most common food allergy for children, and is the second most common food allergy for adults.
The rate of milk allergy, similar to other food allergies, seems to be increasing and affects at least 3% of all children.
While it is relatively common for children to outgrow their milk allergy, sometimes at very young ages, milk allergy can persist into adulthood and even last a lifetime.
Cow’s milk contains many allergens, which are most commonly broken down into the casein and whey components. The whey components include alpha and beta-lactoglobulins, as well as bovine immunoglobulin.
The casein components include alpha and beta-casein components.
Allergies to the lactoglobulin components tend to be more easily outgrown by children, whereas allergies to the casein components tend to persist into adolescence or adulthood.
In children and adults who are predisposed to allergic diseases, the body produces allergic antibodies against various milk allergens. These allergic antibodies bind to allergic cells in the body, called mast calls and basophils.
When milk or dairy products are consumed, these allergic antibodies bind to the milk proteins, causing the allergic cells to release histamine and other allergic chemicals.
These allergic chemicals are responsible for the allergic symptoms that occur.
Symptoms of milk allergy may vary from person to person. Classically, milk allergy most often causes allergic skin symptoms such as urticaria (hives), angioedema (swelling), pruritus (itching), atopic dermatitis (eczema) or other skin rashes.
Other symptoms may involve the respiratory tract (asthma symptoms, nasal allergy symptoms), gastrointestinal tract (nausea, vomiting, diarrhea), and even anaphylaxis.
These classic symptoms of milk allergy are caused by the presence of allergic antibody, and are referred to as being “IgE mediated”.
Milk allergy not caused by allergic antibodies, referred to as “non-IgE mediated,” can also occur.
These reactions are still caused by the immune system, as opposed to reactions not caused by the immune system, such as with lactose intolerance.
These non-IgE mediated forms of milk allergy include the food protein-induced enterocolitis syndrome (FPIES), food protein-induced proctitis, eosinophilic esophagitis (EoE; which can also be IgE-mediated) and Heiner syndrome.
IgE-mediated reactions to milk are typically diagnosed with allergy testing, which can be performed using skin testing or by demonstration of IgE against milk protein in the blood. Skin testing is the most accurate way to diagnose milk allergy, although blood testing is helpful in determining when and if a person is ly to have outgrown a milk allergy.
The diagnosis of the non-IgE mediated milk allergy reactions is more difficult to make, and allergy testing is not useful. Most commonly, the diagnosis is made symptoms and the lack of allergic antibodies being present. Sometimes, patch testing can be helpful in the diagnosis of FPIES and EoE, and blood testing for IgG antibodies is used to diagnose Heiner syndrome.
The only widely accepted treatment of milk allergy at the present time is avoidance of milk and dairy products. Oral immunotherapy (OIT) for milk allergy is currently being studied at medical universities around the world, with promising results.
OIT involves giving very small amounts of milk protein orally to people with milk allergy, and gradually increasing the amount over time. This often results in a person being able to tolerate fairly large amounts of milk protein over time.
It is important to realize, however, that OIT for milk allergy can be extremely dangerous, is only being performed in university settings under close medical supervision. OIT for milk allergy is ly to be many years away from being performed by your local allergist.
Learn how to follow a milk-free diet.
Many children will eventually outgrow their allergy to milk, especially those with non-IgE mediated allergy. For those with an IgE-mediated milk allergy, it may not occur as quickly as previously thought.
Older studies suggested that 80% of children outgrow milk allergy by age 5; a more recent study performed on a larger number of children suggests that nearly 80% of children do outgrow milk allergy – but not until their 16th birthday.
Measuring the amount of allergic antibody to milk can help predict the lihood of a person outgrowing their allergy to milk. If the allergic antibody to milk is below a certain level, an allergist may recommend performing an oral food challenge to milk under medical supervision. This is the only safe way to truly see if a person has outgrown their milk allergy.
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What Happens With a Milk Allergy?
Food allergies involve the body's immune system, which normally fights infection. When someone is allergic to a particular food, the immune system overreacts to proteins in that food.
People who are allergic to cow's milk react to one or more of the proteins in it. Curd, the substance that forms chunks in sour milk, contains 80% of milk's proteins, including several called caseins (pronounced: KAY-seenz). Whey (pronounced: WAY), the watery part of milk, holds the other 20%. A person may be allergic to proteins in either or both parts of milk.
Every time the person eats these proteins, the body thinks they are harmful invaders. The immune system responds by kicking into high gear to fend off the “invader.” This causes an allergic reaction, in which chemicals histamine are released in the body.
The release of these chemicals can cause someone to have the following problems:
- trouble breathing
- throat tightness
- itchy, watery, or swollen eyes
- red spots
- a drop in blood pressure
Milk allergy is most food allergy reactions: It usually happens within minutes to hours after eating foods that contain milk proteins.
Although it's not common, milk allergies can cause a severe reaction called anaphylaxis. Anaphylaxis may begin with some of the same symptoms as a less severe reaction, but then quickly worsen. A person might have trouble breathing, feel lightheaded, or pass out. If it's not treated, anaphylaxis can be life-threatening.
Milk allergy is often confused with lactose intolerance because people can have the same kinds of things happening to them ( stomach pains or bloating, for example) with both conditions. But they're not related:
- Milk allergy is a problem involving the immune system.
- Lactose intolerance involves the digestive system (which doesn't produce enough of the enzyme needed to break down the sugar in milk).
How Can Doctors Tell It's a Milk Allergy?
If your doctor suspects you might have a milk allergy, he or she will probably refer you to an allergist or allergy specialist for more testing. The allergy specialist will ask you questions — how often you have the reaction, the time it takes between eating a particular food and the start of the symptoms, and whether any family members have allergies or conditions eczema and asthma.
The allergy specialist may do a skin test on you. This involves placing liquid extracts of milk protein on your forearm or back, pricking the skin a tiny bit, and waiting to see if a reddish, raised spot forms, indicating an allergic reaction.
You may need to stop taking anti-allergy medications (such as over-the-counter antihistamines) or prescription medicine 5 to 7 days before the skin test because they can affect the results. Most cold medicines and some antidepressants also may affect skin testing. Check with the allergist's office if you are unsure about what medications need to be stopped and for how long.
The doctor also might take a blood sample and send it to a lab, where it will be mixed with some of the suspected allergen and checked for IgE antibodies.
These types of tests are used for diagnosing what doctors call a fast-onset type of milk allergy. But for people whose allergic reactions to milk develop more slowly, skin and blood tests are not as helpful.
In these cases, doctors try to diagnose the person using a food challenge. The person is told not to eat or drink anything made with milk for a period of time — usually a few weeks.
Then, during the challenge, the person eats foods containing milk under a doctor's close supervision.
If symptoms come back after eating milk products, it's a pretty sure bet the person has a milk allergy.
How Is It Treated?
To treat a milk allergy, the person who is allergic needs to completely avoid any foods that contain milk or milk products.
Avoiding milk involves more than just leaving the cheese off your sandwich. If you are allergic to milk, you need to read food labels carefully and not eat anything that you're not sure about. It's a good idea to work with a registered dietitian to develop an eating plan that provides all the nutrients you need while avoiding things you can't eat.
If you have a severe milk allergy — or any kind of serious allergy — your doctor may want you to carry a shot of epinephrine (pronounced: eh-peh-NEH-frin) with you in case of an emergency. Epinephrine comes in an easy-to-carry container about the size of a large marker. It's easy to use — your doctor will show you how.
If you accidentally eat something with milk in it and start having serious allergic symptoms — swelling inside your mouth, chest pain, or difficulty breathing — give yourself the shot right away to counteract the reaction while you're waiting for medical help. Always call for emergency help (911) when using epinephrine. You should make sure your school and even good friends' houses keep injectable epinephrine on hand, too.
Keeping epinephrine with you at all times should be just part of your action plan for living with a milk allergy. It's also a good idea to carry an over-the-counter antihistamine, which can help ease allergy symptoms in some people. But antihistamines should be used in addition to the epinephrine, not as a replacement for the shot.
If you've had to take an epinephrine shot because of an allergic reaction, go immediately to a medical facility or hospital emergency room so they can give you additional treatment if you need it. Sometimes, anaphylactic reactions are followed by a second wave of symptoms a few hours later. So you might need to be watched in a clinic or hospital for 4 to 8 hours following the reaction.
Living With a Milk Allergy
It can be challenging to eliminate milk from your diet, but it's not impossible. Because most people don't get enough calcium in their diets even if they do drink milk, many other foods are now enriched with calcium, such as juices, cereals, and rice and soy beverages. But before you eat or drink anything calcium-enriched, make sure it's also dairy-free.
Milk and milk products can lurk in strange places, such as processed lunchmeats, margarine, baked goods, artificial butter flavor, and non-dairy products. Chocolate is another product that may contain dairy — so be sure to check the label before you eat it.
Manufacturers of foods sold in the United States must list on their labels whether a food contains any of the most common allergens. This means that you should be able to find the word “milk” stated plainly in the ingredients list, in parentheses in the ingredients list, or somewhere on the label with a statement : “Contains milk.”
It is optional, however, for food manufacturers to use “may contain” statements. The U.S. Food and Drug Administration does not control whether companies can say things “Processed in a facility that also processes milk products” or “May contain milk.” So call the manufacturer to be sure if you see statements this on a food label.
New labeling requirements make it a little easier than reading the ingredients list — instead of needing to know that the ingredient “hydrolyzed casein” comes from milk protein, you should be able to tell at a glance which foods to avoid. But it's still a good idea to get to know the “code words” for milk products when you see them in the ingredients of a food.
Some ingredients and foods that contain milk are:
- casein, calcium casein, casein hydrolysate, magenesium casein, potassium casein, rennet casein, sodium casein
- dairy products cheese, yogurt, milk, pudding, sour cream, and cottage cheese
- butter, butter flavoring (such as diacetyl), butter fat, butter oil, ghee
- lactalbumin, lactoalbumin phosphate, lactaglobulin, lactose, lactoferrin, lactulose
- non-dairy creamers
- whey, whey hydrolysate
Vegan foods are made without animal products, such as eggs or milk. You can buy vegan products at health food stores. Be careful to read the labels of soy cheeses, though. They may say “milk-free” but could contain milk protein.
For your sweet tooth, soy- or rice-based frozen desserts, sorbets, and puddings are good substitutes for ice cream (as long as you're not allergic to soy), as are ice pops. For baking, milk substitutes work as well as milk and some come out better. Dairy-free margarine works as well as butter for recipes and spreading on your bagel.
Try to avoid fried foods or foods with batter on them. Even if the batter doesn't contain milk products, the oil used to fry the foods may have been used to fry something that contains milk.
People are usually understanding when it comes to food allergies — nobody wants to risk your health. When dining out, tell the waitstaff about anything you're allergic to. Order the simplest foods and ask the waitstaff detailed questions about menu items. At a friend's house, explain your situation and don't be embarrassed to ask questions if you're staying for a meal.
Having a milk allergy doesn't mean you can't still enjoy eating. In fact, some people think that some of the milk substitutes — vanilla soy milk — taste better than regular cow's milk. As with any specialized diet, you'll probably find that avoiding milk gives you the chance to explore and discover some great foods that you'd never have found otherwise!
Reviewed by: Rupal Christine Gupta, MD
Date reviewed: February 2015
What Is Casein? Foods With Casein, Casein Allergies, and More
If a glass of milk or a slice of pizza causes swollen lips, hives, or other significant symptoms, you may have an allergy to casein, a protein in milk. Another milk protein associated with food allergies is whey. Some people are allergic to both casein and whey.
Most people with an allergy to milk have symptoms which appear when they are infants and outgrow them as they get older. However, some people do not outgrow these symptoms and continue to be allergic as adults. It is unusual to develop an allergy to milk proteins later in life. However, the development of lactose intolerance tends to increase with age.
Symptoms include bloating, pain, gas, diarrhea or gastroesophageal reflux. Lactose intolerance is not an allergy but an intolerance, where individuals are unable to digest lactose, the sugar in milk. Lactose intolerance is uncomfortable but not life threatening. It is, on the other hand, important to learn how to recognize and avoid potential allergens.
A casein allergy occurs when your body's immune system mistakenly thinks the protein is harmful and inappropriately produces allergic (IgE) antibodies for protection. Within minutes, the interaction between these antibodies and the specific protein triggers the release of body chemicals such as histamine that cause symptoms which may include:
- Swelling of the lips, mouth, tongue, face, or throat
- Skin reactions such as hives, a rash, or red, itchy skin
- Nasal congestion, sneezing, runny nose, itchy eyes, coughing, or wheezing
The most serious reaction to milk allergy is called anaphylaxis. This is a potentially life threatening reaction that can occur rapidly. Allergy to foods (including casein in milk) is believed to be the leading cause of anaphylaxis outside the hospital setting. People who have asthma and food allergies are at greater risk of complications and death if they develop an anaphylactic reaction.
Symptoms such as swelling inside your mouth, chest pain, hives or difficulty breathing within minutes of consuming a milk product may mean you are experiencing an anaphylactic reaction and need emergency medical attention.
If you are diagnosed with a food, or specifically milk or casein, allergy, your doctor may advise you carry injectable of epinephrine with you in case you accidentally eat a food containing casein and have a reaction. Your doctor or pharmacist can show you how to give the epinephrine.
You may also want to keep an over-the-counter antihistamine on hand to help alleviate allergy symptoms. In the case of a severe or serious reaction, though, the antihistamine will not be effective.
In that caxse, you need epinephrine, which is the same as adrenaline, the chemical your body produces at times of excitement or stress.
If you experience a severe allergic reaction with symptoms of anaphylaxis, give yourself the epinephrine to counteract the reaction until help arrives. Do not hesitate to use the epinephrine auto-injector, even if you aren’t sure that you are having an allergic reaction.
The medication won’t hurt and could save you. Call 911 for emergency help.
Because up to one-third of anaphylactic reactions can have a second wave of symptoms several hours following the initial attack, you may need to be observed in a clinic or hospital for four to eight hours after the initial reaction.
The best treatment for milk/casein allergy is prevention or avoidance. To prevent an allergic reaction to casein, you must follow a casein-free diet, avoiding all foods that contain milk or milk products.
Avoiding milk products involves more than just leaving the cheese off your sandwich. It may also mean leaving off the deli meat if it was cut with the same equipment used to slice the cheese. Even miniscule amounts of casein may be enough to trigger a reaction.
In people who are allergic, the level of sensitivity varies from person to person. Some individuals might be able to tolerate small amounts of milk, especially if the milk is baked or cooked in items.
However, for most individuals, strict avoidance is best since the amount of milk may not be consistent between products from different manufacturers or even between batches from the same manufacturer.
Giving up milk doesn't have to mean giving up calcium. Because even people who drink milk often don't get enough calcium in their diets, many other foods — including juices, cereals, almond milk, and rice and soy drinks — are now enriched with calcium. Vegetables including kale, spinach, and broccoli are good sources of calcium as well.
Whenever you're selecting packaged foods, always check the label for milk ingredients — even with foods luncheon meats and candy.
In addition to casein, ingredients and foods to watch for and avoid include:
- Calcium casein, casein hydrolysate, magnesium casein, potassium casein, rennet casein, sodium casein
- Dairy products cheese, yogurt, milk, pudding
- Butter, butter flavoring, butter fat
- Lactalbumin, lactoalbumin phosphate, lactaglobulin, lactose
- Nondairy creamers
- Whey, whey hydrolysate
For food products sold in the U.S., manufacturers now must list on the label whether a food contains any of the most common allergens. If a food contains casein, you should find words somewhere on the label such as: “contains milk ingredients,” “made with milk ingredients,” or “processed in a facility that also processes milk products.”
Here are some more tips for casein-free eating:
- Instead of ice cream, try fruit-flavored soy or rice-based frozen desserts, sorbets, and puddings. There are also ice creams made from coconut milk available.
- Use vegetable margarine for cooking and to spread on toast.
- Avoid foods fried in batter, which may contain milk. In some cases, foods fried in oil that has been used to fry something containing milk might be contaminated with small amounts of milk and can cause a reaction.
- When eating out, ask the wait staff detailed questions about menu items and tell them you are allergic to milk.
- Explore new foods vanilla-flavored soy milk, which some people prefer to cow's milk.
It may be a challenge to eliminate all milk from your diet, but with a little effort you can still have proper nutrition with foods you enjoy.
The Nemours Foundation: “Milk Allergy.”
Children's Hospital Boston Center for Young Women's Health: “Milk Allergy: A Guide for Teens.”
The Food Allergy & Anaphylaxis Network: “Anaphylaxis.”
© 2018 WebMD, LLC. All rights reserved. Food Substitutes
Milk Allergy: Symptoms, Treatment & Prevention
In this article, milk refers specifically to cow’s milk and not to other types of milk such as soymilk, rice milk, goat’s milk, etc., unless otherwise specified.
Milk is one of the most common food allergens. An allergen is a food that causes an allergic reaction, such as hives, swelling, and trouble breathing. Although a milk allergy occurs most often in young children, it can appear at any age. The allergic reaction can be triggered by milk-containing foods that had been previously eaten without any problems.
A milk allergy can develop in both formula-fed and breastfed infants. Some infants have a type of cow’s milk allergy commonly referred to as “cow’s milk protein allergy,” which causes blood in the stool. Other infants have an allergic reaction that includes immediate symptoms, such as hives and vomiting. In both cases, many infants will outgrow the symptoms during childhood.
A milk allergy is not the same thing as lactose intolerance. Lactose intolerance is the inability to digest lactose, a sugar found in many dairy products. This leads to bloating and diarrhea after eating or drinking lactose-containing foods. Lactose intolerance is uncommon in infants and young children and is more common in adults.
What are the symptoms of a milk allergy?
Allergic reactions to foods usually begin within minutes of eating the allergen-containing food though may occur up to 2-3 hours after ingestion. The severity of symptoms can vary widely from one person to another.
Mild symptoms may include itching and a few hives while a severe allergic reaction may include life-threatening symptoms, such as difficulty breathing and a sudden drop in blood pressure.
The symptoms of an allergic reaction may include any or several of the following:
Other things to keep in mind if you or a loves one has milk allergy:
- Many people allergic to cow’s milk may not tolerate milk from other mammals, such as milk of goats or sheep.
- Less commonly, some people with cow’s milk allergy may have a reaction after eating beef.
- History of a mild reaction does not mean a subsequent reaction will also be mild.
- History of a severe reaction does place you at risk for a subsequent severe reaction.
Your doctor can make recommendations on alternatives to milk- your child’s age.
Last reviewed by a Cleveland Clinic medical professional on 06/24/2019.
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Milk | Food Allergy Research & Education
To prevent a reaction, it is very important that you avoid cow’s milk and cow’s milk products. Always read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.
If you are allergic to cow’s milk, your doctor may recommend you also avoid milk from other domestic animals. For example, goat's milk protein is similar to cow's milk protein and may cause a reaction in people who have a milk allergy.
Milk is one of the eight major allergens that must be listed on packaged foods sold in the U.S., as required by federal law.
Avoid foods that contain milk or any of these ingredients:
- Butter, butter fat, butter oil, butter acid, butter ester(s)
- Casein hydrolysate
- Caseinates (in all forms)
- Cottage cheese
- Lactalbumin, lactalbumin phosphate
- Milk (in all forms including condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, low-fat, malted, milkfat, non-fat, powder, protein, skimmed, solids, whole)
- Milk protein hydrolysate
- Rennet casein
- Sour cream, sour cream solids
- Sour milk solids
- Whey (in all forms)
- Whey protein hydrolysate
Other Possible Sources of Milk:
- Artificial butter flavor
- Baked goods
- Caramel candies
- Lactic acid starter culture and other bacterial cultures
- Luncheon meat, hot dogs and sausages, which may use the milk protein casein as a binder. Also, deli meat slicers are often used for both meat and cheese products, leading to cross-contact.
- Non-dairy products, as many contain casein
- Shellfish is sometimes dipped in milk to reduce the fishy odor. Ask questions when buying shellfish.
- Tuna fish, as some brands contain casein
- Some specialty products made with milk substitutes (i.e., soy-, nut- or rice-based dairy products) are manufactured on equipment shared with milk.
- Many restaurants put butter on grilled steaks to add extra flavor. You can’t see the butter after it melts.
- Some medications contain milk protein.
Allergens are not always present in these food and products, but milk protein can appear in surprising places. Again, read food labels and ask questions if you’re ever unsure about an item’s ingredients.
Milk in Kosher Foods
Kosher Dairy: A “D” or the word “dairy” following the circled K or U on a product label means the product contains or is contaminated with milk protein. Avoid these products if you have a milk allergy.
Kosher Pareve: A food product labeled “pareve” is considered milk-free under kosher dietary law. However, a product may be considered pareve even if it contains a very small amount of milk protein—possibly enough to cause an allergic reaction in certain people. Do not assume that these products will always be safe.
Do These Ingredients Contain Milk?
People allergic to milk often have questions about the following ingredients. These ingredients do not contain milk protein and are safe to eat.
- Calcium lactate
- Calcium stearoyl lactylate
- Cocoa butter
- Cream of tartar
- Lactic acid (however, lactic acid starter culture may contain milk)
- Sodium lactate
- Sodium stearoyl lactylate