Dairy allergy, or milk allergy, refers to any allergic reaction caused by a component of cow's milk. The three components of cow's milk that cause dietary reactions are casein protein, whey protein, and lactose sugar. Casein and whey are considered more likely to cause true allergies, while lactose causes a well-known intolerance in many adults (and some children) due to the body's lack of an enzyme known as lactase.
Similar components to cow's milk are found in the milk of other ruminants, including goats and sheep, so any patient with a dairy allergy who is considering using other animal milk as a substitute for cow's milk should talk to their allergist before proceeding.
Dairy allergies may appear with a wide variety of symptoms, including hives (urticaria), eczema, chronic congestion, and diarrhea. Lactose intolerance, like many other dietary intolerances, causes gastrointestinal symptoms, such as bloating, cramping, and diarrhea. As always, if you suspect you or your child has a food allergy, contact your physician.
Preventing Dairy Allergies:
Because dairy allergies are especially prevalent among babies, parents with atopic families - that is, families with a history of severe allergies - should discuss feeding options with their pediatricians before delivery, if at all possible. There is some evidence that nursing exclusively until six months and delaying the introduction of solid foods until that time can help prevent the development of allergies.
Foods Containing Dairy Products:
Cheese, butter, yogurt, cream, kefir, sour cream, and ice cream, unless specifically formulated to be dairy-free, always contain milk. Milk is also present in many types of processed food. Processed foods that are likely to contain dairy products include chocolate, salad dressings, pastries, snack foods with butter or cheese flavorings (even if they're artificial), soups, and even canned tuna and deli meats. As with any food allergy, never eat any processed food unless you have read the label, and always be aware of cross-contamination risks from utensils or surfaces where dairy products may have been prepared.
Dairy Products and Labeling Laws:
Dairy is one of the eight most common allergens in the United States, and as such, current food labeling laws require that the presence of milk be clearly marked on ingredient labels. However, it's best to learn the myriad names dairy products appear on in labels. While FDA laws require that the presence of milk be marked in plain English, it's safest to rely on that in conjunction with your own knowledge of dairy-containing ingredients. This printable list includes aliases for milk on food labels plus some foods that are especially likely to contain milk.
Living with Dairy Allergies and Lactose Intolerance:
You'll find substitutes for milk products in many supermarkets and health-food stores. Always check these for the presence of dairy, however; some may include traces of milk and thus be unsuitable for someone with allergies. With that caveat, try the many milk substitutes on the market for baking, drinking, and cooking. Soy milk, rice milk, and nut milks are but a few of the varieties available, and each has different properties. Rice milk is low in protein (so it acts quite differently than cow's milk in baking) but has a mild taste; in its vanilla flavor it is delicious on cereal and good for drinking plain. Soy milk and nut milks have a stronger flavor and can work well in baked goods.
Milk has a somewhat outsized reputation as a nutritional powerhouse. However, with planning, you can easily replace the nutrients in milk. Be especially aware of calcium, protein, and vitamins A, D, E, and K, which are found in abundance in dairy products.
You'll find an even wider variety of dairy-free products at natural foods stores, co-ops, and specialty chains like Whole Foods Market and Fresh Market. There are also online dairy-free retailers like The Wheat- and Dairy-Free Supermarket.
Whether you've got a dairy allergy or lactose intolerance in your family, or you're simply giving up milk for a while as part of an elimination diet, you may find yourself checking out the rows of milk alternatives in the grocery store. There are quite a few options available, and most have slightly different properties for drinking and cooking.
Non-Dairy Substitutes / Dairy Alternatives
The following dairy alternatives / non-dairy substitutes are increasingly available from health shops and some supermarkets :
- Soya milk, Rice Dream, and oat milk drink. Soya milk drinks are also available flavoured with strawberry or chocolate and rice milk drinks are available in some flavours. Rice milk, although sweet, contains no added sugar.
- Soya cheese, both in hard and soft forms is available and also tofu cheese. Soya soft cheese and Veeze cheese spread can be used like Dairylea. Toffutti is a good cream cheese alternative, and cheese slices are now available.
- Soya yoghurts make an excellent snack. They come in many flavours and are sweetened with fruit juice. Many soya yoghurts and desserts have a long shelf life and do not need refrigerating, making them ideal to keep in the drawer at work. Live soya yoghurts containing beneficial cultures are now available from some supermarkets. These are fresh, and so kept in the chilled cabinets with other fresh yoghurts.
- For desserts, use soya cream, soyasun desserts, soya ice cream and soya vanilla dessert (great substitute for custard) and other Provomel deserts.
- Yeast flakes can be delicious sprinkled onto dishes or on toast, giving quite a cheesy taste and lots of B vitamins. Not suitable for a yeast free diet though.
- For sandwich fillers and toppings, use avocado, humus, tahini (mix 1 tablespoon of tahini in water and lemon juice until creamy), salads, guacamole, unhydrogenated vegetable margerines such as Pure, Vitquel, Vitaseig, and Suma.
- You can make your own nut milk by blending almonds in a food processor with water until smooth. Adjust the consistency as required.
If you are avoiding dairy foods, it is wise to avoid goats and sheeps milk products, unless you have been otherwise advised during your consultation with a qualified Nutritionist.
Here's a cheat sheet to your options. Just be prepared to sample a variety to figure out which taste suits you best; most are quite distinctive.
Lactose-free milk is only suitable for people with lactose intolerance; it contains the same proteins as milk and is just as allergenic for people with dairy allergies.
That said, for people with an intolerance, lactose-free milk is almost indistinguishable from "regular" milk. The lactase enzyme added to regular milk to break down lactose into simpler sugars makes it taste slightly sweeter to most people. Lactose-free milk is available in both conventional and organic varieties.
Goat Milk and Other Ruminant Milk
Goat, sheep, and other ruminant milks contain similar proteins to cow's milk and are considered to have a high degree of cross-reactivity. That means that people with an allergy to cow's milk are likely to react to other ruminant milks, too.
If you or a loved one have a dairy allergy and you're considering trying goat milk (say, drinking it yourself, or giving it to a toddler), consult an allergist first. These milks do contain lactose and are not suitable for those who are lactose-intolerant without prior use of an over-the-counter lactase supplement.
The most widely available dairy-free milk alternative is soy milk, which can be found both in cartons on supermarket shelves as well as alongside milk in dairy cases. Competition from national brands, like 8th Continent and Silk, has lowered prices across the board, making soy milk one of the more cost-effective milk alternatives.
Soy milk is high in protein, making it an attractive alternative to milk for cooking and baking. Soy itself has a strong, distinctive taste, so make sure you like it before adding it to a sauce or to your favorite cereal.
Almond milk is among the most common nut milks. Like soy milk, nut milks are high in protein and are useful for baking. You may find their taste blends in with baked goods, coffee, or nutty cereals better than soy milk, although personal tastes vary. Nuts are also high in "good fats" and Vitamin E. One drawback to both soy and nut milk: both of these are common allergens in and of themselves.
Unlike soy and nut milks, rice milk is not especially allergenic, making it an attractive choice for families concerned about avoiding allergens in young children.
Rice milk, especially in its vanilla flavor, is quite sweet. But its texture is the most watery of all milk alternatives, and it is not particularly useful for cooking. Being low in protein, it does not make a good nutritional replacement for milk unless heavily fortified. It is best used as a beverage and for pouring on cereal.
A newer milk alternative, hemp milk may be difficult to find in some places. Its protein level and texture fall in between that of rice and soy milk. It is more watery than regular milk when poured, but has enough protein for use in some cooking applications -- sauces that don't rely on large amounts of protein, for example.
Like hemp milk, oat milk has a moderate amount of protein, making it more useful than rice milk for cooking. However, it's still not a true drop-in replacement for cow's milk in baking.
Oat milk may not be suitable for those with celiac disease, who may be sensitive to avenin protein found in oats. Oat milk is fairly mild and nutty tasting, and is a natural match for hot cereals and many breakfast foods.