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HF 271

Milk Allergy Diet

This handout explains what a milk allergy is and lists other food and drink options.

An allergy to cow’s milk is more common in young children than adults. Most children outgrow a milk allergy by age 5, though some may have it a lifetime. Blood and skin tests can help figure out when and if your child will outgrow their milk allergy. To treat a milk allergy, all milk and milk products are removed from the diet. 

Milk has many essential nutrients. These include protein, vitamins A and D, and calcium. The closest substitution for cow’s milk is soy-based infant formula or fortified soymilk. There are many milk substitutes on the market. Some are low in protein and calories, which can be a problem for toddlers and small children as they grow. 

Many products have milk or a milk byproduct in part of the food. Read all product labels closely. The Food Allergen Labeling and Consumer Protection Act of 2004 makes companies clearly list the eight most common food allergens on product labels. They must use the common name for the allergen. For example, “milk” must be used instead of “casein.” You will see this in the ingredient list or just below in “contains statement.”

Ingredients on the label that point out the presence of milk protein (the label should clearly state milk in common terms):

  • Butter or butter solids

  • Butter fat

  • Butter flavor

  • Buttermilk

  • Casein/caseinates (any form)

  • Cheese

  • Cottage cheese

  • Cream (and half and half)

  • Custard

  • Curds

  • Ghee

  • Lactoglobulin

  • Malted milk

  • Milk protein

  • Nisin

  • Nougat

  • Pudding

  • Rennet

  • Sodium caseinate

  • Sour cream

  • Whey (any form)

  • Yogurt

Foods that may point out the presence of milk protein (the label should clearly state if the food contains milk). If in question, call the company.

  • Caramel

  • Chocolate

  • Cold cuts, processed meats

  • High protein flours

  • Lactic acid starter culture

  • Lactose

  • Margarine

  • Non-dairy products

 Ingredients That Do Not Contain Milk Protein

  • Calcium lactate

  • Calcium stearoyl lactylate

  • Cocoa butter

  • Cream of tartar

  • Lactic acid (starter culture may contain milk)

  • Oleoresin

  • Sodium lactate

  • Sodium stearoyl lactylate

What to Look for When You Read a Food Label

  1. Is the allergen’s name in the ingredient list?

  2. Is the word “contains” followed by the name of the allergen—example, 

    “contains milk.”

  3. Does the ingredient list have the name in parentheses? For example, when the ingredient is a less common form of the allergen such as casein (milk).

“May Contain” Statements

Food companies put warnings on food labels. These include phrases like “may contain,” “processed in a facility that also processes” or “made on equipment with.” These warnings are often found after the ingredient list at the lower part of the food label. There are no laws that require these statements, when to include them and what to write.  

Drinks You Can Eat 

  • Protein hydrolysate formulas

  • Fortified soy milk

  • Soy formulas

  • Rice milk

  • Almond milk

  • Coconut milk

  • Fruit juices

  • Tea

  • Coffee

  • Carbonated drinks

Drinks to Avoid

  • Milk based infant formulas (ex: Good Start, Enfamil, Similac, Lactose free)

  • Milk

  • Cream

  • Dairy Creamers

  • Cocoa made with milk

  • Malted milk

  • Chocolate or cocoa drink mixes

  • Smoothies made with milk or yogurt

  • Powdered drink mixes with milk or milk-based ingredients

  • “Non-dairy” creamers

  • Whipped toppings that contain casein, sodium, caseinate, or other milk proteins

Candy You Can Eat

  • Plain sugar or honey candy

  • Fruit candy

  • Candy (jellybeans, licorice)

  • Marshmallows

Candy to Avoid

  • Caramels

  • Chocolates

  • Fudge

  • German chocolate

  • Milk chocolate

  • Nougat 

Cereals You Can Eat

  • Enriched and whole grain cereals (cooked or dry) that are prepared and served without milk protein 

Cereals to Avoid

  • Cereal mixes that contain milk protein

  • Any cereal cooked or served with milk or cream

Desserts You Can Eat 

  • Angel food cake

  • Gelatin desserts and ices without milk

  • Fruits

  • Any milk-free dessert that contains soy milk, fruit juice, or water as a milk substitute

  • Carob or plain cocoa powder sponge cake

  • Some dark baking chocolate

  • Icings made without milk or milk products

Dessert to Avoid

  • Any dessert made with dairy

  • Custard

  • Pudding made with milk (junket, tapioca)

  • Whipped cream topping

  • Some sherbet

  • Ice Cream

  • Cakes and cookies with dairy

  • Prepared flour mixes

  • Baklava

  • Baking mixes

  • Biscuits

  • Cheesecake

  • Coffee cakes

  • Cream-filled pastries, cream pies and crumb mixtures

  • Doughnuts

  • Pancakes made with milk or butter

  • Pie crusts made with butter

  • Popovers, sweet rolls, breads and

  • Pastries glazed with butter

Fats and Oils You Can Eat

  • Shortenings

  • Kosher margarine

  • Margarine made without milk protein

  • Vegetable oils

Fats and Oils to Avoid

  • Butter

  • Margarine that contains milk

  • Simplesse (fat substitute)

Fruit You Can Eat

  • Fresh or canned fruit served without milk, cream, sour cream or whipped cream

Fruit to Avoid

  • Some store-bought gelatin desserts that contain sour cream, whipped cream or whipped topping 

Meat/Meat Substitutes You Can Eat

  • All meat, fish or poultry prepared without milk or milk products

  • Sausage products without milk filler

  • Eggs cooked without milk, butter or milk products

  • Peanut butter

  • Soy or rice cheeses (read labels)

  • Soy, almond, coconut yogurts

Meat/Meat Substitutes to Avoid

  • Any meat, fish, or poultry cooked in butter or margarine that contains milk

  • Cold cuts and sausage with milk filler

  • Eggs cooked with milk or fried in butter

  • Breaded or creamed meat dishes

  • Meats in white sauces (Mornay or Béarnaise)

  • Quiches, soufflés, fondues

  • Cottage cheese

Potato/Pasta You Can Eat

  • Potatoes, pasta, rice without milk or cheese

Potato/Pasta to Avoid

  • Mashed potatoes made with milk or cheese

  • Creamed or scalloped dishes

  • Pasta made with cheese (ex: lasagna)

  • Instant potatoes

Salad and Dressings You Can Eat

  • All fruit and vegetable salads with dressings that do not contain milk or milk products

  • Real mayo

Salad and Dressings to Avoid

  • Yogurt or sour cream dressings

  • Cooked dressings that contain milk

  • Salads that contain cheese

Sauces You Can Eat

  • Gravy made with water or broth

Sauces to Avoid

  • Gravy made with milk

  • White sauces (Béchamel, Florentine, Mronay, dijonnaise, Hungarian, alfredo

  • Pasta sauces that contain cheese

Seasonings You Can Eat

  • Salt, spices and herbs

  • Mustard

  • Relishes

Seasonings to Avoid

  • Read labels on marinades, dips, appetizers, spreads, sauce mixes, and gravies 

Soups You Can Eat

  • Broth soups made without butter or margarine that contains milk (Bouillon, consume)

  • Homemade soup made without milk or milk products 

Soups to Avoid

  • Some canned soups (bouillabaisse chowders, cream soups made with butter, cream, milk or margarine that contains milk

  • All cream soups

Sweets You Can Eat 

  • All sugars (brown, white, powdered)

  • Honey, jam, jelly and syrups

Sweets to Avoid

  • None

Vegetables You Can Eat

  • Any canned, frozen or raw vegetable cooked without milk or milk products

Vegetables to Avoid

  • Au gratin/scalloped dishes

  • Creamed vegetables

  • Any vegetable seasoned with butter, cream, milk or margarine that contains milk, or cheese

Formulas or Milk Substitutes

Substitute formulas include soybean formulas such as Isomil® and Prosobee®. Protein hydrolysate formulas may be okay to use and include: Alimentum®, Nutramigen® and Pregestimil®. Amino acid-based formulas are often used for milk allergies. Neocate® and Elecare® are widely used amino acid-based formulas.

Soy formulas are well accepted by most children, especially if started when they are a baby. The nutrients in calcium fortified soymilk is almost equal to that of cow’s milk. The infant soymilk formulas are fortified with needed vitamins, minerals, and essential fatty acids. There are many other good milk substitutes for people with a milk allergy. Most are fortified with vitamin D and calcium. Talk with your doctor or dietitian about other options for you.

Tips

  • Some milk-sensitive people may also become allergic to soy protein.

  • If you buy “deli” meats, ask what other products are cut on the slicers to reduce cross-contamination.

  • Be clear about your allergy and ask how foods are prepared at restaurants. Ask if they have a separate grilling space or fryer. Ask if your item will be cooked near or in an area where milk might be used. If you are not sure it is safe, do not order the food. Choose a restaurant that is better able to meet your needs.

  • Blend fruit and non-dairy yogurt to make a smoothie.

  • Use applesauce on hot cereal.

  • Use a milk substitute on cereal.

  • Look for non-dairy substitutes for sour cream and cheese. Tofutti® and Daiya® are two common brands.

  • Calcium fortified orange juice has nearly the same calcium content as milk but does not have all the other nutrients that milk offers. It is not a good substitute for milk.

How to Prevent an Allergic Reaction

  • Avoid foods that cause a reaction. Sometimes just touching foods can cause a severe reaction. Be sure to wash your hands if you touch foods with milk.

  • Read the ingredients lists on food labels each time you buy them to make sure ingredients have not changed as they often can.

  • If you travel, bring some of your own foods. Make sure to wipe the area where you eat to avoid cross-contamination.

  • When you eat out, always ask restaurant staff about ingredients in food and how it is prepared. Tell them about your allergy. It may be best to ask to speak with the manager as well.

  • For infants, elemental formulas or formulas with broken down proteins should prevent food reactions. Talk about formula options with your doctor or dietitian. Do not assume products labeled "hypoallergenic" will not cause a reaction.

  • Be careful with imported products. Food labeling rules vary by country. Imported foods should follow domestic food labeling laws, but do not always do so.

  • “Milk substitute” drink: __________

  • Multivitamin/Calcium: ___________

Other Resources

Who to Call

If you are a UW Health patient and have more questions, please call one of the phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition

Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s Hospital (AFCH) can be reached at: (608) 890-5500.

Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770.