Food - Australasian Society of Clinical Immunology and Allergy (ASCIA)

Dietary Avoidance for Food Allergy Frequently Asked Questions (FAQ)

This document has been developed by ASCIA, the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. ASCIA information is based on published literature and expert review, is not influenced by commercial organisations and is not intended to replace medical advice. For patient or carer support contact Allergy & Anaphylaxis Australia or Allergy New Zealand.

This information is for people with food allergy, and should be used with the ASCIA dietary guides for common allergy causing foods, available on the ASCIA website:

allergy.org.au/patients/food-allergy/ascia-dietary-avoidance-for-food-allergy

ASCIA PCC Dietary Avoidance Food Allergy FAQ 2023280.23 KB

Q 1: What do people with food allergy need to manage their condition?

It is important to note that anyone with food allergy should have:

Regular review by their doctor and a clinical immunology/allergy specialist as required.
Advice from a dietitian if there are multiple food allergies to make sure nutritional needs are met.
Dietary Guides to provide information about foods that need to be avoided, and information about alternative foods that can provide important nutrients. Dietary avoidance should only be undertaken when a food allergy is suspected whilst waiting for medical confirmation, or when a food allergy has been medically confirmed.
An adrenaline (epinephrine) injector if they are considered to be at risk of a severe allergic reaction (anaphylaxis).
An ASCIA Action Plan for Anaphylaxis (red) if an adrenaline injector has been prescribed.
An ASCIA Action Plan for Allergic Reactions (green) if an adrenaline injector has not been prescribed.

Q 2: Why is it important to read and understand food labels?

Many manufactured foods contain common allergy causing foods (food allergens), but it is not always easy to find the allergen information on the product packaging.

Ingredients or processes can be changed by manufacturers at any time without notice, so it is important to always check food labels when buying and preparing food every time you purchase the product, even if it has been a ‘safe’ food in the past,

For short, easy to understand videos about how to read and understand food labels for food allergy, scan this QR code or visit the National Allergy Council food allergy education website www.foodallergyeducation.org.au

Q 3: What information on food labels is required by law?

The Food Standards Code identifies common food allergens that must be declared on a food label if the allergen is contained in the food as:

An ingredient.
Part of a compound ingredient.
A food additive.
A processing aid.

In February 2021, there was a change in the Food Standards Code about the way food allergen information is provided on product labels. The standards in the Australia New Zealand Food Standards Code are legislative instruments under the Legislation Act 2003, which means they are laws which require food suppliers to comply.

This change requires allergen information to be declared in a specific format and location on food labels, and using simple, plain English terms in bold font, known as Plain English Allergen Labelling (PEAL).

There is a transition timeline for food companies to implement these changes, so it may not be until 2026 when all product labels will reflect this change. Therefore it will be important to know how to read labels that comply with the old and new laws.

Under the old law, allergens that must be declared are peanuts, tree nuts, cow’s milk (dairy), egg, soy, fish, shellfish (crustaceans), sesame, gluten and lupin. The source of the gluten (such as wheat) must also be declared.

Q 4: What are the new Plain English Allergen Labelling (PEAL) regulations?

The new PEAL regulations require:

The same consistent names being used for the common food allergens.
A ‘summary statement’ beginning with the word ‘contains’, that lists the allergens in the food.
The summary statement to be located next to the ingredient list, which can be above, below or on either side of the ingredient list.
Common food allergens to be declared as shown in the following table:

Food	Required name for declarations - ingredient list	Required name for other declarations - summary statement
egg	egg	egg
fish	fish	fish
lupin	lupin	lupin
milk	milk	milk
mollusc	mollusc	mollusc
crustacea	crustacean	crustacean
peanut	peanut	peanut
sesame seed	sesame	sesame
soybean	Soy, soya or soybean	soy

Tree nuts
almond	almond	almond
Brazil nut	Brazil nut	Brazil nut
cashew	cashew	cashew
hazelnut	hazelnut	hazelnut
macadamia	macadamia	macadamia
pecan	pecan	pecan
pine nut	pine nut	pine nut
pistachio	pistachio	pistachio
walnut	walnut	walnut

Gluten containing cereals
wheat (including its hybridised strain, e.g. triticale) irrespective of whether it contains gluten	wheat	wheat; and if gluten is present - gluten
barley	barley	gluten
oats	oats	gluten
rye	rye	gluten

Food allergens declared on food label

Examples of how food allergens must be declared on a food label under the new law is shown above.

For more information about the Food Standards Code, visit the Food Standards Australia New Zealand (FSANZ) website www.foodstandards.gov.au

Q 5: What are precautionary allergen statements?

Voluntary information on food labels includes precautionary allergen statements, which are used to declare cross contamination risk (such as ‘may contain...’), and these are not compulsory for food manufacturers.

It is important that people with food allergy discuss what to do about foods that include precautionary allergen statements with their clinical immunology/allergy specialist.

Q 6: What does ‘Free from’ products mean?

Some products are manufactured specifically to replace or exclude an allergen, such as ‘gluten free’. Even if the product is labelled ‘free from’, it is important to check the ingredients list for food allergens, as well as checking for precautionary allergen statements, such as ‘may contain’.

If choosing a ‘free from’ product, check that the preparation instructions do not require the addition of a food that is a confirmed food allergen for you or your child.

Q 7: What mistakes can be made when purchasing foods?

Examples of mistakes that can occur when purchasing foods include:

Food labels are not read or understood.
A person does not clearly disclose their allergy when purchasing unpackaged foods from a food outlet such as a bakery, café or restaurant.
Waitstaff not communicating important information about a customer’s allergy to the chef.
Chef does not check the ingredients in a product prepared offsite.
Food services assuming that a small amount of the food allergen is safe.
A family member forgets to check ingredients or disclose food allergens.

Q 8: Why does eating out require advanced planning?

It is important to plan ahead and communicate about food allergy:

When eating out
Travelling
With institutions before starting school, children’s education and care, universities and workplaces.
With hospitals before being admitted.

Providing information about your food allergy in advance increases the likelihood that they will be able to provide appropriate food which allows you to manage your food allergy.

When eating out, it is important to be assertive and clear. Before ordering, advise food service staff about your allergy clearly, and ask questions about ingredients, food preparation, storage and service.

If you are not sure that the food is suitable, do not eat it. If you have been prescribed an adrenaline injector, do not eat unless you have it with you.

Q 9: How can safe meals be prepared and served at home?

When preparing and serving food at home it is important to:

Choose appropriate ingredients.
Teach other household members and visitors about not sharing food and drinks.
Be aware of cross contamination when storing, preparing and serving foods:
- Use separate cooking equipment.
- Prepare allergen free food first.
- Ensure adequate cleaning.

Q 10: How does cross contamination occur?

Cross contamination occurs when food allergens come into contact with a food that does not contain that allergen. This is similar to cross contamination that can occur with bacteria between raw and cooked meats.

Possible sources of cross contamination during include:

During processing:
- Shared manufacturing lines for different products containing different ingredients.
- Shared packaging lines for different products containing different ingredients.
- Transport and storage of ingredients, particularly where spills can occur.
At the point of purchase:
- Food sold in bulk containers and served using shared utensils.
- Delicatessen items due to use of the same serving utensils or cross contamination from a meat and cheese slicer.
Food preparation using shared equipment:
- Knives, blenders, cutting boards, frying pans and deep fryers and barbecues.
- A different toaster should be used for people with wheat allergy.
Food service:
- Buffets are especially high risk for many reasons, including food from one container being spilled into another food container and the same utensils being used for multiple food items. Even when separate utensils are provided, other customers may contaminate food by using the wrong utensil.
- Juice bars are high risk as the equipment may not be cleaned properly in between preparing different juices.

Q 11: What additional precautions can be taken for children with food allergies?

For very young and mobile children with food allergy, consider not having the allergen in the home.
If you decide to keep the food allergen in the home, you may consider reducing risk of exposure by:
- Having a shelf or container in the pantry and fridge for suitable foods for the child with food allergy.
- For very young children with food allergy, consider storing the food allergen/s out of reach or in a locked cupboard.
Make sure that everyone who looks after your child (relatives, babysitters, friends, children’s education and care services, and school staff), fully understands your child’s food allergies, and how important it is that your child avoids the food they are allergic to. They should also know how to treat an allergic reaction, in case the child accidentally eats the food.
Children should be encouraged from a young age to ask a trusted adult whether they are allowed to eat foods they may be given.
If the child has been prescribed an adrenaline injector, make sure it is easily accessible at all times, and teach everyone who looks after your child to know when and how to use the device.
Make sure the child sees their usual doctor for an updated ASCIA Action Plan, renewal of their adrenaline injector prescription and re-training in its use. The ASCIA Action Plan includes a recommended date for when the child next needs to see their doctor.

Q 12: When can baked egg and milk be eaten?

Some children who are allergic to milk or egg may be able to eat baked egg or milk if this advice is given by their clinical immunology/allergy specialist.
Children with milk or egg allergy should only be given baked milk or egg when supervised by a parent.
Parents should not expect children’s education and care (CEC) staff to give foods containing baked milk or baked egg to their child with a milk or egg allergy when they are at a CEC service.

Q 13: Other than eating the food, are there other ways to contact with food allergens?

Touching or smelling may trigger mild allergic symptoms but it is unlikely to cause anaphylaxis, as the food allergen usually needs to be eaten.
Some cosmetics, shampoos, lotions, medications and alternative therapy products contain food allergens, and it is not mandatory to include allergen information on these product labels.
People with food allergies should wash their hands after handling pet food, as this can contain allergens.
For information about food allergens in medicines, visit the Therapeutic Goods Administration (TGA) website https://www.tga.gov.au/community-qa/allergies-and-medicines

© ASCIA 2023

Content updated December 2023

For more information go to www.allergy.org.au/patients/food-allergy and

www.allergy.org.au/patients/food-other-adverse-reactions

To support allergy and immunology research go to www.allergyimmunology.org.au/donate

ASCIA Dietary Guide - Cow’s Milk Protein (Dairy) and Soy Allergy

ASCIA Dietary Avoidance for Food Allergy FAQ should be used with the ASCIA dietary guide for cow’s milk protein (dairy) and soy allergy.

ASCIA PC Dietary Avoidance Food Allergy FAQ 2023273.67 KB

ASCIA PC Dietary Guide for Cow's Milk Protein (Dairy) and Soy Allergy 2023206.05 KB

Cow's milk and soy are found widely in the foods we eat. Usually people who react to cow's milk protein will also react to similar proteins in goat's and sheep’s milk, and milk from other animals. Avoiding all dairy and soy products including cow’s milk is essential for people with confirmed cow’s milk protein and soy allergy.

Excluding cow’s milk and soy from an individual’s diet should only be undertaken when absolutely necessary with the supervision of health professionals, who can advise on suitable alternatives to ensure optimal growth and nutrition. It is important to read and understand food labels every time you purchase a product, even if you have bought the product before as ingredients can change. It is also important to check other products that may contain cow’s milk or soy including medications, toothpastes, soaps, body wash and creams.

While some individuals will tolerate cow’s milk baked in cakes and biscuits, and occasionally processed dairy in hard cheeses or yoghurts, this should only be tried under the guidance of the medical professional managing your child’s allergies.

The following foods and ingredients CONTAIN cow’s milk protein and should be avoided:

Acidophilus milk	Dried milk / Dried milk solids	Malted milk
Butter	Evaporated milk	Margarine
Buttermilk	Ghee	Milk (A2, full cream, fat free, low fat, skim, lactose free)
Casein / caseinates	Butter oil	Milk derivative
Cheese / cheese powder (including cow, goat, and sheep)	Butter fat	Milk powder
Condensed milk	Hydrolysates (casein, milk protein, whey)	Milk protein
Cream	Ice-cream	Milk solids (regular, non-fat and skim)
Cultured milk	Infant formula (cow and goat milk based, partially hydrolysed formula)	Sour cream
Curd	Kefir	Whey
Custards	Lactalbumin	Yoghurt
Dairy solids	Lactoglobulin

The following foods and ingredients CONTAIN soy protein and should be avoided:

Bean curd	Soy desserts	Soy sauce
Edamame	Soy flour	Soy yoghurt
Miso	Soy formula	Tamari
Soya beans	Soy ice-cream	Tempeh
Soy bean paste	Soy mayonnaise	Teriyaki
Soy bean sprouts	Soy milk (sweetened and un-sweetened)	Tofu
Soy cheeses	Soy protein isolate	Textured/Hydrolysed Vegetable Protein (TVP)

Coconut products

Currently imported coconut milk drinks must undergo testing for the presence of dairy if the dairy content is not declared on the label in an allergy statement or in the ingredients list. If the presence of dairy is detected it will be classified as a LABEL fail against Food Standards Code Standard 1.2.3.

Consumers with IgE-mediated cow's milk allergy are advised to use caution with other coconut products imported from South East Asia. Coconut products made in Australia, using Australian and the Pacific Islands grown coconuts, are most likely safe, but consumers are advised to contact manufacturers to ask about the risk of contamination with cow’s milk.

The following ingredients are made from soy but are tolerated by the vast majority of individuals with soy allergy:

Soy lecithin (Additive No 322)
Soy bean oil (except cold pressed)
Soy derivatives (tocopherols and phytosterols)
Vitamin E or antioxidant (from soy)

Other legumes such as chickpeas or kidney beans and lentils are tolerated by most individuals allergic to soy.

If you are unsure, speak to your clinical Immunology/Allergy Specialist or Dietitian.

The following foods and ingredients DO NOT contain cow’s milk protein and can be eaten:

Butter flavour
Cocoa butter
Cream of tartar
Lactic acid - some lactic acid starter cultures may however contain milk, so check labels carefully.
Lactose in medication - lactose is the sugar contained in cow’s milk and the pure sugar form is used in medications. The chance of an individual with cow’s milk protein allergy reacting to pure lactose sugar in medications that has been contaminated with cow’s milk is very low.
Sodium or calcium lactate
Sodium or calcium stearoyl lactylate

Note: Lactose intolerance refers to an enzyme deficiency that results in an inability to digest large amounts of the sugar in milk (lactose). People with lactose intolerance do not need to avoid all dairy foods unless they also have a confirmed cow’s milk protein allergy.

Soy free bread alternatives

Most breads are made with a starter containing soy. This can make avoiding soy difficult. The following may be options for soy free breads, but it is important to check for cow’s milk protein.

Check your local baker, greengrocer, delicatessen or supermarket for soy free breads – traditional sourdough bread is usually soy free, but you still need to check.

Home-made bread by hand or using a bread maker with allowed flours.

Crumpets
Flat breads such as Lebanese or Indian bread, wraps, mountain breads.

Cow's milk substitutes

Cow’s milk can be an important source of energy, protein and calcium in the diet, especially for developing infants and children. Appropriate substitution is essential to ensure adequate growth and development and sufficient intake of calcium.

Rice, oat, nut, pea or coconut based drinks are NOT suitable as a drink for children under one year of age due to inadequate amounts of energy, fat and protein. For children over one year of age these drinks should only be used after consultation with a clinical immunology/allergy specialist and/or dietitian with experience in paediatric food allergy to ensure your child is getting adequate nutrition and growing appropriately.

Summary of cow’s milk and soy substitutes

Instead of:	Use:
Cow's milk or soy infant formula for a child less than 1 - 2 years of age	Breast milk or appropriate formula as advised by your child’s medical specialist
Cow's milk or soy drink for children over 1 - 2 years of age and adults	Rice, oat, nut, coconut or pea based drinks - choose one with at least 120 mg calcium per 100 mL
Yoghurt and custard	Coconut, nut or other plant based yoghurts, custards and chia puddings – check labels carefully and ideally choose one with added calcium. Homemade desserts with milk substitute.
Cheese	Coconut or nut based cheese
Ice cream	Sorbet, dairy and soy free ice-cream and gelato – check labels carefully
Butter and margarine	Oil or dairy and soy free margarine. Many contain soy lecithin which is tolerated by most people with soy allergy
Cream and mayonnaise	Rice cream, dairy and soy free mayonnaise
Chocolate	Dairy and soy free chocolate. Many contain soy lecithin which is tolerated by most people with soy allergy

Considerations for infants and young children

If your child will not drink the milk substitute, a dietitian can advise how to encourage your child to accept it, or how to supplement the diet with essential nutrients such as calcium, energy protein and ensure appropriate growth.

Breastfeeding mothers may sometimes need to remove cow’s milk protein or soy from their diet. The need to avoid cow’s milk protein and/or soy by a breastfeeding mother should be confirmed by your child’s medical specialist.

Custard recipe

250ml dairy and soy free infant formula or calcium fortified alternative milk
2 tbsp corn flour
½ -1 tbsp sugar
2 drops imitation vanilla essence

Blend sugar and corn flour in a small amount of formula, then add the rest of the formula. Microwave for three minutes on high. Stir. If custard is not thick enough, microwave for another minute. Add vanilla essence last.

Introducing solids on a cow’s milk & soy free diet

Check labels of iron fortified baby cereals and rusks as they often contain cow’s milk and/or soy. Discuss suitable brands with a paediatric allergy dietitian.
Make up cereals with expressed breast milk or specialised formula
Avoid baby yoghurts and custards – see above table for suitable alternatives.
Do not delay the introduction of other common allergenic foods, introduce them before 12 months of age and keep them in the diet at least twice a week.

It is important to ensure an adequate calcium intake.

Adequate intakes of calcium for: 0 - 6 months of age = 210mg/day, 7 - 12 months of age = 270mg/day.

Recommended daily intakes of calcium

AGE	CALCIUM (mg)
1 – 3 years	500
4 – 8 years	700
9 – 11 years	1000
12 – 18 years	1300
Men 19 - 70years	1000
Men > 70 years	1300
Women 19 - 50 years (including if breastfeeding)	1000
Women > 50 years	1300

Amount of non-dairy foods required to provide 1 serve of calcium

Food product	Serve size = 1 serve of calcium (250mg)
Rice, oat, nut, coconut or pea milks with added calcium (120mg/100ml)	200mL
Almonds (raw)*	75 g (1/2 cup)
Tahini (sesame seed paste)*	75 g (3 tbsp)
Canned calcium rich tuna	30 g
Canned sardines with bones (drained)	75 g
Canned salmon with bones	100 g
White sesame seeds (hulled)*	250 g (1 2/3 cups)
Broccoli (boiled)*	500 g (3 ½ cups)
Chia seeds*	32 g (3 tbsp)
Spinach*	430 g boiled (2 cups) or 270 g fresh baby spinach (1 extra large bag)

*Phytates and oxalates in these foods limit calcium absorption.

Use of non-dairy sources of calcium should take into account any other food allergies that would exclude their use, such as individuals with nut or sesame allergy.

Calcium supplements

Calcium supplements can be used to supplement the diet if the dietary intake of calcium is inadequate. A dietitian can provide advice on a suitable supplement and the appropriate dose.

Individuals avoiding multiple foods or food groups in their diet should see an allergy dietitian. Paediatric allergy dietitians are best placed to see infants and children.

Dental products and cow's milk (diary) allergy

It is recommended to advise your dentist at each visit if you or your child has a cow’s milk (dairy) allergy.

People with cow’s milk (dairy) allergy must avoid medicated toothpastes, chewing gums and any other dental products containing Recaldent™ also known as CPP-ACP (casein phosphopeptide-amorphous calcium phosphate), which is made from cow’s milk protein.

The food lists included in this document are not exhaustive. Individuals with food allergy should always check foods labels each time products are purchased.

© ASCIA 2023

Content updated June 2023

For more information go to www.allergy.org.au/patients/food-allergy and

www.allergy.org.au/patients/food-other-adverse-reactions

To support allergy and immunology research go to www.allergyimmunology.org.au/donate

ASCIA Dietary Avoidance for Food Allergy

ASCIA Dietary Avoidance for Food Allergy FAQ should be read (and printed) in conjunction with the appropriate ASCIA dietary guide/s for the most common food allergens.

ASCIA Dietary Avoidance for Food Allergy FAQ Updated December 2023

ASCIA Dietary Guide for Cow's Milk Protein (Dairy Allergy) Updated June 2023

ASCIA Dietary Guide for Cow's Milk Protein (Dairy) and Soy Allergy Updated June 2023

ASCIA Dietary Guide for Egg Allergy Updated June 2023

ASCIA Dietary Guide Fish Allergy Updated June 2023

ASCIA Dietary Guide for Peanut Allergy Updated June 2023

ASCIA Dietary Guide for Sesame Allergy Updated June 2023

ASCIA Dietary Guide for Shellfish Allergy Updated June 2023

ASCIA Dietary Guide for Soy Allergy Updated June 2023

ASCIA Dietary Guide for Tree Nut Allergy Updated June 2023

ASCIA Dietary Guide for Wheat Allergy Updated June 2023

Webpage updated December 2023

ASCIA Dietary Guide - Cow’s Milk Protein (Dairy) Allergy

ASCIA Dietary Avoidance for Food Allergy FAQ should be used with the ASCIA dietary guide for cow’s milk protein (dairy) allergy.

ASCIA PC Dietary Avoidance Food Allergy FAQ 2023273.67 KB

ASCIA PC Dietary Guide Cows Milk Allergy 2023202.26 KB

Cow's milk is found widely in the foods we eat. Usually people who react to cow's milk protein will also react to similar proteins in goat's and sheep’s milk, and milk from other animals. Avoiding all dairy products including cow’s milk is essential for people with confirmed cow’s milk protein allergy. Excluding cow’s milk from the diet of children should only be undertaken when absolutely necessary, with the supervision of health professionals who can advise on suitable alternatives to ensure optimal growth.

It is important to read and understand food labels every time you purchase a product, even if you have bought the product before as ingredients can change. It is also important to check other products that may contain cow’s milk protein. For example, there are some specialty toothpastes available which contain cow’s milk protein and these are labelled as containing casein phosphopeptide amorphous calcium phosphate.

While some children will tolerate cow’s milk baked into cakes and biscuits, and occasionally processed dairy in hard cheeses or yoghurts, this should only be tried with specialist medical advice.

The following foods and ingredients CONTAIN cow’s milk protein and should be avoided:

A2 milk	Dried milk	Low fat milk
Acidophilus milk	Dried milk solids	Malted milk
Butter	Evaporated milk	Milk
Buttermilk	Fat-free milk	Milk derivative
Casein/caseinates	Ghee	Milk powder
Cheese	Butter oil	Milk protein
Cheese powder	Butter fat	Milk solids
Condensed milk	Hydrolysates (casein, milk protein, whey)	Non-fat dairy solids
Cottage cheese	Ice cream	Non-fat milk solids
Cream	Infant formula – cow’s milk based including partially hydrolysed (HA) formula	Skim milk
Cultured milk	Kefir	Skim milk solids
Curds	Lactalbumin	Sour cream
Custard	Lactoglobulin	Whey
Dairy solids	Lactose-free milk	Yoghurt

Coconut products

Consumers with IgE-mediated cow's milk allergy are advised to use caution with coconut drinks, juice, milk, cream and powder products until authorities advise that there has been sufficient testing of all products using coconut imported from South East Asia currently in the market. Consumers with cow's milk allergy need to ask if coconut products are in menu items they purchase when eating out.

Coconut products made in Australia using Australian grown coconuts are most likely safe, but consumers are advised to contact manufacturers to ask about the risk of contamination with cow’s milk.

Check labels on ALL Foods. The following foods are likely to contain cow’s milk protein unless the label says otherwise. Foods to avoid:

Alcoholic cocktails (some)	Breads, breadcrumbs	Caramel or butterscotch desserts
Biscuits, cakes, pastry	Breakfast cereal	Chocolate
Bottled water that is flavoured or protein enriched	Canned spaghetti	Probiotic drinks
Confectionary	Instant mashed potatoes	Processed meats
Drinking Chocolate	Malted milk powder	Protein shakes
Gravy	Margarine	Salad dressings
High energy foods and powders with added protein	Milk ice blocks	Snack food
High protein fruit juice drinks	Non-dairy creamers	Soy cheese
Icing	Nougat	Soups
Infant rusks/rice cereals	Pasta sauces	Sports drinks

The following foods and ingredients DO NOT contain cow’s milk protein (unless otherwise labelled), and can be eaten:

Cocoa butter.
Cream of tartar.
Lactic acid – however, some lactic acid starter culture may contain milk, so check labels carefully.
Lactose in medication - lactose is the sugar contained in cow’s milk and the pure sugar form is used in The chance of a person with cow’s milk protein allergy reacting to pure lactose sugar in medications that has been contaminated with cow’s milk is very low.
Sodium or calcium lactate.
Sodium or calcium stearoyl lactylate.

Note:

Lactose intolerance refers to an enzyme deficiency that results in an inability to digest large amounts of the sugar in milk (lactose).

Cow's milk substitutes

Rice, oat or nut based drinks are NOT suitable for young children (particularly children under two years of age), due to inadequate amounts of fat, calcium and protein. These drinks should only be used after consultation with a clinical immunology/allergy specialist and dietitian with experience in paediatric food allergy.

Summary of cow's milk substitutes

Instead of:	Use:
Cow's milk infant formula for a child less than one to two years of age	Breast milk or appropriate formula as advised by your child’s medical specialist.
Cow's milk for children over one to two years of age and adults	Soy, rice, oat, nut, pea protein based drinks. Choose one with 120-160 mg calcium per 100 ml. Calcium fortified soy milk is the preferred option, nutritionally, if tolerated.
Yoghurt	Soy yoghurt. NOTE: Some products contain a small amount of cow’s milk protein. Check the label carefully.
Cheese, sour cream	Soy cheese, soy sour cream. NOTE: Some soy cheeses contain cow’s milk protein. Check the label carefully.
Ice cream	Soy ice cream, sorbet, milk free gelato. Check the label carefully.
Butter and margarine	Oil or milk free margarine e.g. Nuttelex.
Cream and condensed milk	Soy cream, soy cooking milk, soy condensed milk, rice cream.
Chocolate	Soy or rice based (milk free) chocolate.

Considerations for infants and young children

Breastfeeding mothers may sometimes need to remove cow’s milk protein from their diet. The need to avoid cow’s milk protein by a breastfeeding mother should be confirmed by your child’s medical specialist.

It is important to ensure an adequate calcium intake, as recommended in the following tables.

Recommended daily intakes of calcium

AGE	CALCIUM (mg)
1 – 3 years	500
4 – 8 years	700
9 – 11 years	1000
12 – 18 years	1300
Men 19-70years	1000
Men >70 years	1300
Women 19-50 years	1000
Women >50 years	1300

Amount of non-dairy foods required to provide 1 serve of calcium

Food product	Serve size = 1 serve of calcium (250mg)
Soy drink with at least 120mg/100mL of calcium	200 mL or 1 cup
Rice, oat, nut, pea protein drink with at least 120mg/100mL of calcium	200 mL or 1 cup
Soy yoghurt with added calcium	300 g or 1 regular tub
Soy cheese	125g – 400 g (varies)
Almonds	100 g
Tahini	75 g
Canned sardines (must eat bones)	75 g
Salmon with bones	¼ cup
White sesame seeds	400 g
Broccoli	5 cups

Use of non-dairy sources of calcium should take into account any other food allergies that would exclude their use, such as people with nut or sesame allergy.

Care of children with milk allergy

Parents of a child with milk allergy should only give foods containing baked milk to their child when they are under their supervision.

Parents should not expect early childhood education/care (ECEC) staff to give foods containing baked milk to their child with a milk allergy when they are at ECEC services.

Dental products and cow's milk (dairy) allergy

It is recommended to advise your dentist at each visit if you or your child has a cow’s milk (dairy) allergy.

Calcium supplements

Calcium supplements can be used to supplement the diet if the dietary intake of calcium is inadequate. A dietitian can provide advice on a suitable supplement.

The food lists included in this document are not exhaustive. People with food allergy should always check foods labels each time products are purchased.

Content updated June 2023

For more information go to www.allergy.org.au/patients/food-allergy and

www.allergy.org.au/patients/food-other-adverse-reactions

To support allergy and immunology research go to www.allergyimmunology.org.au/donate

ASCIA Dietary Guide - Egg Allergy

ASCIA Dietary Avoidance for Food Allergy FAQ should be used with the ASCIA dietary guide for egg allergy.

ASCIA PC Dietary Avoidance Food Allergy FAQ 2023273.67 KB

ASCIA PC Dietary Guide for Egg Allergy 2023140.54 KB

Egg allergy is a common food allergy and eggs can be found in a wide range of foods. Avoiding whole egg, raw egg and egg-containing foods is essential for people with confirmed egg allergy. Therefore, it is important to read and understand food labels to be able to choose appropriate foods, and be aware that egg is used as a binder or thickener in many prepared foods. While some children will tolerate some egg baked into cake and biscuits, this should only be tried with specialist medical advice. Uncooked eggs and egg cartons should be kept well out of reach from young children with egg allergy.

Dietary avoidance should only be undertaken if there is a medically confirmed food allergy.

The following foods and ingredients CONTAIN egg and should be avoided:

Albumen or albumin	Globulin	Ovomucin
Apovitelin	Imitation egg product	Ovomucoid
Avidin	Livetin	Ovovitelin
Dried egg	Lysozyme	Silici albuminate
Flavoproteins	Ovalbumin	Simplesse

Check ALL food labels, regardless of the product. MOST deserts will contain egg. The foods below contain, or are likely to contain egg and should be avoided unless otherwise labelled:

Alcoholic cocktails (e.g. sour)	Fried rice	Pancakes, pikelets
Breads, breaded foods, naan bread	Frittata	Pasta
Cakes/cake mixes	Fritters	Pastries (e.g. chocolate eclairs, cream puffs, tarts, pies)
Cake decorations	Health drinks	Pavlova
Chocolate soft centres	Ice cream, frozen desserts	Pie filling
Confectionary/lollies/caramel	Icings	Pizza bases
Creamy salad dressings	Lemon butter	Powdered egg
Croissants	Malted chocolate drinks	Prepared meats (e.g. schnitzel)
Crumbed foods	Mayonnaise on salad	Prepared soups, consommés
Custards	Meringue	Processed meats (e.g. rissoles)
Dessert mixes	Meringue mix	Quiche
Dips	Milk puddings, puddings	Sauces (e.g. hollandaise)
Dressings	Mock or butter cream	Shiny glaze on baked goods
Egg (white or yolk)	Mocktails	Soufflé
Egg noodles	Mousse	Sushi (tuna, crab or mayonnaise)
Egg nog	Muffins	Tarts and pastries
Egg solids	Nougat	Vegetarian meat substitutes
French toast	Omelette	Waffles

Egg alternative/substitutes

It is possible to make cakes and muffins without egg by adapting recipes you use at home.

The texture of the product may be a little different, but they will taste similar.

Summary of substitutes for one egg

For baking (cakes and biscuits):	For binding:
1 tsp egg replacer + 2 tbsp water	¼ cup mashed potato or pumpkin
1 tsp baking soda + 1 tbsp water + 1 tbsp vinegar	½ cup mashed banana or pureed apple
1½ tbsp water + 1½ tbsp oil + 1 tsp baking powder	1½ tbsp ground flaxseed mixed with 3 tbsp warm water (let stand for a few minutes)
1½ tbsp ground flaxseed mixed with 3 tbsp warm water (let stand for a few minutes)	*Aquafaba – 3 tbsp liquid from canned chick peas with ½ tsp cream of tartar mixed with hand mixer to make meringue
*Aquafaba – 3 tbsp liquid from canned chick peas with ½ tsp cream of tartar mixed with hand mixer to make meringue	1 tbsp chia seeds, grind then mix with 3 tbsp water (let stand for a few minutes)
1 tbsp chia seeds, grind then mix with 3 tbsp water (let stand a for few minutes)	*Aquafaba is the viscous water in which legume seeds such as chickpeas have been cooked, which can be used as a replacement for egg whites.

Commercial egg substitutes

Commercial egg substitutes can be used in cakes and biscuits, pancakes and fritters but will not make scrambled eggs or meringues. These products contain potato, tapioca starch and vegetable gums.

Care of children with egg allergy

Parents of a child with egg allergy should only give foods containing baked egg to their child when they are under their supervision.

Parents should not expect early childhood education/care (ECEC) staff to give foods containing baked egg to their child with an egg allergy when they are at ECEC services.

Note:

Egg is sometimes used for fining wine but is considered to pose a very low risk of triggering allergic reactions. Discuss this with your allergy specialist if you are concerned.
Lecithin (additive 322) is commercially isolated, mainly from soybeans or egg yolk. Egg lecithin is tolerated by most people with egg allergy (and soy allergy).

Content updated 2020

Format updated June 2023

For more information go to www.allergy.org.au/patients/food-allergy and

www.allergy.org.au/patients/food-other-adverse-reactions

To support allergy and immunology research go to www.allergyimmunology.org.au/donate

Dietary Avoidance for Food Allergy Frequently Asked Questions (FAQ)

Q 1: What do people with food allergy need to manage their condition?

Q 2: Why is it important to read and understand food labels?

Q 3: What information on food labels is required by law?

Q 4: What are the new Plain English Allergen Labelling (PEAL) regulations?

Q 5: What are precautionary allergen statements?

Q 6: What does ‘Free from’ products mean?

Q 7: What mistakes can be made when purchasing foods?

Q 8: Why does eating out require advanced planning?

Q 9: How can safe meals be prepared and served at home?

Q 10: How does cross contamination occur?

Q 11: What additional precautions can be taken for children with food allergies?

Q 12: When can baked egg and milk be eaten?

Q 13: Other than eating the food, are there other ways to contact with food allergens?

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