ASCIA Dietary avoidance - cow’s milk protein (dairy) allergy

The  ASCIA PCC Dietary Avoidance FAQ should be printed in conjunction with the ASCIA diet sheet for cow’s milk protein (dairy) allergy.

ASCIA PCC Dietary Avoidance FAQ 2021227.27 KB 

ASCIA PCC Dietary Avoidance Cows Milk 2022204.46 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

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 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

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 and protein.

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.

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.

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.

© ASCIA 2022

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

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Content Last Updated December 2022