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

Dietary guide

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

pdfASCIA PCC Dietary Avoidance FAQ 2021227.27 KB 

pdfASCIA 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.

For more information go to www.allergy.org.au

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

Content Last Updated December 2022

 

Mod ASCIA Member
Donate to AIFA
go to NAC website
ASCIA Member Login
ASCIA Update

Information for the community about allergic diseases, immunodeficiencies and other immune diseases.
See latest edition here...
Join our mailing list:

About ASCIA

ASCIA is the peak professional body of clinical immunology and allergy in Australia and New Zealand
ASCIA promotes and advances the study and knowledge of allergy and other immune diseases

Quick Links

About ASCIA

ASCIA is a registered trademark of the Australasian Society of Clinical Immunology and Allergy. All content is subject to copyright for the Australasian Society of Clinical Immunology and Allergy. Read more...

The content for the website is developed and approved by ASCIA Committee and ASCIA Working Party Members. Read more...

Disclaimer I Privacy

The ASCIA website is intended for use by ASCIA members, health professionals and the general public. The content provided is for education, communication and information purposes only and is not intended to replace or constitute medical advice or treatments. Read more...

ASCIA respects your privacy. Read our privacy policy here...

Sponsors | Advertising

ASCIA does not endorse products from sponsoring organisations, nor is it influenced by sponsoring organisations with regard to the content of education programs and websites. 

The ASCIA website does not accept advertising. Any link to a third-party website does not imply any endorsement by ASCIA.

Information Partner

Official Information Partner of Healthdirect Australia