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

pdfASCIA PCC Dietary Avoidance FAQ 2021227.27 KB 

pdfASCIA PCC Dietary Avoidance Cows Milk Soy 2022210.05 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 & 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 & 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 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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Updated December 2022