Dairy allergy: Symptoms, causes and diagnosis



Dairy products are foods made from animal, most commonly cow’s milk, while dairy substitutes are made from plant milk. Dairy products are a good source of nutrition. However, cow’s milk is the most common food allergen in infants and young children, and the allergy can persist into adulthood.

According to the American College of Allergy, Asthma & Immunology (ACAAI), about 2-3% of children under 3 have a milk allergy. While many children are susceptible to overcoming the allergy in their youth, some evidence suggests that it may persist beyond 16 years in about 20% of people.

A dairy or milk allergy occurs when a person’s body undergoes an immune reaction to proteins in milk. Their immune system recognizes proteins as foreign, similar to a pathogen such as bacteria, triggering an immune response with symptoms ranging from mild to very severe.

Although cow’s milk is the most common dairy allergen, people can also have an allergic reaction to other animal milks, such as goat, sheep, or buffalo milk. Milk made from plants, such as almonds, soybeans, and rice, can also trigger an allergic reaction. Many people can confuse dairy allergies with lactose intolerance or cow’s milk protein intolerance because they often share symptoms, but the three conditions are very different.

This article discusses the symptoms and causes of dairy allergies and how they differ from lactose intolerance.

Allergies to dairy products usually appear in the first few months of life before 6 months, with allergic reactions ranging from minor to severe and life threatening. Symptoms usually appear a few minutes to hours after ingesting milk. While dairy allergies can refer to an allergy to any dairy product, they most often involve cow’s milk.

A person may experience various symptoms of a true allergy to milk or dairy products. Those understand:

Sometimes cow’s milk can cause anaphylaxis, a serious allergic reaction that is a medical emergency. Signs that a person is suffering from anaphylaxis may include:

The allergic symptoms that people experience are due to the way their body reacts to the proteins in the dairy product. For example, in cow’s milk, two main proteins called whey and casein may cause an allergic reaction in some people. These allergens trigger an immune response in the body as the immune system tries to fight them off.

In response to milk proteins, which the immune system identifies as an invader, the body overreacts and produces antibodies called immunoglobulin E (IgE). When activated by milk proteins, these antibodies release chemicals, such as histamine, which cause an allergic reaction.

Each type of IgE antibody is specific to each type of allergen. This is why some people may only be allergic to dairy products, as they only have the IgE antibodies specific to dairy products. Other people may have allergic reactions to more than one allergen because they have more types of IgE antibodies.

Researchers don’t quite understand why some substances trigger allergies and others don’t. Multiple factors, such as a family history of allergies, likely play a role in the development of allergic disease.

Many people confuse dairy allergies with lactose intolerance because both require the elimination of dairy products from the diet and have overlapping symptoms. However, dairy allergy affects the immune system, while lactose intolerance is a problem with the digestive system.

Lactose intolerance is a digestive problem that a person misses lactase, an enzyme that breaks down the sugar in milk called lactose. This can cause symptoms such as bloating, gas, diarrhea, and abdominal pain.

People can also confuse a dairy allergy with a cow’s milk protein intolerance (CMPI). However, symptoms of PMPI usually take longer to appear, while allergy symptoms usually appear within minutes to hours. Some people may also call it food protein-induced enterocolitis syndrome (FPIES).

PIDC does not necessarily involve the immune system and can cause damage to the stomach and intestines. Unlike other reactions which can trigger a body-wide response, FPIES normally affects the gastrointestinal system, causing symptoms such as blood in the stool, colic, diarrhea, abdominal pain and cramps. .

Certain factors can increase the risk of developing a milk allergy. These may include:

  • Age: Milk allergy is common in infants and children under 5 years old.
  • Presence of other allergies and atopic conditions: Children who are allergic to milk can develop other allergies and may also be at risk for atopic walking, which involves the development of other allergic conditions, such as eczema, allergic rhinitis and asthma.
  • Family history: A 2018 study indicates that milk allergy is three times higher in children whose parents have allergies.
  • Exposure to antibiotics: A 2021 study in mice suggests that early exposure to antibiotics may increase the risk of food allergies.
  • Age when introducing complementary foods: A Study 2020 found that infants fed before 4 months were at higher risk than those fed to food beyond 6 months.

On the other hand, a prolonged period of breastfeeding and having pets in the home seem to be protective factors that can decrease the risk of milk allergy in children.

There is no specific test to diagnose allergy to milk. Doctors will rely primarily on a physical exam, a detailed history of symptoms, and tests that may indicate an allergy, such as:

  • Skin test: An allergist will inject a small amount of milk protein into the skin. If this area swells or develops a welt within 15 to 20 minutes, it may indicate a milk allergy.
  • Blood test: This test checks for the presence of serum-specific IgE antibodies (sIgE) to help determine if a person can react to milk protein.
  • Oral food challenge: Experts call it the gold standard for diagnosing food allergies. This involves a person eating small amounts of dairy products to see if a reaction occurs. Since this may pose a risk of anaphylaxis, a healthcare professional will perform it in the clinic.

As with other food allergies, the main way to prevent a reaction is to strictly eliminate dairy products from the diet. People can seek the help of a dietitian to plan nutritionally balanced meals and take supplements to replace nutrients in milk, such as calcium, riboflavin, and vitamin D.

The milk is 1 of 8 major allergens that account for the majority of food allergies and severe allergic reactions in the United States. As such, people may want to use the following tips to avoid serious reactions:

  • Checking Food Labels: People should check ingredient labels to exclude foods that contain milk and dairy products. Ingredients derived from milk, such as the artificial flavor of cheese and butter, and hydrolysates of whey and casein are common in processed foods. People should also avoid ingredients with the prefix lac, such as lactitol, lactic acid, and sodium lactate.
  • Ask questions about food preparation: When ordering take out or dining out, it is essential to educate yourself about food preparation. Some people can cook food with milk or butter.
  • Using antihistamines: Over the counter antihistamines can help manage mild allergic reactions.
  • Carry epinephrine: People with severe allergic reactions may need an injection of epinephrine, also called adrenaline. Therefore, the person or caregiver is advised to carry epinephrine at all times in an emergency.

Parents who are unsure if their child has lactose intolerance or a milk allergy should ask their doctor. They should see their doctor right away if their child has symptoms of an allergic reaction, including itching, hives, and abdominal pain. Additionally, they should seek immediate treatment if a person exhibits symptoms of anaphylaxis, such as:

  • difficulty in breathing
  • hives all over the body
  • swelling of the face, tongue and throat

People who have been diagnosed with a dairy allergy should discuss with their doctor how to prepare a plan of action for severe allergic reactions. Doctors may also take this time to demonstrate how to use injectable epinephrine.

People who are allergic to cow’s milk may also be allergic to other animal milks, as well as to plant milks. Usually, a doctor will tell you what alternatives and processes can make dairy products safe to consume.

For infants, a doctor may recommend breast milk. However, it is important that the caregiver also eliminates dairy products from their diet while breastfeeding. They may also suggest hydrolyzed dairy products. These are items that undergo processes to remove protein from milk. Alternatively, they may recommend replacing milk with water or juice.

Click here to learn more about dairy alternatives.

Allergies to milk and dairy products are the most common food allergies in children. They occur as a result of the immune system overreacting to proteins found in dairy products. People can confuse dairy allergies with other conditions, such as lactose or cow’s milk protein intolerance, but the conditions are very different. Allergies involve the immune system and symptoms appear within minutes to hours, ranging from mild to severe and life threatening.

There is currently no cure for dairy allergies, but many children can overcome it. To avoid reactions, people are advised to eliminate dairy products from their diet. This may involve checking food labels, preparing food, and using dairy substitutes.


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