Cows Milk Allergy – The Royal Children’s Hospital

eg PeptiJunior, Alfare, Allerpr, Elecare,. Neocate and Neocate Advance. Specialised Hypoallergenic formula only available on prescription from your doctor.
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Allergy and Immunology Cows Milk Allergy – 5/03/2013 /1 COWS MILK ALLERGY Cows milk is one of the most common causes of food allergic reactions in children. If your child is allergic to cows milk, strict avoidance of milk and all milk containing foods is the only way to prevent symptoms. Cows Milk Alternat ives Milk is an excellent source of protein and calcium, therefore it is important to replace it with a su itable alternative to ensure adequate nutrition and growth. The most appropriate alternative As many i nfant formula e are based on cows milk , c hildren under 1 year of age will require an alternative infant formula which does not contain cows milk proteins . Discuss the options with your doctor or dietitian. Summary of Cows Milk Alternatives Breastfeeding In some cases breastfeeding mothers may need to remove cows milk and cows milk containing products from their diet. Your doctor will discuss this . Partially Hydrolysed Infant Formulae e g , Nan HA, Karicare HA Not suitable for infants with established cows milk allergy . Soy Infant Formulae e g Infasoy, Isomil, Karicare Soy Reasonable first alternative for infants over 6mths of age . Up to 15 – 20% of children who are allergic to cows milk will also be allergic to soy products . Extensively Hydrolysed and Amino Acid Base d Infant Formulae e g PeptiJunior, Alfare, Allerpr, Elecare, Neocate and Neocate Advance Specialised Hypoallergenic formula only available on prescription from your doctor . Sheep and Goats milk Not a suitable alternative to cows milk because they conta in a similar protein to that found in cows milk and could result in similar symptoms Soy Milk Not suitable for infants under 12 months as a breastfeeding alternative. Can be used in cooking and on breakfast cereals . Suitable for older children (> 6 MONT HS) if soy is tolerated . Ensure you are using a brand with added C alcium .

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Cows Milk Allergy – 5/03/2013 / 2 Cereal based beverages (Rice Milk, Oat Milk, Almond milk) Usually well tolerated if reactions to cows milk and soy. Low in fat and protein. Should not be used for infants. N e ed to be use d under the guidance of a dietitian for children between 1 – 2 years of age or children with slow growth. Ensure you are using a brand with calcium added. A2 Cows milk Not suitable for infants with cows milk allergy . Children allergic to cows milk will also be allergic to A2 milk as this milk contains all of the proteins that are present in regular cows milk except for the A1 beta casein . Will my child grow out of their allergy? For the majority of children their cows milk allergy will resolve . 50% of children with cows milk allergy will resolve within 2 years and 80% by 3 – 4 years after diagnosis. The doctors will determine whether your child has grown out of their allergy by a combination of skin testing and food challenge with milk. Sk positive skin test to milk does not always mean your child will have symptoms when they have milk or milk products, therefore a challenge may be the only way to determine if your child has grown out of their milk allergy. Challenges may need to be done in a hospital by experienced medical staff. Do not do challenges at home unless instructed to do so by your doctor. AVOIDING MILK Foods and Ingredients that contain cows milk protein Butter B uttermilk Casein and caseinates Cheese Cheese powder Cheesymite spread Cheese spreads Condensed milk Cottage cheese Cream Cream cheese Curds Custard Dairy solids Hydr olysates (casein, milk protein, whey) Evaporated milk Ghee, butter oil or b utter fat Feta cheese Fruche Ice cream Infant formula (cows milk based) Lactalbumin Lactoglobulin Lactose free milk Milk low fat, skim, A2, UHT Milk derivative Milk protein Milk solids Nonfat dairy or milk solids Probi otic drinks Ricotta cheese Skim milk solids S ustagen and high protein drink powders Sour cream Whey Yoghurt

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Cows Milk Allergy – 5/03/2013 / 3 Foods and ingredients likely to contain cows milk protein Infant feeding rusks Biscuits Breads Breakfast cereals Cakes Canned spaghe tti Caramel, fudge, butterscotch Chocolate Commercial baby foods Confectionary Creamed soups Crumbed and battered products Dips Drinking chocolate, Milo , malted milk powder Gravy powders Margarine Milk ice confectionary Pasta sauces Potato pr oducts mash, salads and instant potato Processed meats – sausages, sandwich meats, hamburgers Sorbet and Gelati Salad dressings Snack foods crisps, crackers Pastry items C ows Milk Product Alternatives Instead of: Use Standard Infant formula Breast milk, soy formula, specialised infant formula prescribed by your doctor Cows milk (children over 1 – 2yrs of age) Soy milk or cereal based beverages such as rice or oat milk. Choose calcium fortified brands (120mg/100ml) Yoghurt Soy yoghurt (hig hly allergic children may still react due to a milk based starter used to make the yogurt) e g. , Soy Life and Kingland brands Cheese Soy based cheese (check as some brands contain casein) Kingland Soy cream cheese and Tofutti soy cheese spread. Redwood brand Cheezly and Parazano brand for hard cheeses Tofutti brand make soy cheese slices in cheddar and mozzarella style Icecream Soy ice cream, sorbet, milk free gelato e g , Soylati Vanilla and Mango Gelati Sanitarium Soy Good Bliss Range Cream and con densed milk Soy cream, soy cooking milk, soy condensed milk e g, Probios brand soy cream, Nestle soy based cooking milk, Tofutti sour cream

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Cows Milk Allergy – 5/03/2013 / 4 Butter and margarine Milk free margarine e g , Becel, Sundew, Nuttelex brands Chocolate Soy based chocolate , e g , Sweet William and Kinnerton brands Rice based chocolate eg , Bonvita If you are having trouble finding some of these products in your supermarket try online allergy or vegetarian product stores such as: www.crueltyfreeshop.com.au or www.veganperfection.com.au . LABEL READING Ingredients List All packaged foods must have an ingredients list. You must check this ingredients list for any ingredients t hat may contain milk. Since 2002, it has been law that all potential food allergens (peanut, tree nut, seafood, fish, milk, eggs, soybeans and wheat) must be clearly identified, however small the amount. Example : I nstead of simply casein the ingredients list should read casein (milk) or milk casein. ALWAYS check the ingredients list every time you buy the food as the ingredients of the product may change. These statements are used by manufacturers to indicate that the product may be contaminated with milk through processing and packaging. At present these statements are voluntary and there are no clear guidelines for companies regarding how and when to use them. The wording of the statements makes it very diffi cult to determine the level of risk and a product that does not contain the statement may be no safer than a product that does. The chances of having a significant allergic reaction through contamination during processing is extremely unlikely. Most famili es choose to ignore these statements as the only safe alternative is to avoid all companies can be contacted directly to explore food processing, packaging and clean ing procedures. LACTOSE IN MEDICATIONS Lactose is the sugar contained in cows milk. The pure sugar form is used in medications. The chance of a person with milk allergy reacting to pure lactose in medications is very low. FOOD PREPARATION Highly al lergic children can have a mild reaction from foods contaminated with milk or from cooking surfaces and utensils contaminated with milk or milk containing foods.

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Cows Milk Allergy – 5/03/2013 / 5 What about Nutrition? Cows milk and products made from cows milk such as yoghurt and chee se are important sources of protein, fat, calcium and vitamin A and D. Cows milk and dairy products are the main source of calcium in our diet. When eliminating cows milk and dairy products from the diet it is important to check your child has enough calci um from other foods. Calcium needs change with age. Below is a table with the recommended daily intake or RDI of calcium and the number of serves of calcium needed to provide the RDI. (1 serve = 250mg Calcium). Age Calcium requirement per day (mg) o r RDI Number of serves per day 1 – 3 yrs 500 2 4 – 8 yrs 700 3 9 – 13 yrs 1000 – 1300 4 – 5 14 – 18 yrs 1300 5 Breastfeeding women 1000 4 The following amounts of food provide on average one serve of calcium. Food Product Serve size = 1 serve of calcium (25 0mg) Breast milk 700mls Infant formula Step 1 From birth 500mls Infant formula Step 2 Follow On 300 – 350mls Toddler Formula Step 3 200mls or 1 cup Soy formula 400mls Peptijunior, Alfare and Neocate formulae 500mls Neocate Advance formula 220mls or 1 cup Elecare formula – < 12 mths of age 300mls Elecare formula - > 12 mths age 200mls or 1 cup Soy milk with added calcium 200mls or 1 cup Rice or Oat drink with added calcium 200ml or 1 cup Soy yoghurt 200g or 1 regular tub Soy cheese 125g 400g (varies) Almonds 100g Tahini 75g Canned sardines (must eat bones) 75g Salmon with bones 1/4cup White sesame seeds 400g Boiled spinach and raw parsley 150g Broccoli 5 cups CALCIUM SUPPLEMENTS Calcium supplements are availab le over the counter at chemists and supermarkets. They are used to supplement the diet if the dietary intake of calcium is low. Some of the available supplements ar e listed below. Ask your pharmacist or dietitian for more information.

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Cows Milk Allergy – 5/03/2013 / 6 Supplement Name Description Calcium Amount Other Actical Vanilla flavoured chewable tablet 200mg/tablet Vit D 100IU Andrews Tums Orange flavoured chewable tablet 200mg/tablet Blackmores Bio Calcium Spearmint flavoured chewable tablet 350mg/tablet s Calcium Strawberry flavoured chewable burstlet 200mg/tablet Vitamin D (Vita Gummies) Vanilla flavoured chewable bears 90mg/tablet Vit D 100IU Calcia Extra Strength Chewable orange flavoured tablet 1000mg/tablet Caltrate Cha lky tablet that can be crushed and added to foods or swallowed whole 600mg/tablet Cal – sup Spearmint flavoured chewable tablet 500mg/tablet Calsource Dissolvable tablet 1000mg/tablet Calvid Orange flavoured dissolvable granules 1000mg/sachet Vit D 880 IU Osteo Vit – D and Calcium Chewable vanilla flavoured tablet 600mg/tablet Vit D 1000IU , discuss this with your doctor or dietitian.

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