Cow's milk is one of the most common cause of food allergies in children.  The good news is that it appears the majority of people with cow's milk allergy will outgrow their food allergy, though this can take many years.   According to a study published in 2007 in the Journal of Allergy and Clinical Immunology, milk allergy resolved in 19% of children at age 4, in 42% by 8 years of age, in 64% by age 12, and in 79% by 16 years of age.  It is thus important to re-appraise food allergies periodically with a board certified allergist to safely determine if the allergy has gone away.

Lactose intolerance is sometimes mistaken as a milk allergy, but it is not. Lactose intoelrance results from difficulties in digesting milk proteins.  This compares to  a milk allergy which results from an abnormal respose of the immune system.

The majority (90%) of cow's milk allergic individuals will also have an allergy to goat's milk.  However, soy milk and rice milk are usually well tolerated in cow's milk allergic individuals.   

90% of infants with cow's milk allergy will tolerate specially formulated cow's milk formula which are "extensively hydrolysed".  This means that the milk particles are broken down into small pieces which the immune system may not recognize as cow's milk proteins.  Extensively hydrolyzed formulas include Pregestimil, Nutramigen and Alimentum.  

If extensively hydrolyzed formulas are not tolerated, you can use "elemental amino acid" formulas, where the cow's milk proteins are broken into even smaller particles.  Elemental formulas include Neocate and EleCare.They are usually very well tolerated, but unfortunately also are very expensive.   

Cow milk avoidance

Avoid foods that contain:

• Artificial butter flavor
  
• Butter
  
• Butter fat
  
• Butter oil
  
• Buttermilk
  
• Casein
  
• Caseinates
  
• Cheese
  
• Cream
  
• Condensed milk
  
• Cottage cheese
  
• Curds
  
• Custard
  
• Ghee
  
• Goat’s milk
  
• Half and Half
  
• Lactalbumin
  
• Lactoglobulin
  
• Lactose
  
• Lactulose
  
• Milk (whole, low fat, non-fat, skimmed)
  
• Milk derivative
  
• Milk powder
  
• Milk protein
  
• Nougat
  
• Pudding
  
• Rennet Casein
  
• Sour cream
  
• Sour cream solid
  
• Sour milk
  
• Whey
  
• Yogurt
  

These foods may contain cow's  milk:

• Bavarian cream
  
• Biscuit
  
• Brown sugar
  
• Caramel flavoring
  
• Cake
  
• Caned tuna
  
• Coconut cream
  
• Cookies
  
• Cream sauce
  
• Cream soup
  
• High protein flour
  
• High protein powder
  
• Ice cream
  
• Instant mashed potatoes
  
• Luncheon meat, hot dogs, sausages
  
• Margarine
  
• Muffins
  
• Packet soups
  
• Pies
  
• Puddings
  
• Sausages
  
• Sherbet
  
• Whipped cream
  

Watch out for contamination from:

• Deli meat slicers used for both meat and cheeses
  
• Pareve labeled foods.   Food products labeled as pareve may contain trace amounts of cow's milk.    There are at least 3 case reports of children with cow's milk allergy who developed allergic reactions after eating
  pareve labeled foods. 
  



For baking

You can substitute cow's milk with water, soy milk, rice milk, or almond milk. You can substitute butter with milk free margarine, vegetable shortening, or soy butter.

You can also make your own milk substitute:

Cow's milk substitutes:
Each option below equals 1 cup of cow's milk:   

• 1 cup of soy milk
  
• 1 cup of rice milk + 1 egg yolk
  
• 1 cup of water + 1 egg yolk
  
• 1 cup of coconut milk
  
• 1 cup of fruit juice
  

Butter replacement:
Each of the following equals 1 stick (8 tablespoons) of butter:

• 8 tablespoons (1 stick) of Fleischmann's unsalted margarine
  
• 8 tablespoons of vegetable or olive oil
  
• 6 tablespoons of unsweetened apple sauce + 2 tablespoons of one of these: olive oil, vegetable oil,
  fleischmann's unsalted margarine
  

If you don't want to make your own milk substitute, or do not like the taste of soy milk (or you are also allergic to
soybean), you may want to try Vance's DariFree milk alternative.  It's made from potatoes (it is milk, soy, rice,
gluten free), and patients tell me that it works very well as a milk substitute for cooking.