By P.K. Daniel

For the first five years of his life, Alex Siverts and his family were wary of eating at a restaurant. When they finally decided to venture out, Alex’s mom Diana was ready.

She packed a plate and utensils for the allergy-safe meal she prepared at home. After arriving at the carefully chosen restaurant, she wiped down the table and chairs to avoid the possibility of food allergen residue coming into contact with Alex’s skin.

“I trusted nothing,” Diana says. “He has such a wide array of allergies – not just the peanuts and tree nuts. If it were just those, it might be different, but the milk makes it much harder.”

Milk remains a challenge for Alex – now 11 – due to its prevalence in food products. It’s in butter, creams, cheese and yogurt, among others. Exposure causes Alex’s skin to break out in hives. He also has asthma, putting him at greater risk for anaphylaxis, a life-threatening allergic reaction.

Dairy, Dairy, Everywhere

Milk is not just in a glass or a bowl of cereal. A host of food products in Western cuisine contain dairy – some obvious, others not so much.

Easily recognizable foods containing milk:

  • Butter
  • Sour cream
  • Ice cream
  • Yogurt
  • Cheese
  • Cottage cheese
  • Custard
  • Pudding

Foods that may contain milk:

  • Salad dressings
  • Caramel candy
  • Chocolate
  • Hot dogs
  • Sausage products
  • White sauces (such as Alfredo)
  • Breads and biscuits
  • Cookies and cakes
  • Pancake/waffle batter
  • Cereals

Even some chewing gum has lactose (milk sugar) sprayed on it. Some tortilla chips and microwave popcorn are coated in a dairy-based powder.

With media attention mostly focused on peanut allergy, milk is sometimes forgotten or misunderstood, even though it is required to appear on food labels as one of the eight most-common allergens. It also has the distinction as the most common food allergy among infants and young children.

Milk allergy affects about 2.5 percent of children younger than 3. The good news is that 80 percent will outgrow it by age 16, according to the American College of Allergy, Asthma & Immunology (ACAAI).

Milk can be one of the most difficult allergies to avoid because it’s in so many dishes and often “hidden” as butter, cream or cheese, says Stephanie Leonard, MD, a food allergy specialist at Rady Children’s Hospital-San Diego.

“I think it’s harder to avoid than peanuts,” she says. “Nowadays more people understand peanut allergy than milk allergy.”

Safeguards for Parents

Bob Geng, MD, a pediatric allergist and immunologist also at Rady Children’s Hospital-San Diego, recommends the following precautions for patients and families:

  • Read food labels carefully
  • Learn various code words for milk ingredients
  • Consult a board-certified allergist and nutritionist

The two main proteins in milk are casein (curds) and whey (watery part). If a product contains milk, it must be listed within the ingredients in parentheses following the name of the allergen, such as “whey (milk),” or listed in the “contains” section adjacent to the ingredients. Beware, however, the “contains” statement is not required for casein and a food can be promoted as “nondairy” on the front of the package even if it contains casein.

In addition to casein and whey, watch out for these terms when checking labels:

  • Caseinates
  • Ghee
  • Lactalbumin
  • Tagatose
  • Any protein or powder derived from milk

Parents should also make sure all caregivers are aware of a child’s milk allergy and able to read food labels when eating out or grocery shopping.

Safeguards for Schools

“Milk allergies are often overlooked in schools,” says Cathy Owens, RN, coordinator of health services for Murrieta Valley Unified School District in Murrieta, California. “We create policies and procedures for nut allergies, but we rarely address the risk to students with milk allergy.”

What precautions can schools take?

Owens recommends providing information about reading food labels to school staff, including teachers and cafeteria workers, and posting signs about milk allergy and anaphylaxis symptoms.

“Posting information about food allergies helps increase awareness,” she says. “I think the key is to be aware of any reaction to food and not just think, ‘It’s nut-free, so it must be safe.’”

Parents and schools can work together to create policies to address how food allergies will be managed in the classroom and cafeteria. These include separating eating and learning spaces, using sanitary wipes to clean tables and chairs where food is eaten, and handwashing by all students after meals.

For classroom parties, arrange a dairy-free treat so milk-allergic children don’t feel left out.