Managing Children with Milk Allergy

Milk allergy is a personal case for me. My second daughter is allergic to several things with milk on the top of the list. She has always been sensitive and prone to skin problems since she was a baby. In her case, she develops a rash around her mouth and/or lips. It is red and scaly. She also has rashes on her inner elbow as a distinctive allergy sign for children with atopic dermatitis. Besides taking antihistamin which sometimes does not do much for her, I would have to vote for food avoidance as best therapy.

Easier said than done because most kids foods especially snacks are milk enriched. God knows why. Avoiding milk in little boxes is not hard but reading snack labels can be a pain. Not to mention food shared at school that she cannot decide on her won. So, our daughter’s daily routine involves lipbalm (can’t live without it) and will do a post on best lipbalms. Light corticosteroid cream and CTM when the rashes are too much too handle.

Actually, the prevalence of milk allergy is estimated to be 0.2-4.9% according to the World Allergy Organization and higher in children compared to adults. Although rare, babies with breastmilk can also experience cow milk allergy. It comes from cow milk consumed in the mother’s diet. Other important factors are the immunomodulators in breast milk and the difference between intestinal flora in babies who are breastfed and those who are not. Milk allergy is caused by immunological reaction of one or more milk protein with various clinical manifestations.



A complete history taking including family atopic history and thorough physical examination are mandatory. Unfortunately, not one single sign is specific for milk allergy besides the pattern and presence of symptoms to assist in diagnosis. Most children experience at least two symptoms of the following organ systems: gastrointestinal (50-60%), skin (40-50%), and respiratory tract. Check the pattern of symptoms and milk consumption.


Gastrointestinal symptoms includes:

  • swelling and itchiness n lips, mouth mucosa, and intestinal systems in contact with milk.
  • vomiting and/or diarrhea. In severe cases, can occur dehydration and electolyte imbalances with weight loss.
  • chronic constipation irresponsive to medications.


Skin symptoms:

  • immediate atopic dermatitis or sensitized up to 2 weeks prior to symptoms
  • urtikaria and angioedema


Respiratory tract symptoms:

  • chronic or recurrent rhinitis, otitis media, and wheezing


Physical Examination

  • general conditions: nutritional and hydration status, sometimes with anemia.
  • skin: dermatitis, urticaria, angioedema
  • respiratory tract: rhinitis signs (pale and swelling concha), wheezing, otitis media
  • gastrointestinal tract: meteorismus, anal fissure


Additional Examination

  • we can perform a food challenge but with exacerbation risks, it is preferable to perform a skin prick test, IgE level test, and a skin patch test.
  • other lab tests such as faeces and CRP, LED does not hold specific diagnostic values.


Managing children with milk allergy

Avoiding milk consumption is the best management and actually is a standard for all types of food allergies. Mind that milk here also includes the processed from as in cheese, yogurt, butter, ice creams, cookies, and cakes. Families must work on it together since we do not want to always exclude the child with allergy. In our family, we tend to avoid eating out such food and I only gave the restricted food for other children not in front of my second daughter. Not easy.

Learn to read food labels. Learn more about the common recipe for food we buy like does sweet bread uses milk? Yes. Does sandwiches contain milk? Actually not but these days they do. Most cookies and cakes also contains milk. Beware of sweet condensed milk in desserts which our daughter absolutely cannot stand. Do trial and errors of which food you child can manage and which he/she can’t. Do not keep food your child cannot eat at home. He/she will eat it eventually.

In general, we must try to persuade our children to eat well on a daily basis so he/she will not rely their meals on midtime snacks. It is hard also for me whereas our daughter is a sweet tooth and does not really like overeating her staple food items. For school we can give them pasta and noodle as a meal variety from biscuits and bread.

Allergic children can surely grow and thrive well provided they can manage balanced meals and follow their food restrictions. In breastfed babies, the mothers must follow suit with her food restrictions to ensure wellness of her baby. For formula fed infants, mothers can choose other milk source such as special hydrolyzed milk with several setbacks such as poor taste and high cost. Another option is providing soya milk for babies < 6 months old. If given for >6 month old , there are concerns for the hormonal effects of phytoestrogens n the reproductive systems.



Most children will grow out of their allergies and become much more tolerant to cow milk in 1-3 years time.



Keep reading and stay supportive of our children, moms. They will be all right 🙂



dr. Fiona Esmeralda, MM



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Panduan Pelayanan Medis, IDAI

World Allergy Organization

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