Cow’s milk is probably the most common item in the American diet. It’s no wonder that allergists tell us that milk is also the number one cause the food allergy, especially for children. Common milk reactions include wheezing, runny nose and congestion, ear infection, rashes, vomiting and bloody diarrhea.

Those symptoms don’t show up immediately, though: there’s usually a time lag between drinking milk and feeling ill. What makes good old milk so troublesome? Allergic people react to one or more of three milk components: protein, fats and carbohydrates.

”Certain milk proteins are absorbed unchanged in allergic people,” explains Del Stigler, M.D., a pediatrician and allergist in Denver, Colorado. ”Beta lactoglobulin, for instance, is a relatively large protein molecule which the normal intestine will strain out.

But the intestine of an allergic person is abnormal, and larger molecules like lactoglobulins penetrate into the bloodstream unchanged, triggering reactions.” Casein is another troublesome milk protein. But heating milk, says Dr. Stigler, break down both.

”Some people who are allergic to milk can tolerate milk that’s been heated. For instance, we don’t see as much allergy to formula or evaporated milk, which have been processed at a high temperature of 260 to 280 degrees. That breaks down the protein. People who are allergic to raw milk,” Dr. Stigler adds, ”can often tolerate well cooked milk.”

On the other hand, Dr. Stigler told us that some people can drink raw milk, but not the heated, homogenized pasteurized type. He also says that whole milk (and butter and cheese) is sometimes better tolerated than skim or low fat. Fat, it seems, slows the time that the stomach takes to empty food into the intestines, allowing more time for milk to be absorbed and fewer problems to develop.

Milk Allergy or Lactase Deficiency?

Still others cannot digest lactose, the main carbohydrate (or sugar) in milk. Normally, fingerlike projections along the intestinal wall, called villi, secrete lactase, an enzyme specifically designed to digest lactase. But lactase intolerant people produce little or no lactase.

So the milk passes through undigested, producing one heck of a bellyache: abdominal discomfort, bloating, gas pains and often diarrhea. Lactase activity is generally highest at birth and slows down as we grow into adults. Many of the world’s peoples – including blacks, Mexicans, Indians, Asians and those of Mediterranean descent – lose lactase in childhood.

Others, particularly whites from northern or western Europe and their descendants, lose lactase later. Also, about with the flu or other virus can shutdown anyone’s lactase activity for several days. When the intertwines are inflamed the tips of the villi are broken off and produce little or no lactase.

That’s why a milk loving child may spurn the drink – or get a tummyache from it – after a stomach virus. Many lactase deficient people find they can tolerate milk if they simply cut down on the milk products, or consume small amounts throughout the day. Others can drink milk that’s been treated with Lactobacillus acidophilus, a special (and perfectly safe) bacteria that breaks down the lactose, doing the work their intestines can’t.

Lactobacillus, incidentally, is the same bacteria that turns milk into yogurt. In Mediterranean, Asian and African countries, where people are frequently lactase deficient, yogurt is the most widely used milk product. Some cheeses, such as cheddar and Cheshire, are very low in lactose, while aged Gouda and Edam are lactose free.

Cottage cheese has 86 percent less lactose deficient, yogurt is the most widely used milk product. You can also try milk’s that been treated with Lact-Aid, a lactose digesting enzyme product, before it leaves the dairy. You may also want to keep liquid Lact-Aid on hand to add to milk when visiting friends or eating in restaurants. (All those products, incidentally, are available in most health food stores and many supermarkets).

Until recently, milk allergy and lactose intolerance were regarded as totally separate problems. If you had both, it was considered a coincidence. Now, some doctors are convinced that, in many people, lactase deficiency actually develops as the result of an allergy reaction to either milk or some other food.

That’s because food allergy usually causes intestinal inflammation, which mows down the villi and create lactose intolerance. Doctors who advance this theory believe that 95 percent of the people who experience stomach distress after drinking milk have lactose intolerance secondary to an allergy of some kind.

Of course, you can be allergic to milk without developing lactose intolerance. In any case, many people with food allergies – children and adults alike – will have to eliminate milk in all forms if they’re ever going to feel better. ”If a child comes in with a stomachache, leg aches and a stuffy or runny nose, and they’re also drinking a lot of milk, we take them off milk,” Dr. Stigler told us.

For parents who are concerned that growing children will miss out on much needed calcium without milk in their diet, Dr. Stigler has some reassuring words, ”Many of us working in the field of allergy feel that allergic people don’t absorb a lot of the calcium in the milk.

If you’re sensitive to milk, the intestines reject it. So allergic kids aren’t necessarily using the calcium in the milk anyway. (for dietary sources of calcium other than milk, refer to Nutrition for Allergy Control). Take away the milk, says Dr. Stigler, and as with most people who give up a food to which they are allergic, a child will probably feel worse for the first couple of days.

”But their symptoms will start to clear up after the first three or four days,” Dr. Stigler predicts. ”In a week’s time, if milk was the cause of the stomachaches and the leg aches and the runny nose or whatever, it will all go away.”

Dr. Stigler also told us that, when milk is eliminated, children may eat ravenously for three or four days, whereas before they were just picking at their food. ”Take away the quart and a half or two quarts of milk a day – the average amount an allergic kid will drink – and they’ll then make up for milk calories with other food. They’ll eat extra hamburgers or three servings of something else to make up the difference.”

Milk allergy, like simple lactose intolerance, may be close related, Dr. Stigler adds, especially when it causes digestive or respiratory upset. ”It may take half a pint or more to cause the stomachache. But if you have the child who has eczema – a skin rash often caused by milk allergy – very often as little as a teaspoon of milk will cause the reaction.”

Table bellow provides guidelines for following a totally milk free diet. Avoiding milk may sound easy at first, but you have to stay on your guard against hidden sources.

Food Category	Foods You Can Eat, unless Allergic	Foods to Avoid
Meat, poultry and fish	Beef, veal, lamb, pork, chicken, turkey, cornish hens, fish*, seafood, nuts, butters.	Be careful of gravies and breadings, which may contain milk
Dairy products	Soy milk (if tolerated+), margarine marked ”pareve” and other margarine not containing milk products	Whole, dry or evaporated milk; ± butter, cream, cheese§, yogurt and margarine containing milk products; ice cream and sherbet; cream substitutes with whey, lactose or casein
Eggs	Hard or soft cooked, fried, poached, scrambled.	Milk, cream or butter in cooking
Grain products	Cereals served with fruit juice	Cereals served with milk or cream
	Homemade bread without milk, water bagels, crackers made without milk (read labels carefully)	Any bread made with milk, waffles and other baked goods made with milk
Soups	Soups made without cream, milk or cheese	Soups with cream, milk or cheese
Vegetables	Fresh or frozen vegetables are recommended, although canned are allowed*	All creamed vegetables; mashed potatoes, unless milk free
Fruit	Fresh, frozen or dried fruit is preferred, but canned is allowed*
Fats and oils	Vegetable oil
Desserts	All that do not contain milk or milk products	Pudding and other desserts containing milk or milk product
Beverages	Fruit juice, carbonated water
Miscellaneous	All foods labeled ”pareve” or ”parve”

SOURCES: Adapted from Basics of Food Allergy, by James C. Breneman (Springfield, III.: Charles C Thomas, 1978). The Elimination Diets, by Albert Rowe, Jr., Collin E. Sinclair, and Peter H. Rowe (Oakland, Calif.: Holmes Book Co., 1976).
* See also sections on sulfur additives and sugar.
+ Ten to 20 percent people with milk allergy are also allergic to soy.
± People with lactose intolerance may tolerate Lact Aid brand milk or milk treated people with lactose intolerance may tolerate Lact Aid brand milk or milk treated with Lact Aid brand commercial enzymes.
§ Lactose intolerant people can usually digest Brick, Camembert, cheddar, Edam, provolone, Swiss and pasteurized process American cheese, which are lactose free.

”You think you’re staying away from milk. But if you eat a hot dog or spaghetti, they may contain milk,” pointed out Constantine J. Falliers, M.D., an allergist and asthma specialist in Denver, Colorado. So you’ll need to read labels carefully – advice that applies to any allergy elimination plan.

Look for the code words ”caseinate,” ”lactose” or ”wey” – all are milk additives. As we mentioned before, most ”nondairy” creamers contain just such milk additives. (non dairy creamers also contain ingredients from other foods – corn, soy, animal and vegetable fats; flavor additives; and petroleum based chemicals – which may trigger allergy on their own.)

You can confidently buy bread, margarine and other foods marked pareve or parve – those are made without a trace of milk to conform to kosher food laws. And if you’re anywhere in the neighborhood of an ethnic bakery, drop in and stock up. Kosher bread (challah) is free of milk, as are more some French, Italian and Syrian breads.

If you’re allergic to penicillin, check to find out if your dairy supplier uses penicillin before you reintroduce mil to your diet. To cook without milk, experiment by substituting water, soy milk or fruit juice in your family’s favorite recipes. By the way, a small number of people with milk allergy are also allergic to soy, so switching to soy milk may not clear up their symptoms. Some people can tolerate goat’s milk as a substitute; others cannot. Only trial and error will tell.

The Cheese Stands Alone

You may find you can tolerate every other milk product except cheese, not even lactose free varieties. The trouble may system from the mold type fermentation that turns milk into cheese. Cottage cheese is mold free. Dr. Breneman told us that some cheese sensitive people can tolerate farmer’s cheese and homemade cheese, which are often mold free.

If molds aren’t your problem, but cheese still makes you miserable, you may be sensitive to tyramine, a natural substance in cheese and other foods – notably chocolate, yogurt, beer, red wine, gin, bourbon and vodka – that tends to trigger migraine headaches. If that’s the case, you may be able to eat only a tiny silver of cheese, as long as you don’t eat any other tyramine containing food or drink along with it.