Milk - A priority food allergen

2017
Cat.: H164-156/4-2017E-PDF
ISBN: 978-0-660-09028-3
Pub.: 170192

Allergic reactions are adverse reactions that occur when the body's immune system overreacts to a particular allergen. These reactions may be caused by food, insect stings, latex, medications and other substances. In Canada, the priority food allergens are peanuts, tree nuts (almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachio nuts and walnuts), sesame seeds, milk, eggs, fish, crustaceans and molluscs, soy, wheat or triticale (a hybrid of wheat and rye grains), and mustard. Sulphites (a food additive), which do not cause true allergic reactions, are generally grouped with the priority allergens because sulphite-sensitive individuals may react to sulphites with allergy-like symptoms.

What are the symptoms of an allergic or allergic-type reaction?

When someone comes in contact with a food allergen or added sulphites, the symptoms of an allergic or allergic-type reaction may develop quickly and rapidly progress from mild to severe. The most severe form of an allergic reaction is called anaphylaxis. Symptoms can include breathing difficulties, a drop in blood pressure or shock, which may result in loss of consciousness and even death. A person experiencing an allergic reaction may have any combination of the following signs or symptoms:

• Skin: hives, swelling (face, lips, tongue), itching, warmth, redness;
• Respiratory: coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneezing), trouble swallowing;
• Gastrointestinal: nausea, pain or cramps, vomiting, diarrhea;
• Cardiovascular: paler than normal skin colour/blue skin colour, weak pulse, dizziness or lightheadedness, loss of consciousness, shock;
• Other: anxiety, sense of impending doom, headache, uterine cramps, metallic taste.

 Source: Anaphylaxis in Schools & Other Settings

How are severe allergic reactions treated?

Currently there is no cure for food allergies. The only option for managing the risk is to completely avoid the specific allergen. Appropriate emergency treatment for anaphylaxis (a severe allergic reaction) includes an injection of epinephrine, which is available in an auto-injector device. Epinephrine is the only medication that can stop an allergic reaction from progressing and must be administered as soon as symptoms of a severe allergic reaction appear. Antihistamines, if used, should be given AFTER epinephrine has been administered.   The injection must be followed by further treatment and observation in a hospital emergency room. If your allergist has diagnosed you with a food allergy and prescribed epinephrine, carry it with you all the time and know how to use it. Follow the advice of your allergist on how to use an auto-injector device.

Frequently asked questions about milk allergies

I have a milk allergy. How can I avoid a milk-related reaction?

• Read food labels.
  
  Avoid all food and products that contain milk and any product whose label carries a precautionary statement warning that the product might have milk in it such as “may contain” milk or similar wording. When provided by a manufacturer, precautionary statements are usually found after the list of ingredients or "Contains" statement if there is one. By December 2021 any precautionary statements will have to appear in this location only.
  
  If milk is part of the product formulation, it must be declared in the list of ingredients or in a separate “contains” statement immediately following the list of ingredients.  

• Avoid any products that do not have an ingredient list. 
• Read labels every time you shop. Manufacturers may occasionally change their recipes or use different ingredients for varieties of the same product.

Can a milk allergy be outgrown?

Studies suggest that while up to four percent of infants are allergic to milk, for many of these infants the allergy will disappear within three years. For some, however, a milk allergy can be a lifelong condition. Consult your allergist before reintroducing your child to milk products.

Can some people with milk allergy safely consume baked products containing milk?

Some people with milk allergy can consume extensively heated/baked products that contain milk (i.e., with the product completely cooked throughout).  Please consult with your allergist before consuming any baked products containing milk.

What is the difference between milk allergy and lactose intolerance?

A milk allergy occurs when a person's immune system reacts abnormally to milk proteins; it can be life-threatening. Lactose intolerance occurs when a person cannot digest lactose, a component of milk, because their body does not produce enough of a specific enzyme that breaks down lactose. Symptoms of lactose intolerance include abdominal pain, bloating and diarrhea after milk ingestion. Lactose intolerance is not an allergy and is not life-threatening. If you are unsure whether you have a milk allergy or lactose intolerance, consult an allergist.

Does the source of the milk make a difference?

The proteins in cow's milk are very similar to those found in milk from goats, sheep and other ruminants (such as deer or buffalo). Therefore, people who are allergic to cow's milk will likely experience reactions to other types of milk. Consult your allergist before consuming milk or products made from the milk of goats, sheep or other ruminants.

What do I do if I am not sure whether a product contains milk?

If you have a milk allergy, do not eat, drink or use the product. Obtain ingredient information from the manufacturer.

Does product size affect the likelihood of an allergic reaction?

Product size does not affect the likelihood of a reaction; however, the same brand of product may be safe to consume for one product size but not another. This is because product formulation may vary between different product sizes of the same product or be produced in a different facility. Always read the ingredient lists carefully.

Other names for milk

In the past, some products have used other names for milk on their labels. These names are not permitted without the word milk also appearing on the label, based on the enhanced labelling requirements for food allergens, gluten sources and added sulphites. However, if you have a milk allergy and see one of the following in the list of ingredients on a product you should not eat it.

• Beta-lactoglobulin
• Casein, rennet casein
• Caseinate (ammonium caseinate, calcium caseinate, magnesium caseinate, potassium caseinate, and sodium caseinate)
• Delactosed or demineralized whey
• Hydrolyzed casein
• Lactalbumin and lactalbumin phosphate
• Lactoferrin, lactoglobulin
• Whey and whey protein concentrate

Avoid food and products that do not have an ingredient list and read labels every time you shop.

Common sources of milk

• Butter, Buttermilk
• Cheese, curds
• Cream, ice cream
• Ghee and butter fat
• Kefir (milk drink)
• Kumiss (fermented milk drink)
• Sour cream
• Yogurt

Examples of foods and products that contain or often contain milk

• Infant baby cereals
• Infant formula, follow-up formula, nutrition supplements for toddlers and children
• Artificial butter, butter flavour or butter oil
• Dark chocolate
• Baked goods (including some type of breads) and baking mixes.
• Battered and fried foods
• Broth and bouillons
• Caramel colouring or flavouring
• Casseroles, frozen prepared foods
• Cereals, cookies and crackers
• Chocolate bars
• Desserts, e.g., custards, frozen yoghurts, ice creams and puddings
• Dips and salad dressings
• Egg and fat substitutes
• Fat replacers, e.g., Opta™ and Simplesse®
• Glazes
• Gravies and sauces
• High-protein flour
• Malt-drink mixes
• Margarine
• Pâtés and sausages
• Pizza
• Potatoes (instant, mashed and scalloped potatoes)
• Seasonings
• Soups and soup mixes, cream soups
• Soy cheese

Other possible sources of milk

• Canned tuna, e.g., seasoned or mixed with other ingredients for flavour
• Candy, fruit and granola bars, e.g., those containing caramel or chocolate
• Flavoured coffee, coffee whitener and non-dairy creamer
• Some french fries (made from potato mixture or mashed potatoes)
• Some hot dogs, deli and processed meats
• Nougats
• Seasoned chips, e.g., sour cream and onion
• Waxes on some fresh fruit and vegetables

Non-food sources of milk

• Cosmetics
• Medications
• Pet food

Ingredients that do not contain milk protein

• Calcium/sodium lactate
• Calcium/sodium stearoyl lactylate
• Cocoa butter
• Cream of tartar
• Oleoresin

Note: These lists are not complete and may change. Food and food products purchased from other countries, through mail-order or the Internet, are not always produced using the same manufacturing and labelling standards as in Canada.

What can I do?

Be informed

Consult your allergist or physician in order to obtain the advice and support needed to help manage your condition. Contact your allergy association for further information.

If you or anyone you know has food allergies and would like to receive information about food being recalled due to improper allergen labelling, sign up for the Canadian Food Inspection Agency's (CFIA) e-mail “Food Recalls and Allergy Alerts” notification service. When you sign up you will automatically receive timely food recall notifications.

Before eating

Allergists recommend that if you do not have your auto-injector device with you that you do not eat. If the label indicates that a product “contains” or “may contain” milk, do not eat it. If you do not recognize an ingredient, if there is no ingredient list available or if you don't understand the language written on the packaging, avoid the product.

Watch out for allergen cross-contamination!

Cross-contamination is the accidental transfer of an ingredient (food allergen) to a product that does not normally have that ingredient in it. Through cross-contamination, a food that should not contain the allergen could become dangerous to eat for those who are allergic.

Cross-contamination can happen:

• during food manufacturing through shared production and packaging equipment;
• at retail through shared equipment, e.g., cheese and deli meats sliced on the same slicer; and through bulk display of food products, e.g., bins of baked goods;
• during food preparation at home, daycares, schools or in restaurants through equipment, utensils and hands.

What is the Government of Canada doing about priority food allergens, gluten sources and added sulphites?

The Government of Canada is committed to providing Canadians with the information they need to make safe and healthy food choices. The Canadian Food Inspection Agency (CFIA) and Health Canada work closely with municipal, provincial and territorial partners and industry to meet this goal.

The CFIA enforces Canada's labelling laws and works with associations, distributors, food manufacturers and importers to ensure complete and appropriate labelling of all foods. The CFIA recommends that food companies establish effective allergen controls to prevent the occurrence of undeclared allergens and cross-contamination. The CFIA has developed guidelines and tools to aid food companies in developing these controls. When the CFIA becomes aware of a potential hazard associated with a food, such as undeclared allergens, Health Canada is asked to assess the situation. When a serious risk is identified, the food product is recalled from the marketplace and a public warning is issued. The CFIA has also published several advisories to industry and consumers regarding allergens in food.

Health Canada has worked with the medical community, consumer associations, and the food industry to enhance labelling regulations for food allergens, gluten sources and added sulphites in pre-packaged food sold in Canada. Health Canada has amended the Food and Drug Regulations to require that the most common foods and food ingredients that may cause life-threatening or severe allergic reactions are always clearly identified by their common names on food labels allowing consumers to easily recognize them and make safe and informed food decisions.

More information on the regulations that enhance the labelling of food allergens, gluten sources and added sulphites can be found on the Health Canada website:

If you come across a food that you think is improperly labelled, contact the CFIA and provide information about the product.

Report a food safety or labelling concern.

Where can I get more information?

For more information on:

• food allergies

visit Health Canada's website.

For information on:

• subscribing to the “Food Recalls and Allergy Alerts” e-mail notification service

visit the CFIA website or call 1-800-442-2342/TTY 1-800-465-7735 (8:00 a.m. to 8:00 p.m. Eastern time, Monday to Friday).

For information on this and other Government of Canada programs and services call

• 1 800 O-Canada (1-800-622-6232)
• TTY 1-800-465-7735

Below are some organizations that can provide additional allergy information:

• Allergy/Asthma Information Association
• Food Allergy Canada
• Allergies Québec (French only)
• Canadian Society of Allergy and Clinical Immunology (English only)