Cow’s Milk (Dairy) Allergy - Fast Facts

This document has been developed by ASCIA, the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. ASCIA information is based on published literature and expert review, is not influenced by commercial organisations and is not intended to replace medical advice.         

For patient or carer support contact Allergy & Anaphylaxis Australia or Allergy New Zealand.

pdfASCIA PC FAST FACTS Cows Milk Allergy 2023154.38 KB

  1. More than 2% of infants in Australia and New Zealand have cow’s milk allergy. Most children outgrow cow’s milk allergy by the age of three to five years, but it can remain a lifelong allergy.

  2. Allergic reactions range from mild to severe. Quick onset allergic reactions usually happen within 15 minutes, and sometimes up to two hours after having cow's milk.

  3. Signs of mild to moderate allergic reactions include swelling of lips, face or eyes, hives (urticaria) or welts on the skin, tingling mouth, abdominal (stomach) pain, vomiting, and diarrhoea.

  4. Severe allergic reactions (anaphylaxis) to cow’s milk should always be treated as medical emergencies that require immediate treatment with adrenaline (epinephrine). Signs of anaphylaxis include any one of the following; difficult or noisy breathing, swelling of tongue, swelling or tightness in throat, wheeze or persistent cough, difficulty talking or hoarse voice, persistent dizziness or collapse. Young children may be pale and floppy.

  5. Delayed allergic reactions usually occur two or more hours after drinking or eating cow’s milk. This may lead to many symptoms including an increase in eczema, rashes or delayed vomiting and/or diarrhoea, but does not include anaphylaxis.

  6. Not all reactions to cow’s milk are due to allergy to the protein in cow’s milk. Reactions may also be due to lactose intolerance which does not cause rashes or anaphylaxis.

  7. Diagnosis of cow’s milk allergy is made by a specialist paediatrician or clinical immunology/allergy specialist. If cow’s milk allergy is confirmed, management usually involves removing cow's milk and other dairy foods from the diet.
    An alternative source of calcium and protein is needed to ensure adequate nutrition and growth, until cow’s milk can be safely reintroduced into the diet. Referral to a dietitian may be needed.

  1. Some people with cow’s milk allergy can tolerate cooked or baked cow’s milk in muffins, cakes or biscuits. This should be discussed with your clinical immunology/allergy specialist.

  2. If not breastfeeding, milk alternatives for infants up to one year of age include cow’s milk based extensively hydrolysed formula (EHF), soy protein formula, rice protein based formula, or amino acid formula (AAF). Milk alternatives for infants over one year of age include soy milk, and calcium enriched rice, oat or nut milks which have around 120mg/100ml of calcium.

  3. Most people who are allergic to cow's milk will be allergic to other animal milks and foods that are made from these milks. Therefore, cow’s milk derived formula/milk, lactose free formula/milk, goat’s milk formula/milk, sheep's milk formula/milk, camel’s milk, HA formula and A2 formula/milk are NOT suitable for people with cow’s milk allergy and may cause allergic reactions.

© ASCIA 2023

Content updated June 2023

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