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Dr. Gellner: Like all food allergies, milk allergy can be difficult to manage in a child. How can you help your child when milk is a common ingredient in so many foods? I'm Dr. Cindy Gellner with some tips for this tricky food allergy on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on the Scope.

Dr. Gellner: A milk allergy is not the same as lactose intolerance. Lactose intolerance only affects the digestive tract and it cause symptoms such as bloating, gas, and diarrhea. A milk allergy is a reaction by your child's immune system to the protein in milk. Our immune systems normally respond to bacteria or viruses that attack the body, but sometimes the body's immune system mistakenly believes that a harmless substance such as the proteins found in milk are harmful.

In order to protect the body, the immune system goes on attack with antibodies against that food. And the next time you eat that food, your immune system releases huge amounts of histamine to protect the body against the evil food proteins. That is what causes the symptoms that make us so miserable.

Casein is the main protein found in milk. It is found in the solid part of milk called curd when the milk goes sour. Whey, which is the liquid that remains once the curd is removed, contains the rest of the proteins. Your child can be allergic to the proteins in the curd, the whey, or both.

In very young children, cow's milk is the leading cause for allergic reactions. Milk is one of the eight foods that are responsible for food allergies in children. The other foods include eggs, soy, peanuts, tree nuts, wheat, fish, and shellfish. The good news is that most kids outgrow milk allergy by two or three years of age.

If you think your child is allergic to milk, dairy products, or any other food, it is important to get a diagnosis from your pediatrician or an allergist. Usually the history of the reaction is all we need to determine the allergy. But there are blood tests to confirm for some of these foods.

Milk allergies are typically discovered very early in formula and breast-fed babies. If a mother drinks cow's milk, the milk protein also comes out in her breast milk. The symptoms seen in milk allergy depend on whether or not the child has a slow or rapid reaction to milk.

The slower reaction is more common and the symptoms develop over time. Symptoms that occur slowly over several hours or sometimes days include diarrhea, often with streaks of blood, wheezing, rashes like eczema flares, and failure to grow very well. Symptoms that occur rapidly within seconds to hours may include severe wheezing, vomiting and hives.

If a mom is nursing, the pediatrician will most likely recommend avoiding milk products to the mom and taking calcium and vitamin D supplements instead. If your baby is formula fed, sometimes pediatricians will recommend a soy-based formula. These formulas contain soybean proteins, vitamins and minerals. The switch to soy formula helps for about half of the baby's allergic to milk. For those babies who still have reactions to milk proteins, pediatricians recommend hypoallergenic formulas. There are two types.

Hydrolyzed formulas contains proteins that have been broken down so they are easily digested and less likely to cause a reaction. These include Nutramigen, Alimentum and Pregestimil. Elemental formulas have proteins in their simplest form and are used when hydrolyzed formulas continue to cause symptoms. These include Neocate and EleCare.

The only treatment for a child with a milk allergy is to completely avoid milk and foods that contain milk products. Many processed food and restaurant foods contains milk or processed milk products. And you will need to change the way you shop and prepare foods.

The first step is to learn how to read labels and become familiar with ingredients that contains milk or dairy products. Always ask about ingredients if you are not sure. Foods and ingredients that contain milk include milk from other animals such as a goat, as well as yogurt, cheese, cottage cheese, cream, anything with casein or whey, butter and sadly chocolate. And also be careful of any ingredients that begin with "lac" such as lactose, lactate, lactalbumin, and lactic acid, and also fat replacers such as Simplese.

Reading labels to avoid allergens has become a lot easier. Foods that contain common allergens must be listed in plain language on the ingredient list. There are still some things to watch out for when reading food labels. Watch out for the words "may contain". Milk may not be an ingredient but the food may be made in a factory which also produces foods made with milk. If you see the words "may contain," there may be very little of the allergen or there may be a large amount.

A common question from parents is how to avoid cross contamination. Avoid battered or fried foods. The oil is often used for many different items, some of which may contain milk. Separate cooking utensils, cutting boards, and dishes used to prepare dairy products from those used to prepare food for your child.

Your child can still have a healthy diet as well as continue to enjoy some kid favorites. The main nutrients found in milk are protein, calcium, vitamin D and riboflavin. It is important to either take supplements or eat foods that are high in these elements. There's a lot of protein in milk, poultry, pork, fish, beans, nuts, and seeds. Ask your pediatrician about calcium and vitamin D supplements. Good sources of riboflavin are meat and eggs, whole grain or enriched cereals, and dark green leafy vegetables. Many foods such as bread and orange juice are now supplemented with calcium and vitamin D.

There are several brands of soy and rice milks that are enriched with calcium. They can be used for drinking and to pour on cereal. If milk is part of a recipe just to provide liquid, you can substitute water. Soy and rice milk, as well as fruit juice works well when substitutes baking. Oils, milk-free margarines, and soy butter can take the place of butter.

You can also visit foodallergy.org where there are many other helpful tips. Prepare your child's lunch at home. Talk with teachers about your child's needs. Ask the teachers to keep an eye out and explain the situation to other children if needed. Have the teacher call you if there is a special event or party planned so that you could bring a few modified treats that your child enjoys and can share with other kids. Make a card that lists foods and ingredients that should be avoided and give one to the teacher.

Living with food allergies is possible. I'm proof of that. By making others aware of your child's food allergy, you will keep your child safe. If your child is old enough, even as young as three or four, make sure they are aware of their food allergy. This will empower them to be in charge of their own health.

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