Milk - One of the nine most common food allergens

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Allergic reactions Allergic reactions are severe 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 nine priority food allergens are peanuts, tree nuts, sesame seeds, milk, eggs, seafood (fish, crustaceans and shellfish), soy, wheat and sulphites (a food additive). What are the symptoms of an allergic reaction? When someone comes in contact with an allergen, the symptoms of a 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 of the following symptoms: Flushed face, hives or a rash, red and itchy skin Swelling of the eyes, face, lips, throat and tongue Trouble breathing, speaking or swallowing Anxiety, distress, faintness, paleness, sense of doom, weakness Cramps, diarrhea, vomiting A drop in blood pressure, rapid heart beat, loss of consciousness

How are food allergies and severe food allergy reactions treated?

Currently there is no cure for food allergies. The only option is complete avoidance of the specific allergen. Appropriate emergency treatment for a severe food allergy reaction includes an injection of epinephrine (adrenalin), which is available in an auto-injector device. Epinephrine must be administered as soon as symptoms of a severe allergic reaction appear. 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 your allergist's advice on how to use an epinephrine auto-injector device.

Frequently asked questions about milk allergies

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

Avoid all food and products that contain milk and milk derivatives. These include any product whose ingredient list warns it "may contain" or "may contain traces of" milk.

Can a milk allergy be outgrown?

Studies show that two to four per cent of infants are milk allergic and most outgrow their allergy by three years of age. However, a severe milk allergy can last a lifetime. Consult your allergist before reintroducing milk products.

What is the difference between milk allergy and lactose intolerance?

When someone has a milk allergy his/her immune system has an abnormal reaction to milk proteins, which may be life-threatening. When a person is lactose intolerant, his/her body does not have enough of the enzyme lactase, needed by the digestive system, to break down the milk sugar lactose. Symptoms of lactose intolerance include abdominal pain, bloating and diarrhea after milk ingestion. Lactose intolerance is not an allergy. If you are unsure whether you have milk allergy or lactose intolerance, consult an allergist.

How can I determine if a product contains milk or milk derivatives?

Always read the ingredient list carefully. Milk and milk derivatives can often be present under different names, e.g., casein. For other common ingredient label names, refer to the list below.

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

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

Does product size affect the likelihood of an allergic reaction?

It 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.

Avoiding milk and milk derivatives

Make sure you read product labels carefully to avoid products that contain milk and milk derivatives. Avoid food and products that do not have an ingredient list and read labels every time you shop. Manufacturers may occasionally change their recipes or use different ingredients for varieties of the same brand. Refer to the following list before shopping:

Other names for milk

Ammonium/calcium/magnesium/potassium/sodium caseinate
Casein/caseinate/rennet casein
Curds
Delactosed/demineralized whey
Dry milk/milk/sour cream/sour milk solids
Hydrolyzed casein, hydrolyzed milk protein
Lactalbumin/lactalbumin phosphate
Lactate/lactose
Lactoferrin
Lactoglobulin
Milk derivative/fat/protein
Modified milk ingredients
Opta^™, Simplesse^® (fat replacers)
Whey, whey protein concentrate

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

Possible sources of milk

Artificial butter, butter fat/flavour/oil, ghee, margarine
Baked goods and baking mixes e.g., breads, cakes, doughnuts
Brown sugar, high-protein flour
Buttermilk, cream, dips, salad dressings, sour cream, spreads
Caramel colouring/flavouring
Casein in wax, e.g., fresh fruits and vegetables
Casseroles, frozen prepared foods
Cereals, cookies, crackers
Cheese, cheese curds, cottage/soy cheese
Chocolate
Desserts, e.g., custard, frozen yogurt, ice cream, pudding, sherbet, yogurt
Egg/fat substitutes
Flavoured coffee, coffee whitener, non-dairy creamer
Glazes, nougat
Gravy, sauces
Kefir (milk drink), kumiss (fermented milk drink), malt drink mixes
Meats, e.g., canned tuna, deli/processed meats, hot dogs, pâtés, sausages
Pizza
Potatoes, e.g., instant/mashed/scalloped potatoes, seasoned french fries/potato chips
Seasonings
Snack foods, e.g., candy, fruit bars, granola bars
Soups, soup mixes
Tofu
Wax coated fruits 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

See an allergist and educate yourself about food allergies. Contact your local allergy association for further information.

If you or anyone you know has food allergies or would like to receive information about food being recalled, sign up for the Canadian Food Inspection Agency's (CFIA) free e-mail "Food Recalls and Allergy Alerts" notification service available at
www.inspection.gc.ca/english/tools/listserv/listsube.shtml?foodrecalls_rappelsaliments. When you sign up you will automatically receive food recall public warnings.

Before eating

Allergists recommend that if you do not have your auto-injector device with you that you do not eat. If an ingredient list says a product "may contain" or "does contain" milk or milk derivatives, do not eat it. If you do not recognize an ingredient or there is no ingredient list available, avoid the product.

Watch out for allergen cross contamination!

Cross contamination is the 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, bulk nuts; and
• during food preparation at home or in restaurants through equipment, utensils and hands.

What is the Government of Canada doing about food allergens?

The Government of Canada is committed to providing safe food to all Canadians. The 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 them in developing these controls. When the CFIA becomes aware of a potential serious hazard associated with a food, such as undeclared allergens, 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 priority allergens, gluten sources and sulphites in pre-packaged food sold in Canada. Health Canada is proposing to amend the Food and Drug Regulations to require that the most common food and food ingredients that cause life-threatening or severe allergic reactions are always identified by their common names allowing consumers to easily recognize them.

Where can I get more information?

For more information on:

• food allergies;
• ordering free copies of this pamphlet; and
• subscribing to the free "Food Recalls and Allergy Alerts" e-mail notification service, visit the CFIA Website at www.inspection.gc.ca 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).

Below are some organizations that can provide additional allergy information:

Allergy/Asthma Information Association
www.aaia.ca

Anaphylaxis Canada
www.anaphylaxis.ca

Association québécoise des allergies alimentaires
www.aqaa.qc.ca(French only)

Canadian Society of Allergy and Clinical Immunology
www.csaci.medical.org (English only)

Health Canada
www.hc-sc.gc.ca

Developed in consultation with Allergy/Asthma Information Association, Anaphylaxis Canada, Association québécoise des allergies alimentaires, Canadian Society of Allergy and Clinical Immunology and Health Canada.

Cat. No. A104-27/6-2005E
ISBN 0-662-40355-X
P0424-05/07E