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Key Allergens

There are 12 allergens associated with cows, 9 of them relate to an allergy to the milk they produce (rather than the consumption of meat they produce).

The allergenic proteins in cow's milk are generally split into albumins (commonly called whey) and casein. In human milk the split is usually 60% whey to 40% casein. In cow's milk the split is 20% whey to 80% casein. This massive difference in composition is thought to be the cause of IgE allergic reaction to cow's milk, with most people being allergic to casein proteins in the milk.

Cow's Milk Protein Allergy (also called CMPA) is not be confused with lactose intolerance. A true allergy is to proteins in a food, lactose intolerance is due to a reaction to sugars in milk. Lactose free products should not be used by people with an allergy as they may still contain proteins - always check your labels!

Cross reactivity is usually caused by the proteins in one food being similarly shaped to those in another food. Unusually there is cross reactivity between the seed storage proteins in soya beans and the casein in cows milk. This is called non-homologous cross reactivity. This is a common anecdote, that babies allergic to cows milk can often not tolerate soya milk either and this would be the reason.

Cow's milk is usually the first food for many babies, which is why it seems such a common allergy. It is advisable to see your GP or health provider if your baby has an allergy as many very young children with a milk allergy will outgrow it.

Food Intolerances

Food is low in histamine Food is high in FODMAP

Fresh pasteurised cows' milk is low in histamine, so is suitable for people following a low histamine diet, however the histamine levels increase once it is made into yoghurt and even higher once made into various cheeses.

Milk is a high FODMAP food. FODMAP stands for Fermentable oligosaccharides, disaccharides, monosaccharides and polyols. Foods high in FODMAPs can cause symptoms of food intolerance, affecting the gastro intestinal system and this can be mistaken for a true IgE food allergy.

Associated Syndromes

Cow's milk allergy is not currently associated with any allergic syndromes.

Cross Reactivity

There is a lot of evidence of cross reactivity between cow's milk and eggs and this is due to serum albumin proteins found in both.

About 13 - 20% of cow's milk allergy sufferers will also react to beef when consumed. This is, again, due to serum albumin proteins found in both foods.

Cow's milk allergy has also been linked to a soya allergy - the soya protein component that cross-reacts with casein has been identified as a glycinin molecule.



Science Direct - Cow Milk

Allergen Encyclopedia - Cow's Milk

Allergy information for: Milk, cow (Bos taurus)

Allergy UK - Cow's Milk Allergy

ACAAI - Milk & Dairy Allergy

Anaphylaxis Campaign - Milk Allergy

FARE - Milk Allergy

Healthline - FODMAP Foods

Articles and Journals

Consensus document on the primary prevention of cow’s milk protein allergy in infants aged less than 7 days, 2022

Predictors of the outcome of the Oral Food Challenge for Cow’s Milk Protein Allergy: raw vs. processed foods, 2022

Cow milk protein allergy: clinical phenotype and risk factors, 2022

Cows’ Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review, 2022

Milk allergy over-diagnosis, 2022

IgE sensitisation predicts threshold but not anaphylaxis during oral food challenges to cow's milk, 2021

Early-Life Respiratory Infections in Infants with Cow’s Milk Allergy: An Expert Opinion on the Available Evidence and Recommendations for Future Research, 2021

Oral immunotherapy for IgE-mediated cow’s milk allergy in children: a systematic review and meta-analysis, 2021

Long-term Outcomes of Children with Cow’s Milk Protein Allergy in a Pediatric Allergy Clinic, 2021

The effect of a cow’s milk-free diet on asthma control in children: a quasi-experimental study, 2021

Cow's milk allergy in infancy and later development of type 1 diabetes–nationwide case‐cohort study, 2021

Cross-reactivities of non-homologous allergens, 2019

The natural history of milk allergy in an observational cohort, 2013

Milk and Soy Allergy, 2011

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines, 2010

Beef allergy in children with cow's milk allergy; cow's milk allergy in children with beef allergy, 2002

Anaphylaxis to cow's milk and beef meat proteins, 2002

Specificity of the human IgE response to the different purified caseins in allergy to cow's milk proteins, 1998

Gastroesophageal reflux and cow's milk allergy in infants: A prospective study, 1996

Allergen-specific IgE antibodies against antigenic components in cow milk and milk substitutes, 1986

Let me know if you found any of these interesting or useful. If you spot an article or research that you think is interesting you can message me or tag me on Facebook or Twitter - links at the bottom of the page.

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