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Cow’s Milk Allergy or Intolerance?

Cow’s milk is one of the most common causes of adverse reactions in Australian children, but there is often confusion whether the child’s reactions are due to an allergy or intolerance, as many of the symptoms can be the same. This is why it’s so important to seek medical advice as soon as possible when your child has a reaction to cow’s milk.  

3 mins to read Jun 15, 2023

What is the difference?

  1. Cow’s milk allergy occurs when the immune system reacts to the protein found in cow’s milk. Around 2% of Australian infants are allergic to cow’s milk and dairy products, and while most will grow out of it by school age, some may have it for life.
  2. Cow’s milk intolerance on the other hand is not an immune response, it’s a reaction to the sugar in milk (lactose). This is often referred to as Lactose Intolerance.

It is sometimes not easy to recognise the difference between an allergy or intolerance as the signs vary and may be confused with other conditions. It’s important to always get a medical diagnosis.

1. Cow’s milk allergy – Indications and management

Cow’s milk protein allergy can result in immediate (within 15 minutes) or delayed (after about 2 hours) reactions and range from mild to severe.  Some of the symptoms may include:

  • Skin: hives, eczema, redness or paleness in the face, oedema (swelling);
  • Digestive: regurgitation, vomiting, diarrhoea, stomach pain;
  • Respiratory: wheezy cough, asthma, difficulty breathing.


Management of cow’s milk allergy may include:

  • Removing all cow’s milk and dairy from your child’s diet. If you are breastfeeding, it is important to continue. 
  • Reviewing a breastfeeding Mum’s diet. In some cases, a mum might be advised to limit or exclude intake of dairy from her diet as small amounts of dairy protein may pass through the breastmilk, but this is not common or a first line of action. 
  • Reviewing the formula being fed to baby. If your baby is formula fed, a paediatric allergist will advise you on which formula is best for your baby. They may prescribe an extensively hydrolysed-protein formula, or an amino acid formula. The protein in these formulas are broken down to a size where the immune system no longer over-reacts to it.  This special milk is no less nutrient-rich than your baby’s previous milk formula and will contribute just as effectively to your baby’s growth. Other alternative formulas include soy, and rice infant formulas.

Your doctor will determine the most appropriate feeding plan for your infant.

2. Lactose intolerance – Indications and management

Symptoms of lactose intolerance are most often less severe than symptoms associated with a cow’s milk allergy, and often occur 30 minutes to 2 hours after eating or drinking foods containing lactose. Common symptoms include:

  • acute and irritable diarrhoea that can be frothy;
  • bloating and stomach cramps;
  • excessive wind;
  • nappy rash;
  • nausea

Management of lactose intolerance primarily involves avoiding foods containing lactose (mainly dairy), however it’s not a straightforward exclusion of lactose for everyone. Once a doctor diagnoses lactose intolerance, it’s worth seeing a dietitian for tailored dietary advice as the amount of lactose that can be tolerated will vary from person to person. There are a range of low lactose and lactose free products available in Australia.

More on lactose intolerance here.