Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Allergy Unit

Student research

Cow's milk allergy and cow's milk intolerance - dietary, health and social issues

Jenny Clancy
Master of Nutrition and Dietetics, The University of Sydney
Supervisors: Anne Swain, Velencia Soutter, Robert Loblay
June 2001

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Adverse reactions to cow's milk are common in infants and children. Infants and children present with a myriad of dietary, health and social issues. There are two types of adverse reactions to cow's milk, cow's milk allergy and cow's milk intolerance. Little is known about the similarities and differences between these two groups.


To describe the spectrum of nutrition, health and social issues surrounding infants and children who have been diagnosed with either cows milk allergy or cows milk intolerance, so that best practice management guidelines can be developed for each group.


A questionnaire was sent to infants and children who had presented with adverse reactions to cow's milk (allergy or intolerance) at the Allergy Unit at Royal Prince Alfred Hospital. Questions covered the child's current diet, past diet, health problems, health professional advice, support from care outside the home, nutrition and cooking and family and social support. Reponses were analysed using SQL Query Analyser and Microsoft Excel. Descriptive statistics and Student T-tests were used.


Data from 169 patients was analysed. Adverse reactions to milk were not isolated problems. Children with cow's milk allergy were often allergic to egg and peanut. A range of intolerances was seen in both the allergic and intolerant children, the most tolerated foods had a low chemical level and the least tolerated foods had a high chemical level.  Skin, gastrointestinal and behavioural symptoms were the most commonly reported in each group. Children with milk allergies reported significantly more cases of skin symptoms and children with milk intolerance reported significantly more cases of gastrointestinal symptoms. The presentation of both gastrointestinal and behavioural symptoms pointed towards milk intolerance. Diet was found to significantly improve symptoms. Although some health professionals gave useful information, early childhood nurses and GPs were not seen to be useful resources. Parents felt that they were very supported by carers and immediate family members but other family members and friends were not so supportive.


Adverse reactions to cow's milk are not isolated problems and cannot be diagnosed purely from a clinical history. Investigation into co-existing allergies and/or intolerances is vital to ensure best practice management. Management strategies must incorporate dietary, health and social issues.