What to watch for: Milk allergy vs lactose intolerance

The difference as I've pointed out in other posts, is that milk allergy is a reaction to a milk protein (most likely the casein but it could be one of the whey proteins), while lactose intolerance is a usually milder reaction to the sugar in milk.

As a result, with milk allergy, you have to read labels and see whether they list anything that could contain milk protein. These include:

• milk, cow's milk
• milk solids
• casein
• whey 
• whey protein

You can make a judgment if your or child's condition is relatively mild: milk that has been cooked into a cake or similar will rarely cause a reaction. That's because the cooked protein is now altered, denatured.  However, if milk is one of the primary ingredients (in a pudding for example), I wouldn't want to take the chance. I am sure some allergists disagree with me and will tell you to avoid anything that could possibly have milk protein, while others might side with my view and be less strict.

Other milky drinks such as rice, almond or soy "milk" can be used instead, and products made from them should be fine too, though a small percentage of children who are milk-allergic will also be allergic to soy. The bigger problem for growing children is that cow's milk has 8 grams of protein in 8 oz, but rice and almond milk only have 1 gram in that same 8 oz. serving. So you will need other good sources of protein to keep your child healthy.

What about Lactose Intolerance?

Lactose intolerance provides a different, but similar, set of circumstances. The problem isn't with the protein, but with the sugar. That's why even if you are lactose intolerant, you or your child can drink real milk where an enzyme has been added to digest the lactose and make it easy to absorb. That digestion does increase the sweetness slightly, but changes nothing else. 

You can also eat other dairy products, like butter, ice cream and soft cheeses (cream cheese, cottage cheese and mozzarella, for example) as long as you take the enzyme when you eat. The enzyme will break down the lactose, just as it does in milk. Of course, you have to consider the situation. If you have a slice of pizza, the enzyme will probably work to prevent the gas, pain and diarrhea you might otherwise get.  Eat the whole pizza or an entire milk shake and you will overwhelm your system and what the enzyme can accomplish. 

Interestingly, aged cheeses have very little lactose so they can be eaten without taking the enzyme. At the same time, some hot dogs and medicines use lactose as a filler, so you may have to take enzymes along with them. 

The enzyme I recommend is Lactaid, because it's effective if you take it when you eat dairy products in modest amounts. I simply don't understand how the once a day enzymes work, since they are needed i   

the intestine along with the food. Some probiotics may also help, since many of the "good" feed on the lactose, meaning that there is less for your intestine to process. 

Bottom Line: 

If you have lactose intolerance, you can eat modest amounts of dairy products so long as they are either predigested or you take an enzyme when you eat them. But if you have milk allergy, you shouldn't have milk or cow's milk products because the protein could cause another, possibly worse, reaction.