Lactose intolerance vs milk allergy

Don’t get lactose intolerance confused with a milk allergy. They're not the same thing. Lactose intolerance is when you can't digest lactose, the sugar found in dairy products. You'll often get symptoms like stomach pain, gas, and diarrhea. With a milk allergy, the symptoms affect more than just your digestive tract. A milk allergy is when your immune system thinks dairy is a foreign invader and attacks it by releasing chemicals called histamines.

Difference between lactose intolerance and milk allergy

A milk allergy is an immune reaction to one of the many proteins in animal milk. It’s most often caused by the alpha S1-casein protein in cow’s milk.
A milk allergy is sometimes confused with lactose intolerance because they often share symptoms. The two conditions are very different, however. Lactose intolerance occurs when a person lacks the enzyme (lactase) to metabolize lactose — a milk sugar — in the intestines.

What are the symptoms of a milk allergy?
Allergic reactions to foods usually begin within minutes of eating the allergen-containing food though may occur up to 2-3 hours after ingestion. The severity of symptoms can vary widely from one person to another. Mild symptoms may include itching and a few hives while a severe allergic reaction may include life-threatening symptoms, such as difficulty breathing and a sudden drop in blood pressure. The symptoms of an allergic reaction may include any or several of the following:
Itching.
Hives.
Tingling or swelling of the lips, tongue, or throat.
Chest tightness, shortness of breath, or difficulty breathing.
 Wheezing.
Abdominal pain.
Nausea, vomiting, or diarrhea.
Dizziness and fainting 
Symptoms can range from wheezing problems to vomiting and diarrhea,abdominal cramps
loose stool (which may contain blood or mucus)
skin rash
intermittent coughing
runny nose or sinus infection
 failure to thrive (slow to gain weight or height)

vomiting
Drop in blood pressure and loss of consciousness.
Severe reactions can result in death.

Can You Eat Dairy With Lactose Intolerance or Milk Allergy?
For both of these conditions, you’ll need to avoid or limit most dairy products. But it is important to make sure you are getting enough calcium.
Lactose intolerance is easily managed, mostly by limiting the amount of dairy food and drink you consume. You can also try lactose-reduced ice cream and milk, or take lactase enzyme supplements when you eat dairy products to help your body digest lactose.
If you have milk allergy, you’ll need to avoid all dairy foods and other foods that contain dairy products. Staying safe means reading food labels to see if milk or ingredients containing milk are included. Milk proteins are found in many foods you wouldn’t expect. Some canned tuna, energy drinks and even chewing gum contain them. And don’t eat lactose-reduced foods if you have a milk allergy. They still contain the milk proteins that can cause allergic reactions. Some of these milk proteins are casein, whey, lactulose, lactalbumin, and ghee.

How do you avoid exposure if you have a milk allergy?
If you have a milk allergy, strict avoidance of milk is the only way to prevent an allergic reaction. The Food and Drug Administration (FDA) requires food manufacturers to list common food allergens on food labels in plain terms to make it easier to identify the food allergens. Food labels must clearly list eight allergens which account for almost 90% of all food allergies: cow’s milk, soy, wheat, egg, peanut, tree nuts, fish, and shellfish.

Anyone allergic to milk should avoid the following ingredients/foods:
Milk: in all forms, including condensed, dry, evaporated, and powdered milk, and milk from mammals (such as goat or sheep).
Casein and casein hydrolysates.
Caseinates (such as sodium caseinate).
Whey.
Lactalbumin, lactalbumin phosphate, lactoglobulin, lactoferrin and lactulose.
Butter: including butter, butter fat, butter oil, artificial butter flavor.
Buttermilk.
Cheese and cream cheese.
Cream, half & half, and ice cream.
Cottage cheese and curds.
Custard, pudding and yogurt.
Ghee.

 Sour cream, sour milk.

How can you be prepared if you have a milk allergy?
 

Always know what you are eating and drinking.

Always check the label ingredients before you use/consume a product, even if the food was safe the last time you ate it. Manufacturers can change recipes and a milk-containing food may be added to the recipe.
 

Teach children who have milk allergy not to accept food from classmates or friends.
 

When dining out, ask detailed questions about ingredients and how the food was prepared. You want to make sure there is no problem with cross-contact.
 

Wear a medical alert bracelet with information about your allergy or carry an alert card with you. Also, add your food allergy to your cell phone’s medical emergency setting or app.
 

Talk with your doctor about how to prepare for a reaction. Your doctor will prescribe self-injectable epinephrine to carry with you at all times in case you have a severe reaction.

How can you prevent milk allergy?
The cause of milk allergy remains unknown as do prevention strategies, but your healthcare provider may be able to provide guidance if someone has been found to have a certain type of allergy.
If you do have an allergy to milk or milk products, you can best prevent a reaction by completely avoiding milk and milk products.

Tips for Living Well With a Milk Allergy
 

Find other ways to get vitamins and minerals. Dairy products are an important source of calcium, protein, and vitamins D and B12. If you have a milk allergy, foods such as broccoli, spinach, and soy products can help fill the void. A registered dietitian can help you develop a well-balanced eating plan.
 

Try dairy substitutes. Drink soy, rice, oat,  and almond milks that are fortified with calcium and vitamin D. Look for non-dairy ice cream, chocolate, cheese, and yogurt. Use margarines made with vegetable oil instead of butter. A tablespoon of vinegar in a cup of rice milk or soy milk works as a buttermilk substitute.
 

Stay away from foods without labels, like from salad bars, deli counters, and bakeries. They're more likely to accidentally have your allergy triggers in them.
 

Always read labels, even on things that you buy every week. Food companies change ingredients all the time. Just because something has been safe for you in the past doesn't mean it always will be.
 

Avoid milk outside the kitchen. Check labels on cosmetics, creams, and ointments to see if they contain cow’s milk in any form. Some medicines also contain whey, which is made from milk.

REFERENCES
 

 American College of Asthma, Allergy and Immunology; Milk and Dairy Allergies, 2019

Chris Iliades; Lactose intolerance vs Milk allergy, Everyday Health, 2012

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