Patients with very sensitive milk allergy can react to a very small quantity of milk protein, including minor contamination and even inhalation of milk powder.
Milk may be found in a large variety of processed foods (some obvious and others not), including confections, margarine, cheese, and pies (Table III) . Cheese and cream contain milk protein and should be avoided. Milk contamination of a product is possible if the same manufacturing equipment is used for various products. There is also a carryover effect when one product is used in the manufacture of another. In addition, patients should be careful when ordering sliced products from outlets that use the same slicers for cutting a variety of foods (e.g., cheese and cold meat). Lactose, which may contain residual milk protein, may be found in foods and as a filler in the manufacture of medicines such as Benadryl capsules (United States).
Hypoallergenic milk formulas have been used as a milk replacement for children with milk hypersensitivity. However, hypoallergenic milk formulas are not nonallergenic, and many children react to these, depending on the particular formula.
Common descriptions on ingredient panels are milk, pasteurized milk, full cream milk powder, dried milk, and skim milk powder'' (Table IV) . Extracted milk proteins added to foods retain their antigenicity and may be described as casein, caseinate, whey, or whey powder. In our community, many individuals consider skim milk and skim milk powder not to be milk and substitute these for milk. In some instances milk is used in emulsions and can be described as caseinate, emulsifier, or protein.
Soy products are often purchased by those specifically avoiding cow's milk, with the assumption that a soy-based product is free of cow's milk protein. This is not true. Vegetarian cheese may contain cow's milk protein. This term simply means that the rennet used in its manufacture is of vegetable origin.