Re-introduction of dairy in cow’s milk allergy (the Milk Ladder)

This page describes how one can re-introduce cow’s milk products safely in a child who has been previously diagnosed with Delayed (non-) Cow's Milk Protein Allergy (previous symptoms including bloody diarrhoea, eczema, gastro-oesophageal reflux and colic). 

Allergy testing in such children is usually negative and diagnosis made on symptomatic improvement on exclusion of cow’s milk in the diet.

Most children outgrow this type of allergy by the second year of life. The reintroduction of cow’s milk products can be made by going through the stages, starting off at the stage currently tolerated as described below, and progressing through the stages until stage six, waiting at least a couple of weeks of regular amounts of food at a particular stage, before progressing to the next stage. 

If foods in each stage are not tolerated and there is symptom recurrence, then go back to previous stage which was tolerated. If stage 1 is not tolerated exclude cows milk completely. As long as there are no immediate symptoms at any stage, you can try to re-introduce stage previously not tolerated every 3-6 months and build up as described above. 

If any immediate symptoms (including rash, swelling, breathing difficulties) occur with the introduction of dairy, and/or any other medical concerns, seek medical advice urgently. 

Stage 1: Processed milk (baked traces of milk) such as:

  • McVitie’s digestive biscuits    
  • Malted Milk biscuits
  • Scones
  • Plain cakes without icing
  • Cheesy breadsticks
  • Pastry
  • Shortbread
  • Crackers (containing cheese/milk/milk powder)
  • Croissant
  • Brioche
  • Bread that contains milk, eg. Warburton's Milk Loaf

Stage 2: Dairy that has been in the oven for at least half an hour such as: 

  • Shepherd’s Pie with milk/cheese
  • Fish pie with milk/cheese
  • Lasagne with milk/cheese 
  • Stage 3    Lightly cooked dairy such as:
  • Homemade custard
  • Cheese on toast 
  • Tinned/pots of rice pudding/custard
  • Cheese crisps

Stage 4: Uncooked dairy such as:

  • Plain cheese, uncooked
  • Yogurt
  • Ice cream
  • Chocolate/chocolate bars

Stage 5: Cow’s milk boiled for at least five minutes

Stage 6: Cow’s milk unheated

Who should I contact if I have a problem or question?

Call allergy/respiratory nurses on 01895 279721- leave a message and we will get back to you.

What should I do in case of an emergency?

Seek urgent medical advice or call an ambulance for emergencies