Cream is the fat-rich part of milk, containing about 2–3% protein — less than whole milk but more than butter. It triggers eczema through the same immune pathways as milk because it contains the same casein and whey proteins. It is not a significant source of histamine, so the histamine concerns that apply to aged cheese are not relevant here.

The main practical issue with cream is that it appears in many foods where it might not be expected — 'non-dairy' whipped toppings often contain milk protein (sodium caseinate), cream sauces are standard in restaurant cooking, and cream liqueurs contain dairy. For those testing dairy tolerance, cream falls between butter (lower protein, usually better tolerated) and milk (higher protein, more likely to trigger). Heating cream in cooking destroys some whey proteins but leaves casein intact.