Breastfeeding the Infant with Known Food Allergies
by Anne Eglash MD, IBCLC, FABM
The general term ‘food allergy’ is not very specific regarding symptoms that people experience. For example, some people describe a rash, diarrhea, dizziness, swelling, wheezing, nasal congestion, brain fog, and/or itching as their food allergy reactions.
For this week’s topic, we are discussing infants who have IgE-mediated allergic reactions to certain foods. IgE-mediated reactions typically occur within 20 minutes of food ingestion and can lead to hives, wheezing, swelling, vomiting, a decreased blood pressure, and potentially death. Any infant can develop an IgE mediated allergic reaction to a food, whether breastfed or not.
This week we are reviewing a study of how lactating parents are counseled regarding whether they can continue to eat foods that their infant has an IgE-mediated allergy to.
According to the authors, although there is a temporal association between breastmilk exposure and infant development of food allergies, there is no evidence that parental avoidance of foods during pregnancy or lactation prevents food allergies in their infants. And, there are no evidence-based guidelines or consensus statements on whether the lactating parent should avoid foods in their diet that their infant has an IgE-mediated allergic reaction to.
The authors therefore wanted to find out what dietary advice lactating parents have received when their child has an IgE-mediated food allergy. This study, utilizing an online survey, recruited 133 breastfeeding mothers or mothers of food-allergic children, and asked what advice they received from health care providers about their diets. They were also asked if they consumed the foods their infants were allergic to, and whether the children had any allergic reactions. The most common food allergies were egg, peanut and tree nut. Most of the infants had more than 1 food allergy. Sesame allergy was more common that fish/shellfish, at 24%.
- 86% of breastfeeding mothers were told by their healthcare providers to avoid consuming foods that their infants were allergic to.
- 43% of breastfeeding mothers were told by their healthcare providers to avoid consuming foods that their infants were allergic to.
- 72% of breastfeeding mothers continued to eat the foods that their infants had a known IgE reaction to, and the majority of these mothers noticed that their infants had a major allergic reaction while consuming the breastmilk.
- 46% of breastfeeding mothers continued to eat the foods that their infants had a known IgE reaction to, and the majority did not notice a major allergic reaction while consuming the breastmilk.
See the Answer
There is limited research investigating maternal dietary practices and health care provider recommendations when providing breast milk (BM) to children with IgE-mediated food allergy.
This study explored health care provider recommendations and maternal practices when providing BM to children with IgE-mediated food allergy. We also assessed for possible IgE-mediated reactions to BM while the mother consumed the food to which her child was allergic.
A web-based survey was distributed to breastfeeding (BF) mothers of children with IgE-mediated food allergies. Reported reactions to BM were scored by an allergist, provided only with details of the possible reaction and not the suspect allergen or route of exposure, as to the likelihood that the reaction was IgE-mediated.
133 mothers completed the survey. After food allergy diagnosis, 43.4% (n = 63) of mothers reported they were advised by their health care provider to continue BF without dietary restriction, 17.3% (n = 23) were advised to avoid eating the food(s) their child was allergic to while BF, and in 28.6% (n = 38) this concern was not addressed. A minority of mothers (12%, n = 16/133) reported their child experienced an allergic reaction to BM. An allergist evaluated most of these reactions (75%, n = 12/16) as not likely IgE-mediated.
This study exposed inconsistent recommendations for mothers providing BM to children with IgE-mediated food allergies. Most mothers were able to consume the food their child was allergic to without adverse sequelae. Standardized, evidence-based recommendations would enhance the well-being of these mother/infant dyads.
It is amazing that we don’t know what to advise lactating parents regarding dietary avoidance when they have an infant with an IgE-mediated food allergy.
Approximately 30% of breastfeeding mothers in this study received conflicting advice on whether to eat or avoid the foods that their infants were allergic to- and for good reason, given that there is no actual guidance.
Among the 46% of breastfeeding mothers who continued to ingest the foods their infants were allergic to, 88% didn’t notice an allergic reaction in their infants. There were 16 reported cases of allergic reaction in the infants, and only 25% of the reactions were considered IgE mediated, all being mild in nature. Most of the reactions that were not considered IgE mediated were worsening atopic dermatitis.
This survey adds to the evidence that it may be safe for lactating parents to continue eating the foods that their infants are allergic to. However, this study is limited because it is a survey, which inherently has a selection bias. They may not have captured the parents who were traumatized by having their infants experience a severe allergic reaction to a food in their diet, and therefore may have quit breastfeeding and were not in some of these social media groups.