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Allergies and Breastfeeding

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Updated June 13, 2014

The incidence of food allergy has risen dramatically in the past few decades. Whenever the topic arises, adults have the same response. "Do you remember anyone in your elementary school class with food allergies?" The answer for the majority is, "No way!" In fact, most will recall receiving a pre-wrapped peanut butter and jelly sandwich on the days where they left their lunch on their kitchen counter. Now, signs outside of classrooms warn parents that there is an allergic child in the class and list the foods that cannot be sent with their non-allergic children. Some schools are even designated as peanut-free. Some of the reasons for the increase in incidence are due to:

  • Food allergens in human breast milk
  • Increased popularity of peanuts
  • Early introduction of solid foods
  • Low breastfeeding rates in the 1960s and 1970s
  • Low breastfeeding rates in certain ethnic populations
Whether your child has an allergy or food intolerance (a very broad term where one can have any unfavorable reaction to food which is not defined by an increase in IgE), let's learn how breastfeeding fits into the puzzle.

Allergic Conditions In The Baby

We know that an allergy results when there are immunologic changes in IgE, but many different conditions can manifest from that change:

  • Atopic dermatitis or eczema: Dry skin with reddened areas primarily on the face of the baby. This does not typically present on the diaper area or on the nose. In an older baby, it may advance to limbs. This affects about 18% of babies in the first 2 years of life.
  • Asthma: Coughing at night
  • Wheezing
  • Retractions: The diaphragm is being pulled in dramatically when having trouble breathing
  • Food allergy: Infantile colic (affects 15% to 40% of babies in the first 4 months of life), loose stools, reflux, atopic dermatitis, hives, vomiting, failure to thrive
  • Allergic rhinitis: Runny nose, reddened eyes
  • Hives
  • Hay fever

So I understand there are many different allergic conditions, but how does the reaction actually occur?

The mechanism of allergic conditions is very intense. In most cases, a person will have more than one exposure to an allergen, and over time they develop a hypersensitivity to it. Following, there is an irregularity of the immune system where the outcome is an antibody-antigen reaction, which leads to a secretion of lymphokines by T-lymphocytes. It is possible to have a delayed hypersensitivity to an allergen, where the reaction occurs 24 to 48 hours after exposure. The more immediate allergic response is anaphylaxis, which is moderated by antibodies made by B lymphocytes. With any allergic reaction, there is a release of mast cells, which contain heparin and histamine and then follows by an increase in IgE.

Now, what role does breast milk play in allergies? The intestine is made up of epithelial cells. Before 6 to 9 months of age, the membrane of the baby's intestines is very absorbent to proteins -- he hasn't yet developed the IgA molecule, which breast milk contains, that usually covers the intestine, in addition to safeguarding against bacterial, viral and harmful exposures. A perfect example is cow's milk, which contains quite a few proteins which act as allergens, such as lactoglobulin, casein, bovine serum albumin (or BSA), and lactalbumin. A baby (or child) with a cow's milk allergy may display any of the following:

  • Vomiting
  • Chronic diarrhea
  • Colic
  • Colitis
  • Incessant crying
  • Unwillingness to feed
  • Poor sleep patterns
  • Eczema
  • Hives
  • Acute diaper rash
  • Extreme paleness
On top of these symptoms, many clinical diseases are associated with cow's milk allergy -- food intolerance, food allergy/hypersensitivity, food anaphylactic, and anaphylactoid reaction.

Is there any prevention of allergies?

Past studies have suggested that a mother's avoidance of certain foods, such as peanuts and shellfish, during her third trimester of pregnancy may prevent food allergy, but more recent research has shown no association between maternal exclusion diets and prevention of allergies. Yet, the majority of studies authenticate that exclusive breastfeeding (even as little as one month) can lessen the occurrence of eczema and food allergy. As with all breastfeeding topics, we hear conflicting advice about breasfeeding and allergies, and we have to recognize that allergy studies are very difficult to execute on account of many factors -- food introduction, genetic factors, and maternal diet being the most significant. However, breastfeeding is still cited by The American Academy of Pediatrics as the best means to prevent allergies in babies.

If I have to supplement with formula, is one better than the other as far as allergies are concerned?

First, let's recognize that many different types of formula are on the market: cow's milk, soy, hydrolyzed (such as Alimentum and Nutramigen), and elemental amino-acid derived (such as Neocate, Neocate One+, Elecare). Many moms default to soy formula if their baby is reacting to a cow's milk version, but this is not necessarily the most effective move -- soy protein may still cause an immune response and allergic sensitization (although less than that of cow's milk). In fact, the prevalence of having a soy intolerance and a cow's milk allergy simultaneously ranges from 0% to 60%. The higher rate of occurrences are reported in non-IgE mediated enterocolitis or enteropathy syndromes. Studies have consistently failed to prove any decrease in the development of allergic conditions in babyhood (and in childhood) stemming from soy compared with cow's milk formula.

My baby has terrible colic. My pediatrician recommended that I stop breastfeeding because she may be allergic to cow's milk. Is this really the best remedy?

You do not have to stop breastfeeding your baby. However, there are studies of using Neocate formula for treatment of colic. In the research, cow's milk was completely removed from the mother's diet and the baby was put on Neocate for 4 to 8 days. The babies all responded well to this intervention and most went back to the breast with virtually no issues.

Sources:

Greer FR: Effects of Early Nutritional Interventions on the Development of Atopic Disease Pediatrics 121: 183-191, 2008.

Soy Protein Formula, Sydney: RACP 2006.

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