Allergies and the Breastfeeding Family
Baton Rouge, Louisiana, USA
From: LEAVEN, Vol. 33 No. 4, August-September 1997, pp. 75-77
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
Breastfeeding serves as both a preventive measure and a cure for allergic disease.
One in five children shows some degree of allergy by age 20, according to Ruth Lawrence in Breastfeeding: A Guide for the Medical Profession. So it's not surprising that Leaders are frequently called upon to answer questions about allergies.
Lawrence also reports that the incidence of allergies has increased tenfold over the last 20 years. The increase may be due to better recognition of allergic symptoms as well as the increased incidence of exposure to known allergens. Increased longevity has helped us recognize the connection between allergy and many chronic illnesses.
The change in man's diet from his hunter-gatherer days when he ate foods seasonally to year-round availability of most foods has, surprisingly, reduced the number of foods in a typical diet from around 200 to just about 20. Narrowing food choices in this way increases exposure to these foods and predisposes people to allergies. The earlier and more often a food is ingested, the greater likelihood it has of becoming an allergen. Babies tend to be most allergic to the first foods they have been offered.
A study by Saarinen and Kajosaari showed that breastfeeding reduces food allergies-at least through adolescence. Protection from allergic disorders and resistance to infection are the most often cited immunologic benefits of breastfeeding. Symptoms of cow's milk allergies are up to seven times more common in babies who are fed manufactured baby milk instead of human milk, according to Lawrence.
At birth, a baby has no functional immune system of his own; he depends entirely on antibodies from his mother's placenta, colostrum and milk. By about six weeks of age, Peyer's Patches in the intestines begin operating, assisting baby's immunities by producing immunoglobulins. By six months of age, a baby has a functional, although immature, immune system and secretory immunoglobulin A (IgA) is produced.
Fed from his mother's breast, a baby first receives colostrum, a pre-milk fluid rich in antibodies that begins "painting" the insides of a baby's intestines preventing penetration by potential antigens. Mature milk continues this protective help. It provides antibodies specific to challenges that both mother and baby may be exposed to.
At a higher risk are children with a family (paternal or maternal) history of allergies. These babies seem to have a defective immunoglobulin E (IgE) system with increased IgE levels and lower T-cell counts, according to Riordan and Auerbach in Breastfeeding and Human Lactation. IgE and T-cells are important components of the body's allergy response.
An allergy is formed when a normally harmless substance, such as pollen, mold, dust or a food, is perceived by the body as an invader. In its own defense, the body produces large amounts of an antibody, immunoglobulin E or IgE. Antibodies attach themselves to tissue and blood cells when they come in contact with the substance the body perceives as dangerous. This signals these cells to release powerful inflammatory chemicals called mediators: histamines, prostaglandins and leukotrienes. The mediators affect mucous glands, capillaries and smooth muscles, causing the sufferer allergic symptoms.
Symptoms are usually found concurrently in more than one system in the body and can be downright contradictory. Reactions most commonly cause symptoms in the gastrointestinal system. Symptoms may include spitting up, diarrhea (which in a breastfed infant means that the stool is looser, more watery and greater in number and volume than usual), cramping, constipation, gas, malabsorption of nutrients (resulting in poor weight gain), and colitis. The respiratory system, skin, eyes and central nervous system may also be involved.
Behavior is often a clue to allergies in child. It is an observable tip of an imaginary iceberg that rests on how the child thinks, which is influenced by how the child feels and is based in part on his individual body chemistry. If allergies muddle the body chemistry, it may affect how the child feels, thinks and acts.
Cow's Milk Tops List
Lists of foods that trigger allergic responses differ from source to source but cow's milk and dairy products top them all. According to Stigler in his article "Preventive Dietary Management: Prenatal, Neonatal and in Infancy," there are more than 20 substances in cow's milk that have been shown to be human allergens.
Colic and vomiting are often caused by cow's milk allergy. Eczema-dry, rough, red skin patches that can progress to open, weeping sores-plagues many allergic children. Cow's milk has also been found to cause sleeplessness in infants and toddlers.
When fed artificial baby milk, babies react to the large amount of cow's milk they receive. When a typical baby is fed manufactured baby milk it's as if an adult consumed seven quarts (almost eight liters) of milk a day!
Breast milk protects against allergies by coating the insides of the intestines and making leakage of foreign substances into the gut difficult. The baby is only exposed to what the mother eats and secretes in her milk, thus lessening the absorption of these foods.
When a breastfed baby is exposed to an allergen, small amounts of the offending substance may trigger a response: IgE levels rise and a severe reaction may occur. Early and occasional exposure to cow's milk proteins sensitizes a baby so that even tiny amounts of cow's milk may act as booster doses in provoking an allergic response. In families demonstrating milk allergies, a mother should avoid such foods and not offer them to baby. Severe, perhaps even life-threatening reactions could occur.
Research by Gruskay has shown soy-based artificial milks demonstrate little or no advantage over cow's milk-based based baby milks.
Other common foods which cause reactions are wheat, corn, pork, fish and shellfish, peanuts, tomatoes, onions, cabbage, berries, nuts, spices, citrus fruits and juices, and chocolate.
Sometimes mothers feel that because a food could be a potential allergen, it best to avoid it entirely. If there is no history of allergy to these foods in mother's or father's family, this may be an unnecessary precaution. Eating foods a mother enjoys will help her find breastfeeding more satisfying. Only if a baby shows allergic symptoms should a mother consider avoiding certain foods.
A Detective Game
Since there is no cure for allergies, the best, easiest and least-expensive treatment for sufferers is simply to avoid the allergens. Finding the allergens can be a difficult process but worth the effort.
For a breastfed baby, this might involve keeping a record of foods eaten by the mother along with notes on the baby's symptoms and behavior. In time, it is usually possible to determine which foods cause the baby distress.
The mother then may develop an eating plan for herself that eliminates suspected foods. If doing so makes for a happier baby, the mother can then challenge the baby by eating some of the suspected food. A reaction from the baby confirms his sensitivity, and his mother may well choose to limit or avoid the suspected food.
Many mothers have found that following a rotation diet allows inclusion of most foods, even those to which the baby has reacted, says Stigler. Rotation diets allow a food to be completely eliminated from the mother's body before she ingests it again. By waiting three to seven days before eating the food again, the mother can usually include that food in her diet. The stronger the baby's reaction to the food, the longer the mother should wait before exposing the baby to it again. Trial and error will permit the mother to make the best choice for her circumstances.
Interestingly, foods that cause problems in babies often bother their mothers as well but more subtly; they may be unaware of their sensitivity until the elimination finds both mother and baby much happier. Ironically, foods that a mother consumes and eats on a daily basis often fall into this category.
Eczema on the mother's nipples may be caused by a food her baby or toddler is eating or medications he may be taking. Residuals of that substance in his mouth may cause reactions on the mother's skin.
Other treatment options for allergy include medication, immunotherapy and allergy tests. These can be particularly helpful when the allergen is one not easily avoided, such as pollen, dust and environmental allergens.
Changing the child's environment by stripping his room to the bare walls and floor will often help an allergic child; the results have been likened to a military- barracks look. No curtains, bedspreads, fluffy quilts, dust ruffles, carpeting, rugs, shutters, slatted blinds, upholstered furniture, stuffed animals (except those which are hypoallergenic on both the outside and the inside), or furred or feathered pets.
Roll-up shades may be used on the windows; pillows should be synthetic; blankets cotton or synthetic and washed weekly; mattress and box springs should be encased in plastic and furniture should be plain wood or plastic. The closet should hold only the clothes for the current season and nothing should be stored under the bed. Heating/air conditioning vents could be covered in muslin "shower caps" for easy removal and washing. Walls, woodwork and furniture should be scrubbed at least every three months. If a vaporizer is used, it must be kept scrupulously clean. Some families have found air cleaning machines worth the investment.
Some families have been helped by changing to unscented soaps and laundry detergents and avoiding other products with additives, such as hair sprays, deodorants, disposable diapers, wipes and other personal products. Avoiding fumes and odors where possible, such as gas (car fuel and stove/heating fuel), paint, pesticides, chemicals, exhausts, hay and other dried harvest products, insulation materials and new carpeting, may also help.
Eating foods that are chilled or cold sets off reactions for some. Selecting foods that have been exposed to few chemicals while being grown or raised has helped some allergy sufferers. This includes additives, flavorings, preservatives and colorings. In some places, cows and chickens are fed antibiotics to produce healthy animals; these may cause or trigger allergies in susceptible individuals.
Coatings on vitamins or other medications have often been causative as well, as have fluoride, iron and some herbal preparations.
If the baby with suspected allergies is not the only child in the household, be sure that older siblings do not give him a taste of anything—this is one time when sharing is not appropriate.
Prevention for Subsequent Children
Once a family has experienced an allergic child, they are most concerned with avoiding allergies or mitigating them for subsequent children. Studies by Chandra and others have shown that avoidance during pregnancy and lactation of foods to which any family members show sensitivity will produce far fewer instances of allergy in later children. Avoidance of large amounts of any food during pregnancy will lessen the likelihood of infant allergies to that food.
Recently, reports have been published indicating an increased incidence of peanut allergies in young children. Some doctors are recommending that peanuts and peanut butter be limited during pregnancy and lactation and that babies not be given peanuts or peanut butter until three years of age. These precautions would be most important in families with a history of allergy.
If milk is one of the foods to be avoided, a pregnant mother needs to get adequate calcium from sources other than dairy foods, either through her diet or a calcium supplement. Lawrence recommends reagent-quality powdered calcium carbonate. Dark green vegetables, egg yolks, carrots, sardines, oatmeal, salmon, shellfish and cabbage are other dietary sources.
Mothers who are practicing food avoidance during pregnancy seem to have less incidence of pre-eclampsia, swelling and yeast infections, says Stigler. They also have less trouble with runny noses during pregnancy. These benefits may reward mothers for giving up foods they enjoy.
Pregnant mothers may also wish to stay inside during high pollen counts. Research shows that during high hay fever periods, there is a seasonal clustering of more miscarriages, late-pregnancy bleeding, extreme swelling and ectopic pregnancies; and ten days after an elevated ragweed count, hospitals admit more women with toxemia of pregnancy, says a study by Mabray quoted in Stigler's article.
Stigler feels frequent hiccoughs by a baby in utero may indicate allergies: the hiccoughs are caused by exposure to an antigen. Questioning women of the author's acquaintance revealed that this proved quite true.
Although discovering allergies and taking steps to reduce exposure may be tedious and difficult, the results are rewarding. The change in a child from a whiny, aggressive, rash-prone, doesn't-know-what-he-wants, non-sleeper to a pleasant, clear-skinned, easygoing child who sleeps well is extraordinary. Once parents have seen this "child they had never met," they are willing to do what it takes to keep him that way.
Why protect against allergies by breastfeeding?
- Protection from allergies is one of the most cited advantages of breastfeeding (Neifert 1993).
- One-third of all pediatric office visits are due to allergies (Lawrence 1994).
- One-third of all chronic conditions under age 17 are due to allergies (Lawrence 1994).
- One-third of all school absences are due to asthma (Lawrence 1994).
Generally more than one body system is involved in an allergic reaction. Gastrointestinal symptoms are most common.
Meintz-Maher, S. An overview of solutions to breastfeeding and sucking problems. LLLI, 1988. Publication No. 67;7-8.
Mohrbacher N. and Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, IL: LLLI, 1997; 97-99, 142, 149, 281, 586.
THE WOMANLY ART OF BREASTFEEDING Schaumburg, IL: LLLI, 1991; 230-31, 240-42, 363-70.
Chandra, R., Puri, S., and Hamed, A. Influence of maternal diet during lactation and use of formula feeds on development of atopic eczema in high risk infants. Br Med J 1989; 299:228-30.
Gruskay, F. Comparison of breast, cow and soy feedings in the prevention of onset of allergic disease: a 15-year prospective study Clin Pediatr, 1982;21 (8):486-91.
Lawrence. R. Breastfeeding: A Guide for the Medical Profession, 4th edition. St. Louis: Mosby, 1994:300, 541-551, 817-18.
Neifert, M. and Neville, M. Lactation Physiology, Nutrition and Breastfeeding. New York: Plenum Press. 1983:249.
Riordan, J. and Auerbach, K. Breastfeeding arid Human Lactation. Boston, Massachusetts: Jones and Bartlett, 1993;126-27,501-03.
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For further reading
Jandl, A. Allergies. NEW BEGINNINGS, Mar-Apr 1996; 40-41.
Lesniewski, L. Coping with allergies. NEW BEGINNINGS, Sept-Oct 1988 140-142.
Mohrbacher, N. Reducing the risk of allergies. NEW BEGINNINGS, Sept-Oct 1988;143-44.
Sehee, C. Late solids and allergies. NEW BEGINNINGS, Sept-Oct 1988:142-43.
Shircliff, S. Bottoms up. NEW BEGINNINGS. Mar-Apr 1995; 43-44.
Sutin, K. Eliminating foods worked wonders. NEW BEGINNINGS, Sept-Oct 1988; 145.
Blair, H. Natural history of childhood asthma: a 20-year follow-up. Arch Dis Child, 1977, 52:613-619.
Crook, W. Tracking Down Hidden Food Allergies. Jackson, Tennessee: Professional Books, 1978;1-95.
Crook, W. You and Allergy. Jackson, Tennessee: Professional Books, 1984;1-32.
Gerrard, J. Food allergy: two common types as seen in breast and formula fed babies. Ann Allergy, 1983; 50:375-79.
Host, A, Husby, S., and Osterballe, O. A prospective study of cow's milk allergy in exclusively breastfed infants. Acta Paediatr Scand, 1988; 77:663-70.
Kahn, A, Mozin, M., Casimir. C., et al. Insomnia and cow's milk allergy in infants. Pediatrics, 1985; 76:880-85.
Merrett, T., et al. Infant feeding and allergy: 12-month prospective study of 500 babies born into allergic families. Ann Allergy, 1988; 61:13.
Rapp, D. Sneezing, Wheezing and Scratching. Los Altos, California: The ECR Collection, 1974;2-22.