Allergies and the Breastfeeding Family
Baton Rouge, Louisiana
From: NEW BEGINNINGS, Vol. 15 No. 4, July - August 1998, p. 100
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.
Allergies today are more common than ever before--one in five children now shows some degree of allergy by age 20. The incidence of allergies has increased tenfold over the past 20 years. This is partly due to increased exposure to known allergens (allergy-causing substances). It is also because physicians and allergy sufferers are more likely to recognize that certain symptoms or illnesses are caused by allergies (Lawrence 1994). Changes in the human diet from the days of hunter-gatherers eating seasonal foods to the 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 manner increases exposure to these foods and predisposes people to food 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 foods they have been offered first. While a baby is exclusively breastfed, he is only exposed to the foods his mother eats and secretes in her milk, so his exposure to potential allergens is minimized.
One long-term study of children who were breastfed showed that breastfeeding reduces food allergies at least through adolescence (Grasky 1982). Protection from allergies is one of the most important benefits of breastfeeding. The incidence of cow's milk allergies is up to seven times greater in babies who are fed artificial baby milk instead of human milk (Lawrence 1994).
Breastfeeding protects against allergies in two ways. The first and most obvious reason breastfed babies have fewer allergies is that they are exposed to fewer allergens in the first months of life. They aren't given formula based cow's milk or soy products. Less exposure to these foods means less chance of allergy later on. The other reason breastfed babies have fewer allergies has to do with the development of the immune system. At birth, a baby's immune system is immature. Babies depend heavily on antibodies obtained from their mothers while in the womb. Their digestive systems are not really ready for substances other than their mothers' milk. At about six weeks of age, Peyer's Patches in the intestines begin to produce immunoglobulins or antibodies. At six months of age, a baby has a functional, if immature, immune system that is capable of producing secretory immunoglobulin A (sIgA), the antibody found in all body secretions that is the first line of defense against foreign substances.
In the meantime, a baby depends on mother's milk for protection. Fed from his mother's breast, a baby first receives colostrum, the first milk, which is especially rich in antibodies, including sIgA. The sIgA "paints" a protective coating on the inside of a baby's intestines to prevent penetration by potential allergens. Mature milk continues to provide this protection-from-the-inside to help the baby remain healthy and allergy-free. Human milk and colostrum also provide antibodies specifically designed to fight germs to which either the mother or baby has been exposed.
The tendency to be allergic is often inherited from a child's mother or father. Babies with a family history of allergy seem to have different immune responses than those without allergies.
How Allergies Occur
Allergies happen when a person's body perceives a normally harmless substance, such as pollen, mold, dust, or a particular food, as an invader. In its own defense, the body produces large amounts of the antibody immunoglobulin E (IgE). When the antibodies come in contact with the substance the body perceives as dangerous, they attach themselves to tissue and blood cells. These cells then release powerful inflammatory chemicals, called mediators: histamines, prostaglandins, and leukotrienes. These in turn affect mucous glands, capillaries, and smooth muscles, causing the sufferer to experience allergic symptoms.
Symptoms are usually found in more than one body system and can be downright contradictory. Reactions to food most commonly cause symptoms in the gastrointestinal system, including spitting up, diarrhea (in a breastfed infant, this means stools are looser, more watery, and greater in number and volume than usual), cramping, constipation, gas, malabsorption of nutrients (which could result in poor weight gain), and colitis. The respiratory system, skin, eyes, and central nervous system may also be involved in allergic reactions to food. The table at the bottom gives an idea of what form allergic symptoms can take.
Parents often use behavior to help identify allergies in their child. How a child feels will be revealed in behavior. A child who doesn't feel well can't behave well. A baby whose body chemistry is muddled by allergies will be confused and miserable.
Cow's Milk Tops the List
Lists of the foods most likely to trigger allergic responses differ from source to source and culture to culture, but cow's milk and dairy products top them all. There are more than 20 substances in cow's milk that have been shown to be human allergens (Stigler 1985). Colic and vomiting are often caused by cow's milk allergy. Eczema--dry, rough, red skin patches which can progress to open, weeping sores--is another common symptom among children allergic to cow's milk. Cow's milk has been found to cause sleeplessness in infants and toddlers. Dairy allergy has also been suggested as a cause of bed wetting in an older child.
When fed cow's milk-based formulas, some babies react simply because of the large amounts of cow's milk they receive. Feeding a baby artificial baby milk is equivalent to an adult drinking seven quarts (almost eight liters) of milk a day! Allergies such as these are not accompanied by changes in the immune system-there is no rise in IgE levels-and they often subside spontaneously. Parents who are bottle-feeding keep switching brands of formula until they find one that works or until the baby outgrows the symptoms.
Early and occasional exposure to cow's milk proteins can sensitize a baby so that even tiny amounts of cow's milk may trigger a response: IgE levels rise and a severe reaction may occur. Thus, sensitive babies may react to cow's milk in their mothers' diet. Small amounts of cow's milk protein may appear in a mother's milk and provoke a response in her baby, even if the mother herself is not allergic to cow's milk. If there is a family history of milk allergies, a mother may prefer to avoid dairy products in her diet as well as not offering them directly to her baby. Severe reactions could otherwise occur.
Larissa Lee, from North Brunswick, New Jersey, USA, tells of her son Aleksei, who had severe eczema beginning in his first month of life. It began on his face, spread to his scalp, and then all over his body. It would ooze, then get infected. Their family doctor said it was the worst case he had ever seen. He referred them to several dermatologists, including a pediatric dermatologist. The physicians made a lot of suggestions about soaps, detergents, and lotions, but mostly they relied on hydrocortisone products to contain the rash.
Larissa eliminated dairy products from her diet, and within a week there was a drastic improvement in Aleksei's eczema. The eczema did not completely disappear (there is a family history of milder cases), but it became much more controllable. Larissa tried eliminating other foods from her diet to try to totally eliminate the eczema, but nothing else made the big difference that eliminating the dairy products had. During his first year, she couldn't reintroduce dairy into her diet without noticing a flare-up in Aleksei's eczema. After he turned one, Larissa could have dairy products occasionally. Now that Aleksei is two and a half, he occasionally has milk products himself without much worsening of his symptoms.
Other common foods which cause allergic reactions are eggs, wheat, corn, pork, fish and shellfish, peanuts, tomatoes, onions, cabbage, berries, nuts, spices, citrus fruits and juices, and chocolate.
Some allergy sufferers have been helped by avoiding foods which have been exposed to chemicals while being grown or raised. Other things to consider avoiding include additives, flavorings, preservatives, and colorings. In many places, cows, pigs, and chickens are fed antibiotics to produce healthy animals; these may cause or trigger allergies in very susceptible individuals. Coatings on vitamins or other medications can cause an allergic response, as can fluoride, iron, and some herbal preparations. Be sure no siblings or other family members are giving the baby a taste of anything--this is one time when sharing is not appropriate. Eating foods that are chilled or cold sets off reactions for some.
Sometimes mothers feel that because a food could be a potential allergen, it is best to avoid it entirely. If there is no history of allergy to these foods in the mother's or father's family, this may be an unnecessary precaution. Eating foods a mother enjoys will help her to find breastfeeding more satisfying. Mothers do not have to give up foods they love while breastfeeding. Only if a baby shows allergic symptoms should a mother consider avoiding certain foods.
A Detective Game
There is no cure for allergies. The easiest and least expensive treatment for many who suffer from allergies to foods is simply to avoid those foods.
Discovering exactly which foods a baby reacts to can be a difficult process, but is well 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. Over time, it is usually possible to see connections between certain foods and a baby's distress. If highly allergic, babies can react to foods their mothers have eaten within minutes, although symptoms generally show up between four and 24 hours after exposure. The mother then may develop an eating plan for herself which eliminates suspected foods. If this produces a happier baby, the mother can then challenge her findings by eating some of the suspected food. A repeated reaction from the baby confirms his sensitivity to this food, and his mother may well choose to limit or avoid it for some time.
Most babies will show distinct improvement after an allergenic food has been removed from the mother's diet for five to seven days, but it may take two weeks or more to totally eliminate all traces of the offending substance from both the mother and her baby. Elimination diets can be time-consuming; however, many mothers find they are worth the effort.
Dawn Story, from Denver, Colorado, USA comments, "When you have an extremely colicky baby who doesn't seem to be comforted by anything, the only sure help is time. Nevertheless, it always made me feel better if I was doing something--anything--to try to discover what was making my baby so uncomfortable."
Many mothers have found that following a rotation diet permits them to eat even foods to which the baby has reacted (Stigler 1985). A rotation diet allows troublesome foods to be eaten in a rotating schedule so that there is a three to seven day gap in between days the food is eaten. This allows a food to be completely eliminated from the mother's body before she ingests it again, which can prevent allergic symptoms from developing in her baby. The stronger the baby's reaction to the food, the longer the mother should go before exposing the baby to it again. Trial and error will permit the mother to make the best choice for her circumstances.
Foods that cause problems in babies often bother their mothers as well, but so much more subtly that the mothers are unaware until eliminating a food makes both mother and baby feel better, Ironically, foods that the mother craves and eats on a daily basis often fall into this category.
When a child begins eating solids, some mothers experience dermatitis or eczema on their nipples which 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.
Robin Slaw's daughter, Alanna, has a dairy sensitivity which appeared immediately after birth. But it took Robin almost three months to realize that the nightmarish colic Alanna was experiencing was controllable, simply by removing dairy products from her diet. Alanna would scream at the top of her lungs every evening, from 10 PM until 2 AM, and nothing that Robin or her husband did would help. They spent many hours walking her, literally bouncing off the hallway walls from exhaustion.
After Alanna got over her colicky stage, Robin thought she was over her sensitivity to dairy products, and when she was a year old, allowed her to start having dairy products in her diet. It wasn't until she was three years old that Robin finally associated Alanna's out-of-control temper tantrums with her consumption of dairy products. Robin removed dairy products from Alanna's diet, and now she's fine. Robin adds, "I can always tell when she tries to slip a little milk on her cereal in the morning. She turns into a rude and inconsiderate child, instead of the normally boisterous but caring six-year- old that she is."
Robin's second daughter, Sarah, has multiple food sensitivities that all appeared by the time she was three months old. "It was a long slow struggle to find all her sensitivities. We started with our family doctor, who couldn't diagnose her rashes, but sent us to a dermatologist. The dermatologist then sent us to a pediatric dermatologist, who diagnosed atopic dermatitis, and suggested that certain foods could be the source of her reactions. I had already suspected this, and was trying to eliminate what I knew were common allergens, but in the US, it's very hard to get away from wheat and corn if you eat any processed foods. Through lots of hard work, and the help of a wonderful book called Is This Your Child? by Doris Rapp, I managed to identify almost all of her allergies by the time she turned one. The only two I hadn't discovered yet were chocolate (which I suspected but hadn't confirmed, since I didn't eat it often anyway) and oats, which I hadn't even begun to suspect."
Sarah wasn't interested in solid foods until after the end of her first year. Robin has scrupulously removed all allergenic foods from both Sarah's diet and her own, and reports that Sarah can now eat nuts, peanuts, oats, and corn with no reaction. By offering these foods infrequently and staying on a rotation diet, Robin hopes to keep Sarah from developing any new allergies.
Other treatment options for allergies 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, blinds, upholstered furniture, stuffed animals (except those which are hypoallergenic on both the outside and the inside), or furred or feathered pets. Shades may be used on the windows; pillows should be synthetic; blankets should be cotton or synthetic and should be 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--no stored items. The space under the bed should be kept empty. Heating/air conditioning vents can 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.
Changing to unscented soaps and laundry powders and avoiding other products with additives, such as hair sprays, deodorants, disposable diapers and wipes, and other personal hygiene products has helped some families. Avoiding fumes and odors where possible, such as those from gas (both fuel for automobiles and cooking and heating fuel), paint, pesticides, chemicals, exhausts, insulation materials, new carpeting, and hay and other dried harvest products may also help.
Prevention for Subsequent Children
Once a family has experienced an allergic child, parents want to avoid allergy problems for subsequent children. Studies have shown that if a mother avoids all foods to which any members of her family show sensitivity during her entire pregnancy and period of lactation, later children are far less likely to have allergic symptoms (Chandra 1989). Avoiding eating any food in large amounts during pregnancy will lessen the likelihood of infant allergies to that food.
Tricia Jalbert, from Oakland, California, USA, tells of her daughter, Gwen, who awoke frequently in pain and was hard to settle back to sleep. She was also extremely colicky and would spit up often. The pain, the colic, and the spitting confused Tricia, making her too tired to think things through. When Gwen was close to a year Tricia learned that her husband had had diarrhea his whole first year of life. Now the Jalberts are eliminating milk products from their diet in preparation for a future pregnancy, as they don't want to take any chances that another baby will have any problems with cow's milk protein. Gwen likes to have a little cow's milk to drink from time to time, but she only takes a couple of sips of it. Tricia says she thinks that Gwen knows to stay away from it.
A pregnant woman who avoids cow's milk products must be sure to get adequate calcium from other sources, either through her diet or a calcium supplement. Ruth Lawrence recommends reagent quality powdered calcium carbonate (Lawrence 1994). Dietary sources of calcium include calcium-enriched tofu, collards, spinach, broccoli, turnip greens, kale, liver, almonds and Brazil nuts, as well as canned sardines and salmon.
Mothers who avoid potential allergens during pregnancy seem to have a lower incidence of pre-eclampsia, swelling, and yeast infections. They also have less trouble with runny noses during pregnancy (Stigler 1985). These benefits to mothers may help compensate for giving up foods they may enjoy.
Pregnant mothers may also wish to stay inside on days when the pollen count is high. Research shows there is a seasonal clustering of higher miscarriages, late-pregnancy bleeding, extreme swelling, and ectopic pregnancies during hayfever season; and 10 days after an elevated ragweed count, hospitals admit more women with toxemia of pregnancy (Stigler 1985).
Although taking steps to reduce exposure to allergens may be tedious and difficult, the results are rewarding. It's extraordinary to see a child change from a whiny, irritable, aggressive, rash-prone, doesn't-know-what-he-wants, non-sleeper to a pleasant, clear-skinned, easy-going child who sleeps well. Once parents are confronted with this dramatic change, they are willing to do what it takes to help their child.
Generally more than one body system is involved in an allergic reaction. Gastrointestinal symptoms are most common.
Vomiting, spitting up
Blood in stools
Malabsorption (and resulting poor
Protein and iron-losing enteropathy
Neonatal thrombocytopenia (low levels of platelets in the blood)
Red, itchy nose (allergic salute)
Congestion, prolonged cold-like symptoms
Stridor (noisy breathing)
Dark circles under eyes
Constant tearing of eyes
Gelatin-like fluid in eyes
Redness around rectum
|Central Nervous System:
Poor weight gain
Aching in legs and other muscles
Short attention span
Poor school performance
Hard to live with
Spots on tongue
Swelling of lips, tongue, throat
Life-threatening drop in blood pressure
Crook, W. Tracking Down Hidden Food Allergies. Jackson, Tennessee: Professional Books, 1978.
Crook, W. You and Allergy. Jackson, Tennessee: Professional Books, 1984.
La Leche League International. THE WOMANLY ART OF BREASTFEEDING. Schaumburg, IL: LLLI, 1997.
Lawrence. R. Breastfeeding: A Guide for the Medical Profession, 4th edition. St. Louis: Mosby, 1994.
Mohrbacher, N. and Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, IL: LLLI, 1997.
Rapp, D. Is This Your Child? New York: William Morrow and Company, Inc., 1991.
Rapp, D. Sneezing, Wheezing and Scratching. Los Altos, CA: The ECR Collection, 1974.
Riordan, J. and Auerbach, K. Breastfeeding and Human Lactation. Boston, MA: Jones and Bartlett, 1993.
Blair, H. Natural history of childhood asthma: a 20-year follow-up. Arch Dis Child, 1977, 52:613-619.
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.
Gerrard, J. Food allergy: two common types as seen in breast and formula fed babies. Ann Allergy, 1983; 50:375-79.
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.
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.
Jandl, A. Allergies. NEW BEGINNINGS, Mar-Apr 1996; 40-41.
Kahn, A, Mozin, M., Casimir. C., et al. Insomnia and cow's milk allergy in infants. Pediatrics, 1985; 76:880-85.
Lesniewski, L. Coping with allergies. NEW BEGINNINGS, Sept-Oct 1988 140-142.
Merrett, T., et al. Infant feeding and allergy: 12-month prospective study of 500 babies born into allergic families. Ann Allergy, 1988; 61:13.
Mohrbacher, N. Reducing the risk of allergies. NEW BEGINNINGS, Sept-Oct 1988;143-44.
Saarinen, L. and Kajosaari, M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet, 1995 346:1065-69.
Sehee, C. Late solids and allergies. NEW BEGINNINGS, Sept-Oct 1988:142-43.
Shircliff, S. Bottoms up. NEW BEGINNINGS. Mar-Apr 1995; 43-44.
Stigler, U. Preventive dietary management: prenatal, neonatal and in infancy. Clin Ecol, 1985;3:1:50-54.
Sutin, K. Eliminating foods worked wonders. NEW BEGINNINGS, Sept-Oct 1988; 145.