Last update: March 19, 2019

Allergic reaction

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

Histamine exists naturally in our bodies. It is produced and stored in gastric cells, neurons, in the granules of mastocytes, basophils and in many other cells. It is a neuronal neurotransmisor and an immunostimulant (Kovacova 2015).
Due to certain stimuli (Cold, heat, trauma, vibration, intense exercise, sexual relations, alcohol and some foods) mastocytes release histamine in plasma causing the signs and symptoms of an allergic reaction (Maurer 2008).
Some foods are naturally rich in histamine, while in others, histamine is derived from the process of fermentation (chese, wine, beer, yoghurt) or through the contamination/putrefaction of fish or meat (Visciano 2014).

Allergic reactions from ingesting shellfish or other foods produce an exaggerated endogenous release of histamine from the degranulation of mastocytes in the body and causes the local symptoms known as urticaria: flushing, inflammation, hives, heat, pain and itching. Although most allergic reactions remain as hives, a more severe reaction can cause what is known as anaphylactic shock: bronchoconstriction, respiratory distress, headache, hypotension and vomiting-diarrhea.

An excess consumption of foods rich in histamine or fish (Visciano 2014) or spoiled foods can cause symptoms similar to an allergic reaction (Wantke 1993).

At the date of this last update we did not find published data regarding the excretion of histamine in breast milk.

Most of the histamine released during an allergic reaction is not circulating in plasma since it quickly bonds to peripheral tissue causing inflammation and symptoms like itching and flushing. It is unlikely that significant amounts of histamine could pass into breast milk.

If the event is not due to an allergic reaction but because an excessive consumption of foods rich in histamine or spoiled foods (with abundant histamine), despite the intestinal mechanisms which slow down its absorption, and increase in plasma histamine can occur.

Histamine is quickly eliminated from plasma due to an elimination half-life that ranges from 3 to 11 minutes (Hale 2017 p 450, Middleton 2002) and 0.75 to 1.5 hours (EMA 2013). Clearance is twice as fast in women (EMA 2013).

Breast milk can degrade histamine because it contains as an anti inflammatory factor the enzyme histaminase (Lawrence 2016 p183) and therefore any amount that could pass into breast milk would be degraded and would not reach the lactating infant.

The same enzyme, histaminase or diaminoxidase (DAO) is present in the small intestine and ascending colon (and kidney) and would degrade the ingested histamine, preventing the absorption of any significant amounts in plasma (Kovacova 2015, Kanny 1999).
Infants would thus be protected from a possible excess of histamine in breast milk, except perhaps in the case of premature infants and during the neonatal period due to immaturity of the intestinal and renal systems.

Except for one published case of a mild allergic reaction in a 12 day old newborn that breastfeed one hour after her mother was stung by a bee on her lip causing extensive swelling of her face (Kaya 2012), we did not find published data relating urticaria or any other allergic reaction to problems in the breastfeeding infant.

Expert authors consider breastfeeding compatible with conditions in which there is a large release of histamine like urticaria, mastocytosis and even illnesses or syndromes causing pruritic syndromes of pregnancy (Lawrence 2016 p617).

Medications commonly used to treat an allergic reaction are compatible with breastfeeding: antihistamines (preferably those which cause little or no sedation: Lawlor 2014), adrenaline, and (though usually poorly prescribed) corticosteroids.

Maternal allergic reaction due to breastfeeding is a rare occurrence which does not cause problems to the breastfeeding infant but it might require the administration of antihistamines to the mother and, if the reaction is severe (breastfeeding anaphylaxis), breastfeeding should be interrupted (Durgakeri 2015, McKinney 2011, Shank 2009, Villalta 2007).


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Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

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References

  1. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  2. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  3. Kovacova-Hanuskova E, Buday T, Gavliakova S, Plevkova J. Histamine, histamine intoxication and intolerance. Allergol Immunopathol (Madr). 2015 Sep-Oct;43(5):498-506. Abstract
  4. Durgakeri P, Jones B. A rare case of lactation anaphylaxis. Australas Med J. 2015 Mar 31;8(3):103-5. Abstract
  5. Lawlor F. Urticaria and angioedema in pregnancy and lactation. Immunol Allergy Clin North Am. 2014 Feb;34(1):149-56. Abstract
  6. Visciano P, Schirone M, Tofalo R, Suzzi G. Histamine poisoning and control measures in fish and fishery products. Front Microbiol. 2014 Sep 23;5:500. Abstract
  7. Kaya A, Okur M. Bee sting in mother and urticarial rash in her baby. Indian Pediatr. 2012 Abstract Full text (link to original source) Full text (in our servers)
  8. McKinney KK, Scranton SE. A case report of breastfeeding anaphylaxis: successful prophylaxis with oral antihistamines. Allergy. 2011 Mar;66(3):435-6. Abstract
  9. Shank JJ, Olney SC, Lin FL, McNamara MF. Recurrent postpartum anaphylaxis with breast-feeding. Obstet Gynecol. 2009 Aug;114(2 Pt 2):415-6. Abstract
  10. Maurer M, Grabbe J. Urticaria: its history-based diagnosis and etiologically oriented treatment. Dtsch Arztebl Int. 2008 Jun;105(25):458-65; quiz 465-6. Abstract
  11. Villalta D, Martelli P. A case of breastfeeding anaphylaxis. Eur Ann Allergy Clin Immunol. 2007 Jan;39(1):26-7. No abstract available. Abstract
  12. Middleton M, Sarno M, Agarwala SS, Glaspy J, Laurent A, McMasters K, Naredi P, O'Day S, Whitman E, Danson S, Cosford R, Gehlsen K. Pharmacokinetics of histamine dihydrochloride in healthy volunteers and cancer patients: implications for combined immunotherapy with interleukin-2. J Clin Pharmacol. 2002 Jul;42(7):774-81. Abstract
  13. Kanny G, Bauza T, Frémont S, Guillemin F, Blaise A, Daumas F, Cabanis JC, Nicolas JP, Moneret-Vautrin DA. Histamine content does not influence the tolerance of wine in normal subjects. Allerg Immunol (Paris). 1999 Feb;31(2):45-8. Abstract
  14. Wantke F, Götz M, Jarisch R. Histamine-free diet: treatment of choice for histamine-induced food intolerance and supporting treatment for chronic headaches. Clin Exp Allergy. 1993 Dec;23(12):982-5. Abstract

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