Dairy allergy, breastfeeding: evidence of pass through?

[BlairsBabe]

Hi there, 4 months old DS has bad eczema and suspected dairy allergy and I've cut out dairy, eggs, nuts on advice of a paedeatric dermatologist.

varioua people I've mentioned it to in last few weeks, including a dietician, have told me that there's no - or very little - evidence of dairy (proteins? not sure) passing through breast milk - so effectively saying that I'm wasting my time and that the eczema is likely caused by something else.

I know there's loads and loads of anecdotal evidence about breastfeeding mums cutting out dairy and finding the eczema really improves but from my own experience I know that at the same time, you are probably also trying loads of different creams and making other changes (e.g. to washing powder) that might also be making a difference. So how do you know for sure that cutting out the dairy is making a difference?

Was wondering whether anyone could link to any real medical research / published papers that discuss this link, rather than the anecdotal stuff? The stories are useful, but I kind of like to know the science behind things and would find this really useful.

thanks in advance

Don't know of any actual research papers, but My DS's allergy specialist said "of course it does". I wish I'd asked her about research papers!

I don't suppose this counts as 'evidence' (our paediatric dermatologist certainly didn't think so!) but I kept a very detailed food diary for many months and proved beyond a shadow of a doubt that my DS was reacting not only to egg and milk proteins in my diet but also to non-protein things like citrus, tomatoes and cherries.

I'll be watching this thread with interest, as I have found it very frustrating to be told by HCPs that dietary exclusions are useless.

Just had a quick search through the online archives of the British Medical Journal and found this article, entitled "Guidelines for the diagnosis and management of cow's milk protein allergy in infants" (Yvan Vanderplas, Dept of Paediatrics, Vrijie Universitiet Brussel, 15th April 2007).

Here's a quote from it:
There is evidence that food proteins from milk, egg, peanut and wheat are excreted in breast milk and may cause adverse reactions during exclusive breast feeding in sensitised infants. Due to the many benefits of breast feeding to the infant and the mother, clinicians should advise mothers to continue breast feeding but avoid the causal foods in their own diet.

There must be more articles out there somewhere...

Oooh well done you bananas thank you! Think I need to print off and give to my GP, the GP who lives on my street, my mum, MIL, etc etc etc.

Yes - good luck with convincing them! Especially the family and friends, as they're around even when the health professionals aren't...

Here's another link to a site which may or may not be of use - it quotes an article in the New England Journal of Medicine as saying 'Nursing mothers can help prevent or delay food allergic reactions in high-risk infants through dietary modifications'. There must be loads of evidence out there... wish more GPs and HVs knew about it!

sorry - forgot to put the link in! It's here

Hi there.
I am both a mummy and a nutritionist and I work specifically with pregnancy and infants/toddlers etc.
Frankly, when it comes to allergies and intolerances you are going to find it hard to get a straight answer out of anyone!
There is such little data around cows milk protien allergy because by the time it is correctly diagnoised(via GPs/allergists/peadatricians etc) most infants are over 1 and are no longer being breast fed & the problem is solved because child can be fed other things etc. It is a very taboo subject.
My best and most honest advice would be to go with your "gut feeling" (please excuse the pun). If you are noticing a correlation between your food intake and your childs condition, cut the foods out of your diet, but make sure you supplement well (i.e calcium and vitamin D if you cut out dairy). The main stream thoughts with HCPs is that there is no evidence, but the honest truth is that there is no evidence because no one has really bothered to test it. As far as I am concerened I have seen far too many patients who insist on a correlation between their food intake and the reaction of their children for me to ignore it.
You will find that no one will want to advice you to stop breastfeeding because of all the benefits it brings and therefore also say there is no link because if there would be one, perhaps more mummys would consider a high quality baby formula free of cows milk protein and this would very strongly go against NHS guigelines encouranging mothers to breastfeed.
If you want any other advice, please ask - happy to help where I can ;)
Leanne x

The Mayo Clinic is a pretty mainstream US medical establishment (with a very informative website) and, according to them: "...If you're breast-feeding and your child has a milk allergy, cow's milk proteins passed through your breast milk may cause an allergic reaction. If this is the case, you may need to exclude all products that contain milk from your diet. Talk to your doctor if you know ? or suspect ? your child has a milk allergy and has allergy signs and symptoms that occur after breast-feeding. ..." www.mayoclinic.com/health/milk-allergy/DS01008/DSECTION=prevention

I think the lack of knowledge here in the UK is possibly due more to the lack of paediatric allergy specialists rather than there not being any data - as others have posted, the articles are there. If there was better provision in this area and expertise more easily accessible to GPs and other health workers, I'm sure the information given to parents in primary - and secondary care - would be more accurate.

I would be cautious about diy exclusion diets in very young children. Nutritional imbalance is the major concern but also there is a small possibility that accidental ingestion of the excluded food might cause a severe reaction, so proper professional advice is really important.

DrOli4 - thank you. I'm so glad that you listen to parents and keep an open mind and I do wish that I had met more HCPs like you! It's hard to be told "there's no evidence" after keeping a detailed food diary for months and months.

ClaireOB - about exclusion diets: you say that "accidental ingestion of the excluded food might cause a severe reaction" - does this mean that total exclusion is a bad thing? The reason I am asking is that recently I have excluded potato waffles from DS's diet after realising that they contained small amounts of mustard (which he has never been tested for). I noticed that although he liked them he wouldn't ever eat them 2 days in a row, so I put mustard on his skin and he got red itchy hives that kept on spreading... Does this mean I should exclude mustard completely or should I keep on feeding him waffles once a week?

Sorry if I'm asking unreasonable questions - I just wondered if you knew

Greenbananas, as I'm not a medical professional I'm not qualified to advise but I really think you should discuss the mustard issue with your GP and ask for a referral to a paediatric allergist. Also, the Anaphylaxis Campaign can advise on all aspects of food allergy - www.anaphylaxis.org.uk/. I think calling their helpline would be a good idea -01252 542029.
As I understand it, the risk of unsupervised/accidental reintroduction of an excluded food causing a serious reaction is small but it exists, so I think it's best to avoid the risk in the first place.

Edit: gb - I see you're already seeing an allergy specialist. Have you discussed them mustard issue with him/her?

Claire, I'm sorry, I didn't mean to put you on the spot, just wondered if you'd got a particular piece of research in mind. I'll get in touch with the paediatrician we have been seeing - have not seen her since last November and are not due to go again until next November but I'll see if I can maybe speak to her before that.

Thanks ever so much for the helpline number - I did ring it and they were ever so helpful, even though they couldn't answer my specific question. If only there were some easy answers! Anyway, I do appreciate your reply

no worries greenbananas. If anything, I was thinking of the official NHS advice about diagnosing food allergies here where they say about exclusion diets: "It is recommended that you only carry out an exclusion diet under the supervision of a dietitian or other qualified healthcare professional..." and about 'challenge testing' (i.e reintroduction of excluded food): "...Never attempt to carry out a challenge test at home because there is a small risk that you will have an anaphylactic reaction..."
Well, hear, hear, but it would be nice if we could have a few more people qualified in paediatric allergy in the NHS so that parents don't have to wait so long for diagnosis!

I think talking to your paediatrician is probably the best way to go with the waffle/mustard question as s/he knows your child's history.

www.jstor.org/pss/29704769