Rita Brhel, Hastings, Nebraska

All of my children have allergies, and all of my children breastfed for at least six months. Even my third baby, whom I breastfed well into the third year, didn’t escape without eczema. So if one of the benefits* of breastfeeding is a reduced risk of allergies, what happened?

Turns out, it’s not that simple. Allergy risk is a mix of genetic and environmental factors, and how exactly breastfeeding works into that equation is not as straightforward as a blanket protection.

In August 2017, I attended the University of Nebraska Medical Center’s 2017 Breastfeeding Conference with particular interest in one of the speakers who would be covering allergy prevention research for in-utero and breastfeeding children.

Ebrahim Shakir, MD, opened his conference session by referencing a common scenario beheld by lactation specialists near and far — the baby who presents with a good latch and good weight gain but frequent, high-pitched crying, a bloated stomach, and an arched back. The parents believe the problem is excess gas. From a lactation perspective, there are a myriad of possibilities — one of them being a possible food intolerance. Dr. Shakir’s diagnosis in this particular case study: severe acid reflux.

Food allergies often get blamed any time a baby appears uncomfortable. Some of the real conditions behind the symptoms, like acid reflux, do need medical treatment. Sometimes, though, a baby who may appear to have some sort of food allergy is actually a baby with a higher-needs temperament who would benefit greatly from being held more often or a baby whose mother has an under-managed overly abundant milk supply.

For the symptoms to be related specifically to food allergy, there needs to be a documented allergic reaction. Dr. Shakir would prefer that all babies diagnosed with a food allergy are tested specifically for food allergies by a health care provider. The role of the lactation specialist is to try to decipher which babies need to be referred to a medical doctor for evaluation. Symptoms of an allergic reaction are an eczema-like rash, runny nose, asthma, and/or an immediate gastrointestinal or anaphylactic reaction. Babies also tend to be very fussy as their only way to verbally communicate their discomfort of these symptoms.

Generally, a lactation consultant working in concert with the baby’s medical doctor can help parents pinpoint the baby’s food allergen. In most cases, breastfeeding can and is encouraged to continue. While the latest research shows that the protective factor of breastfeeding against allergy risk is short-term (the benefit tends to fall away past early childhood), we all know that breastfeeding has so many more benefits that far outweigh the risk of not breastfeeding.

However, Dr. Shakir said that breastfeeding may be contraindicated if the baby suffers from allergic anaphylaxis or from severe, widespread eczema that doesn’t resolve. Fortunately, both of these types of reactions are very rare, he said.

If a breastfeeding baby or child does develop signs of a food allergy, and the allergen can be pinpointed, it is recommended that the mother (and child if eating solids) avoids eating the trigger food. However, Dr. Shakir advises parents not to forever remove the offending food but to eliminate the trigger for three to four weeks past the point when the child’s symptoms resolve, and then to reintroduce it. It appears children are more likely to “outgrow” their allergy risk if they are exposed to a trigger through careful oversight by their health care provider, rather than fall back on the complete, long-term avoidance so touted until recently.

So, if breastfeeding can’t entirely eliminate allergy risk, what about preventing allergies prenatally?

Dr. Shakir said that the research shows no benefit to a child when the mother avoids certain foods while pregnant and that there’s also no link between what foods a pregnant mother eats and her child’s eventual development of allergies. Dr. Shakir also stated that breastfeeding mothers who restrict their diets severely and long-term to try to help their babies’ perceived discomfort, or who attempt to manage a known allergen without medical oversight, may be putting their babies at higher risk of developing more food allergies because breastfed babies need that exposure to a mother’s varied diet for the best immune development.

Still, Dr. Shakir was very clear in his presentation that a child genetically prone to allergy will develop an allergy eventually anyway, despite having been breastfed, even if exclusively breastfed and even if breastfed well into toddlerhood.

That said, there are benefits from breastfeeding for the genetically allergy-prone infant, toddler, and preschooler. Dr. Shakir said that breastfeeding for at least four to six months is associated with a reduced allergy risk through early childhood, and the best way to reduce the risk of cow milk allergy is by avoiding cow milk formula through a baby’s first birthday. Other risk factors outside breastfeeding that increase allergy development potential include: a family history, smoking exposure, Vitamin D deficiency, and possible acetaminophen use in early childhood.

I came away from Dr. Shakir’s talk with a great deal more understanding of the intersection between breastfeeding and its effect on lowering allergy risk. It’s not at all cut-and-dry, but the advice in the end is the same — breastfeed as much and as long as possible. Breastfeeding won’t keep your child from developing allergies, but it still bestows important benefits found nowhere else.

Editor’s Note:

*LLL recognizes that breastfeeding is the norm, and as such, there are no “benefits” and there are risks caused by not breastfeeding. In the context of this article, we feel that using the language of “benefits” is helpful for many who will be reading it.

Dr. Ebrahim Shakir has previously had a number of articles published in professional journals on the topic of allergies, as well as allergies and the breastfed child. References to these published articles are available at: https://health.usnews.com/doctors/ebrahim-shakir-782094.

The author has previously written about Dr. Shakir’s presentation at: http://www.mothering.com/articles/breastfeeding-wont-protect-your-kid-from-allergies-but-its-still-worth-it/.

Please send your story ideas to Amy at [email protected].

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