LivingCan the baby have a breast milk allergy?

Can the baby have a breast milk allergy?

Breast milk is the ideal food for the newborn and for the baby up to six months of life exclusively, that is, it does not need other foods. It is well tolerated by the vast majority of babies; otherwise, we would not have gotten here as a species! But are there any exceptions to this? Can some babies not tolerate their mother’s milk or have an allergy to it?

Is there an allergy to breast milk?

No, the term breast milk allergy does not exist. What does exist is an allergy to some of its components , and it is that small “pieces” of food that the mother takes can pass into breast milk and it may happen that the baby develops an allergy to any of them. During the first 12 months of life, the most common allergy is to cow’s milk proteins . In these cases, the mother should eliminate the allergen (the food to which the child is allergic) in question from her diet and breastfeeding can be safely maintained.

Types of cow’s milk protein allergy

We can distinguish two types of allergies in this case:

  • Allergy to non-IgE-mediated cow’s milk proteins (formerly known as intolerance). The predominant symptoms are digestive: colic, diarrhea, bloody stools, reflux …

  • IgE-mediated allergy to cow’s milk proteins . The most common symptoms are urticaria (skin lesions), edema, respiratory symptoms, and even anaphylaxis.

For an allergy to develop we must have, on the one hand, a genetic predisposition. On the other, a previous exposure to the allergen, in this case cow’s milk proteins.

Formula is made almost entirely from cow’s milk (except for goat’s milk-based formula). In contrast, only traces, very small amounts of cow’s milk pass into breast milk. Therefore, although breastfed babies may develop an allergy to cow’s milk proteins or other foods that pass into breast milk, the symptoms are usually mild and predominantly digestive (non-IgE-mediated allergies).

Sometimes it happens that, when introducing the first bottle of formula milk, babies develop allergy symptoms (hives, respiratory symptoms or even anaphylaxis).

Current recommendations recommend avoiding cow’s milk supplements in breastfed babies during the first week of life, whenever possible, to prevent allergy to cow’s milk proteins.

Years ago, and unfortunately it still happens in some maternity wards, the baby used to be given one or two bottles of formula after birth until the mother’s “milk came in.” Remember that the first two or three days of life babies receive colostrum; This “first breast milk” has a special composition, different from that of mature milk, which perfectly meets the needs of the newborn. It is secreted in small amounts, but the newborn, with its small stomach and immaturity, does not need more. Colostrum is produced already during pregnancy, which is why all women have.

So, except for special cases in which it is justified (premature infants, CIR; very low weight babies, babies with hypoglycemia …) we must avoid giving those first bottles, which some popularly call “pirate bottle”.

Can a baby with a cow’s milk protein allergy continue to breastfeed?

An allergy to cow’s milk proteins is not a contraindication to breastfeeding . In many cases (it is not always necessary, it depends on the type of allergy and when it developed), mothers of children with an allergy to cow’s milk proteins must eliminate milk and its derivatives from their diet .

It is also not recommended that they drink goat or sheep milk or its derivatives. In general, they can have beef. When following this diet, the mother may suffer from a calcium deficiency, so, in general, a calcium and vitamin D supplement is usually prescribed to the mother and she will be advised on those foods rich in calcium.

What other allergens can breast milk have?

Small traces of the food that the mother eats pass into the breast milk. Thus, other foods that frequently cause allergies in children such as eggs, soybeans, fish or shellfish could also be found in very small amounts in breast milk.

If your child has an allergy to any of these foods, in some cases it will be necessary for the mother to remove it from her diet.

There is no allergy to breast milk. What does exist is an allergy to any of its components: the most common is an allergy to cow’s milk proteins consumed by the mother.

Is there a lactose allergy?

Lactose is present in breast milk and contributes 40% of total calories. It is a sugar that, by the action of an enzyme called lactase, present in the intestine, is divided into galactose and glucose. Lactose is always present in breast milk , it does not depend on the mother’s diet but is manufactured within the mammary gland. There is no allergy to lactose . On the other hand, there is lactose intolerance. In this case, the person lacks or has little lactase enzyme, so that it cannot divide lactose into glucose and galactose, causing florid symptoms such as abdominal pain, flatulence or diarrhea.

Congenital lactase deficiency (that is, from birth), is a very rare disease that has been described mainly in Finland. In this rare disease, breastfeeding would be contraindicated as there is no way to eliminate lactose from breast milk.

Secondary lactase deficiency , on the other hand, is relatively common in children, for example, after prolonged gastroenteritis, and recovers in a few days . In this case it is not necessary to suspend breastfeeding. In fact, the recommendation in cases of acute gastroenteritis is to maintain breastfeeding on demand and offer the breast frequently.

Some people, over time, lose the lactase enzyme and can become intolerant when they reach adulthood ; in this case the enzyme is no longer recovered.

Is there a situation where breast milk is not well tolerated by the baby?

Humans are mammals and breast milk is the ideal food for the newborn and up to the first six months of life exclusively (later also together with other foods). So, in the vast majority of cases, it is well tolerated.

An exception would be, as we have mentioned, an allergy to some of the foods that can pass into breast milk (the most frequent is milk, but it could be eggs, soybeans …); In this case, it would be enough for the mother to eliminate these foods from her diet and the baby could continue breastfeeding normally.

Another very exceptional case is the rare disease that we have also talked about (and it is not an allergy): congenital lactase deficiency ; these babies lack the enzyme that “breaks down” lactose into glucose and galactose; as lactose is always present in breast milk, breastfeeding would be contraindicated.

And another exception would be babies with galactosemia , a rare disease in which the baby lacks some of the enzymes that metabolize galactose. As breast milk contains lactose, and this is divided into glucose and galactose, galactosemia would also be a contraindication for breastfeeding.

Summarizing; the concept of allergy to breast milk, thus in general, does not exist . What is true is that small amounts of the foods that the mother eats pass into breast milk and this can cause babies to become sensitized and develop allergies to some of them. As the amounts are usually very small, symptoms in exclusively breastfed babies are usually mild. When these babies take larger amounts of the food (for example, a bottle of formula, or introduce eggs or fish into their diet when starting complementary feeding), they may develop more florid allergy symptoms.

Allergic babies and children should eat a diet free of the foods to which they are allergic. In the case of continuing breastfeeding, it is likely that the mother will also have to eliminate these foods from her diet.

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