Recurrent Postpartum Anaphylaxis With Breast-Feeding

Abstract

Three cases of postpartum breast-feeding anaphylaxis have been reported. Although the pathophysiology is unclear, it may involve the decrease in progesterone and rise of prolactin causing mast cell degranulation. Avoidance of nonsteroidal antiinflammatories and prophylaxis with corticosteroids and antihistamines may offer the best protection.

Anaphylaxis during pregnancy

“…Anaphylaxis during breast-feeding is reported to be amplified in some women by concurrent use of nonsteroidal anti-inflammatory drugs. 8,9,28 Rapid change in progesterone levels might be important because increased progesterone levels during the second and third trimesters of pregnancy are also rarely associated with anaphylaxis that is relieved by delivery. 29 …”

Breast milk: friend or FOE?

“…2 -4 However, one case reported no symptoms with the fi rst child but developed anaphylaxis associated with breastfeeding with her second and third child. 5 Skin prick testing to breast milk has been negative in previous reports 4 and in our patient. IgE mediated allergy is thus unlikely.…”

“…The withdrawal of the stabilising effect of progesterone on mast cells has been suggested. 4 Other hormones that may have a role include prolactin, oxytocin, adrenocorticotropic hormone and corticotropin-releasing hormone. 3 4 Murine mast cells have been shown to express oxytocin receptors.…”

Breast milk: friend or foe?

“…This correlates well with the onset of symptoms and suggests hormonal influence. The withdrawal of the stabilising effect of progesterone on mast cells has been suggested 4. Other hormones that may have a role include prolactin, oxytocin, adrenocorticotropic hormone and corticotropin-releasing hormone 3 4.…”