Q&A: HCP advice on maternal diet while breastfeeding children with food allergy varies

Many women receive conflicting information on their diet while breastfeeding children with food allergy, according to research published in the Annals of Allergy, Asthma and Immunology.

Researchers assessed health care provider recommendations and maternal practices using a web-based survey that was sent to nursing mothers of children with IgE-mediated food allergies.

Of the 133 women who completed the survey, 43.4% reported that after their child received a food allergy diagnosis, health care providers told them to continue breastfeeding without any dietary restrictions, and 17.3% were advised to avoid eating what their child was allergic to while breastfeeding. Among participants, 28.6% reported that this concern was not discussed by their health care provider.

Further, 12% of the women said that their child had an allergic reaction to breast milk. Of these reactions, an allergist found that 75% were likely not IgE-mediated.

Healio Primary Care spoke with Hannah Wangberg, MD, a pediatrician and internist in San Diego, to learn more about the survey findings and what guidance is needed on maternal diet while breastfeeding children with food allergy.

Healio: Why is uniform guidance needed on maternal diet when breastfeeding children with food allergy?

Wangberg: In our study, we found that 30% of breastfeeding mothers of children with IgE-mediated food allergies received conflicting advice from health care providers as to whether they should — or should not — eat the foods to which their child was allergic. We believe that mixed messages on this practice may be confusing for mothers and could have unintended consequences such as early breastfeeding cessation. Inconsistent advice from health care providers also has potential to compromise trust in the health care system. For these reasons and more, we believe consistent and evidence-based guidance from health care providers would benefit breastfeeding mothers of children with IgE-mediated food allergy.

Healio: What should the guidance be?

Wangberg: Based on the available evidence to date, we do not recommend maternal elimination diets for most mothers providing breast milk to children with IgE-mediated food allergies. This guidance only applies to IgE-mediated food allergies and does not apply to non-IgE-mediated conditions such as food protein-induced allergic proctocolitis (FPIAP).

Healio: What does current research suggest about maternal diet while breastfeeding children with food allergy? What additional research is needed?

Wangberg: While several studies have confirmed the presence of low quantities of food antigens within the breast milk of some women, our study suggests that most breastfeeding mothers may safely consume the food(s) to which her child is allergic. More research with prospective studies would help fully stratify the risks and benefits of this practice.

Healio: What should physicians tell mothers of children with food allergy about breastfeeding?

Wangberg: We do not recommend maternal elimination diets for most mothers providing breast milk to children with IgE-mediated food allergies. Should a mother express concern about an allergic reaction to possible food antigens within breast milk in her food allergic child, she should be encouraged to discuss these concerns with her child’s allergist who will provide further guidance based upon the nature of the described reaction.

References:

Healio Interview

Wangberg H, et al. Ann Allergy Asthma Immunol. 2021;doi: 10.1016/j.anai.2021.02.015.