A 12-day-old female infant was admitted with complaints of
redness covering the whole body. In history, the mother had
been stung on the lip by a bee 4 hours earlier. Swelling and
pain subsequently developed in the mother’s upper lip and
cheek. No treatment other than ice compression was applied.
The area on the lip stung by the bee could be seen, but the
sting itself could not be identified. Approximately 1 hour
afterward, the infant was breastfed by the mother, following
which a widespread urticarial rash was observed over the
whole body of the infant. Mother and baby had consumed no
allergenic food or medications and had not been exposed to
any allergens. It proved technically impossible to test the
breast milk for IgE against wasp venom. Subsequently, 1/5
saline solution of 150 mL/kg (dextrose monohydrate + sodium
chloride) and single dose dexamethasone (1 mg/kg) was
administered intravenously. The rash started to disappear
within the first 30 minutes and had completely resolved 2
hours later. Formula food was recommended instead of
breastfeeding for the next 12 hours. The infant was
discharged with full recovery.
Breastmilk contains dietary antigens [1].
Maternal antigen exposure affects antigen presence in breast
milk [2]. This can be important for neonates as antigen
handling in the infant gut may be impaired due to their
higher gastric pH and lower secretion of pancreatic enzymes
[3]. Various levels of antigen can be found in breastmilk,
depending on maternal antigen exposure and mammary gland
permeability [4].
Our 12-day-old patient was breastfeed
after her mother was stung by a bee. After breastfeeding,
urticarial rash developed over her whole body. We think that
the mother was sensitized to wasp venom and that the
specific IgE may have been transferred to the child during
birth. The rashes resolved following the administration of
dexamethasone. In the case of allergic reactions in children
of breastfeeding mothers, we recommend that food intake,
medications taken and exposure to any allergens in the
mother be enquired into.
References
1. Palmer DJ, Makrides M. Diet of
lactating women and allergic reactions in their infants.
Curr Opin Clin Nutr Metab Care. 2006;9:284-8.
2. Palmer DJ, Gold MS, Makrides M. Effect
of cooked and raw egg consumption on ovalbumin content of
human milk: a randomized, double-blind, cross-over trial.
Clin Exp Allergy. 2005;35:173-8.
3. Agunod M, Yamaguchi N, Lopez R, Luhby
AL, Glass GB. Correlative study of hydrochloric acid,
pepsin, and intrinsic factor secretion in newborns and
infants. Am J Dig Dis. 1969;14:400-14.
4. Verhasselt V. Neonatal tolerance under breastfeeding
influence. Curr Opin Immunol. 2010;22:623-30.
