Skin testing breast feeding mother
Question:
Reviewed: February 24, 2020
12/24/2014
An otherwise healthy woman had an uncomplicated childbirth, utilizing epidural anesthesia. Postpartum urticaria raised the possibility of allergy to one of the anesthetic medications. At four months postpartum, she is being considered for skin testing to assess this possibility. She is currently breastfeeding. Is it safe to perform allergy skin testing while breastfeeding? Specifically, is there any risk of sensitization of the infant via allergens and antigens administered to the mother during the testing?
Answer:
I could find no evidence or reports of fetal sensitization occurring to a drug used for allergy skin testing of the breast feeding mother. There is a prior question from the Ask the Expert Archives asking about allergen immunotherapy, the injection of larger amounts of allergen, in the breast feeding mother and risk of sensitization of the child, albeit this discussion is related to aeroallergens. However, I think the concepts are similar.
There is evidence of foods in the diet of the breast feeding mother may expose the infant to sufficient food antigen to result in sensitization of or triggering symptoms in the infant. The amount of allergen introduced into the mother is multiple orders of magnitude greater with food ingestion than drug allergy testing. Therefore, I am confident you may reassure your patient that there is no risk of sensitization of the infant by the testing.
Safety of aeroallergen skin testing in a woman who is breast-feeding
Q: 5/28/2014
A nursing mother has concerns regarding skin end point titration intradermal testing. She was concerned that following the test she may pass the antigens to the nursing baby through her breast milk potentially causing an anaphylactic reaction in the child. I could not specifically find any contraindications regarding nursing and SET. I would appreciate any further assistance regarding this matter.
A: I am assuming that your skin tests are being performed to aeroallergens. In this case, I would consider allergy skin tests safe to administer during breast-feeding. Although there are no studies in this regard, perhaps the best way to answer your question is to cite a quote from the most recent guidelines (Parameters) on Allergen Immunotherapy, which discusses the administration of allergy injections during breast-feeding. As you know, injections contain the same allergens, but in larger doses than would be administered in skin testing. The above noted quote is copied for you below:
"There is no evidence of an increased risk of prescribing or continuing allergen immunotherapy for a mother while breastfeeding and no risk for the breast-fed child. SOURCE: Cox L, et al: Allergen immunotherapy: A practice parameter third update, Journal of Allergy and Clinical Immunology Vol. 127, Issue 1, Supplement, Pages S1-S55, 2011."
In addition, there is a website here with an opinion from a pediatric neonatologist about this subject that might be helpful to your patient, which also states the opinion that injections of allergen during breast-feeding are safe.
Thank you again for your inquiry and we hope this response is helpful to you.
Sincerely,
Phil Lieberman, M.D.
I hope this information is of some help to you and your patient.
All my best.
Dennis K. Ledford, MD, FAAAA