Dear Debbie,
My wife is a lactnet junky and I was reading over her shoulder. I am
an allergist-immunologist and see scores of patients with hives every
year. I am sorry for your daughter's difficulties, and hope she will
be feeling better soon. I suggest the following as long as the hives
are itchy but not painful, are not accompanied by fever or bruising,
and that she is otherwise feeling well.
1) Avoid all non-steroidal anti-inflammatory drugs (NSAIDs such as
ibuprofen, naprosyn, and aspirin)
2) A short (7 days) course of prednisone at 20-30mg per day taken with
food should not harm her or the baby and will help get the hives under
control
3) Cetirizine (in the US this is Zyrtec) 10 mg twice daily is not
passed on in breast milk
4) Discontinue all topical medications (for example, any topical
Benadryl = diphenhydramine) as they can actually worsen the hives
because the so called inactive ingredients trigger an allergic contact
dermatitis; other topical agents are fine, as long as they are
hypoallergenic and dye and perfume free -- an example is Eucerine Cream
5) Stress may be a precipitant, but quantifying it is difficult, so no
rigorous studies shed light on this factor, though many patients
attest to its role
6) The arrhythmia was likely an effect of the antihistamine, but
cetirizine is less likely to get into the baby's system and cause
this; be careful of sedation, even with this "non-sedating" drug, as
it can be dangerous to drive if she is feeling sleepy or disoriented
Mind you, I am a very close minded, Western-medicine-type person, so
you and your daughter may dislike my suggestions. Hives that last more
than 6 weeks (so called "chronic urticaria") are due to an autoimmune
basis 35-50% of the time. The condition is distressing but not
dangerous as long as the hives and swelling do not involve the mouth
and throat. Using medicines for a short but intense period will likely
get the hives under control and will save her taking a larger
aggregate amount of medicine in the long term.
Minimizing all medicines, including any "remedies" is best -- all
medicines are potentially poisons, regardless of whether they are
advertised as totally natural or totally safe and evaluated by
government agencies such as the US FDA. This is all the more true of
medicines that are not evaluated by any agency because they are
considered "supplements."
Sorry to respond "off list" but I do not know how to respond to lactnet.
Kol tuv,
David Sloane, MD
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