---------- Forwarded Message ----------

From:   Diane T. Herforth, 75334,3713
TO:     Lactnet, INTERNET:[log in to unmask]
DATE:   5/14/98 8:10 AM

RE:     Copy of: Hives and Breastfeeding

We are working with a 25 year old g2p2 presenting with hives related to the
introduction of solid foods in her babies. This client has a hx of
hypothyroidism and takes 0.125 mg synthyroid daily. She also has a hx of
allergies to PCN and codeine and ASA intolerance. Strong family hx of
immune system disorders. 

She has two children. First child, NSVD, no complications during pregnancy
or labor. She introduced solid foods at appx. 4 months following a
progression of simple grains to yellow vegetables to green vegetables to
fruits fairly rapidly. Several weeks into solids the client woke up with
pressure uticaria on her abdomen. This persisted and progressed slowly to
include much of her trunk area and onto the extremities. This progressed to
angioedema of the face, eyes and mouth that resulted in three separate ER
visits. ASA was involved in at least one of these episodes. She
subsequently weaned the child on advise of her physician, and the hives
subsided within three weeks. 

Second child, NSVD with epidural, dx of PUPPP in first trimester, well
controlled with Zyrtec prn.  Child is currently 5.5 months old. Solids were
introduced appx. 1 month ago with the same progression. Two weeks ago this
client noticed hives again, which have progressed rapidly to facial
angioedema within a week. She noted a particularly severe reaction to the
baby ingesting sweet potatos. She also reported that the hives are
cyclic-increase and spread in the afternoon and evening, and taper off
during the morning hours. The initial problem appears to correspond with
the introduction of yellow vegetables in each of her children's diets.

I saw her today in our office. She had multiple small uticaric lesions on
her arms with minor redness on face and back. We recommended she eliminate
all solid foods, or if that wasn't possible, offer only simple rice cereal
and rinse the baby's mouth afterwards with clear water, and to nurse
exclusively for two weeks. We then plan to possibly use a breast pump to
offer the baby milk while eliminating the mouth-to-breast contact if
necessary. 

Our questions is: are we on the right track suspecting a  contact
dermatitis related to solid food residue in the baby's mouth resulting in
an immune system reaction of some sort?  What else could we be looking at
ruling out? Please, please! any ideas to help this gal would be strongly
appreciated! She feels she will have to wean again if she can't find help. 

Thanks.
Pamela Golliet & Diane Herforth