Pamela,
I've sent this to lactnet, I dont know if you did, your original at the end
To reply to pionts you raise
-antibiotic prophylaxis: A concoern is creating resistance to the prophylatic drug which has been shown in useing amoxicillin for prophylaxis which is why I use (as trained) sulfa for this. I dont treat any active infections with just sulfa.
-IgA deficiency occurs in 1:600 why havent we heard more? It may be that docs dont look for it, no set rules when to look or arent aware of it (some arent ware of safety of Synthriod or lact of IGG in Bm but we wont start that agian) Also there isnt a lot to do with treating it. Find a 10 page article in the med literature and 9.5 pages are on pathogensis and presentation and have a page on treatment.
-IVIG (intervenous immunoglobulin is a blood product and generally safe as preparation technique remove viruses, there was a problem of Hep C at one time but to my knowledge no cases of HIV. Micheal Ryan DO (peds ID) has a review article on this.
- Will Bm better stimulate an IgA deficent person to produce IgA? I dont know. Interesting question. Something in breastmilk stimulates the immune system.
If anone has info on this I'd like to know.
fDr Rob (frozen Dr Rob in Wikes Barre, PA as apposed to wDr Nancy warm in San Diego)
>>> Pamela Morrison IBCLC <[log in to unmask]> 01/24 12:53 PM >>>
Dear Dr Rob, thank you so much for helping to educate me a little about this
topic. My client's baby is described as "a different child" since receiving
breastmilk again. No-one has suggested antibiotic prophylaxis as far as I
know, just that he has had a lot of them - mostly for repeated ear
infections. Thank you too for your reassurances concerning vaccines, etc.
As I live in Africa I am pro-vaccines too! I think *not* vaccinating (risks
notwithstanding) is a luxury we cannot afford. A few thoughts occur to me:
If this deficiency occurs to 1 in 600 of the European population, why
haven't we heard more about it??
You wrote, "Replacind IgG in an IgA def person is very dangerous as with any
blood produce anaphylatic rx can occur. An immunologist told me in relation
to my patient that he would not replace IgG unless defiecent and sick enough
to need a ventolator a few times a year."
My client was thinking of having baby's IgG levels tested just before she
came back to me to talk about re-lactating, but the results would have taken
six weeks to come from South Africa. In view of the baby's improved health
since receiving EBM the doctor advised not to go this route because he said
IgG comes from human plasma, imported from Switzerland, and he considered
the risk of acquiring other infections by this route (we think he was
referring to HIV) to be not worth the benefit to the baby. So I was
pleased to hear what you said about this Tx. Baby had contracted pneumonia
two weeks after being weaned at 2 months, was receiving oxygen in the
hospital (not sure of the ventilator), very sick indeed, but did recover.
"I think Dayna did by far the best thing in prolonged breastfeding a child
who really needed it."
My client says she will provide EBM for this little boy (now 10 months)
until he is four years old if it will be helpful. I am encouraging her in
this (though I will be surprised if she carries on that long). In your
opinion, is there a possibility that the longer the baby has EBM the greater
the chance that, not only will he be protected during the time that he
receives it, but that his *own* immune system will be better stimulated to
produce IgA in the future (after weaning again) - is this possible?
Once again, thank you for your valuable contributions to Lactnet, which I am
finding so helpful.
Pamela Morrison
IBCLC in private practice
Harare
Zimbabwe
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