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Subject:
From:
Tsila Sloane <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 2 Aug 2009 00:45:47 -0400
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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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