Kathy Birt wrote, "... havent' been able to determine if there has ever
been a proven
allergy to breastmilk.  A pediatrician called me today for advice as he is
reluctantly thinking of recommending to a mother of a one month old to stop
breastfeeding.  Her baby has severe reflux being tx with medications with
no improvements. Baby is gaining wgt slowly also.  The baby was seen by a
gastrointerologist who told him babies can have a rare allergy to the
mothers milk from antibodies passed on by the baby's father.  They have
eliminated grains, dairy, and nuts from mom's diet supposedly, and no
improvement.  I suggested they try giving expressed breastmilk thickened by
cereal to see if the thickness would decrease the reflux.  I haven't talked
to the mom but wonder if it might be overactive letdown or oversupply that
could give the same symptoms.  Also baby very fussy.  Any advice would be
helpful....how do I determine the oversupply/overactive letdown as a cause?
reply to [log in to unmask] or post to list"

Kathy, it is unlikely that a human baby could be allergic to human
breastmilk.  But it is quite possible for the baby to be allergic to foreign
proteins ingested by the mother that are excreted in the breastmilk.  What
you describe in the baby - severe reflux, gaining weight slowly, and very
fussy - fits the profile perfectly, and would not seem to be due to
over-supply.  I see that mom has eliminated grains, dairy and nuts
(supposedly???) but this may not be enough.  The most likely cause of these
kind of symptoms in an exclusively breastfed baby is bovine proteins in the
mother's diet.  The next most likely cause is ingestion of foods that the
mother herself doesn't really like, or hated as a child.  I once had a
client whose baby reacted to mushrooms, of all things, because mom was
getting them for free, and eating them four times a week, in soups, fried,
you name it, and eventually remembered that she had hated them when she was
a little girl.

But bovine proteins are far and away the most likely offender.  In order to
"test" this, mom would need to completely eliminate *all* milk, cream,
butter, yoghurt, cheese, and beef, and all foods containing even traces of
these products, for a full two weeks.  It's difficult, and it's tedious, but
I have seen near-miracle "cures" if the mom is diligent about this.  Babies
like this can take to feeding for *very* short times, drinking ravenously
for just a few minutes, you can see that they are frantic and starving, but
then they arch back and scream, behaving as if the milk is "poisonous" and
refusing to take any more.   This, as well as the vomiting, naturally leads
to inadequate weight gain.  Symptoms start to lessen about 3 - 5 days into
the elimination, but may not completely resolve until about the thirteenth
day.  But eventually the vomiting stops, the baby drinks more milk and this
is followed by a calmer baby who starts to gain weight at a better rate. I
have seen the most incredible resolution of symptoms with this - the mom
will describe her baby as "a different child".

So if this was my client I would suggest a total bovine elimination, and for
good measure I'd eliminate the nuts too, as you have suggested.  But I would
think grains are OK for now (incidentally, putting cereal in EBM will mean
that the baby is getting grains direct, and is too young for weaning foods!)
This is very hard for the mom, but well worth the sacrifice if she can stick
with it.  After two weeks, and if she feels brave enough, she can
"challenge" by having a steak and a milk-shake to see what happens.  The
baby usually starts spitting up again within just a few hours, but symptoms
will usually resolve the second time within just a few days.    Usually she
is *not* willing to challenge, but it happens inadvertently when she eats
out, and so the connection is made.

Nancy Holtzman posted to LACTNET in October 1998 about a study which the
paediatrician might find relevant, and she described her personal experience
with her own son.  The ref is:
Forget P, Arends JW, Cow's milk protein allergy and gastro-oesophageal
reflux. Eur J Pediatr 1985 Nov;144(4):298-300

In addition, Susan Burger posted to LACTNET about this in May 2001, with the
ref:
Sorva J et atl, 1994.  Beta-lactoglobulin secretion in human milk varies
widely after cow's milk ingestion in mothers if infants with cow's milk
allergy.  J. Clin Immunol 19(4):787-92.

And there is lots more about this in the LACTNET archives.

I would love to hear the outcome of this case - whatever you try, and what
works!

Pamela Morrison IBCLC, Zimbabwe
mailto:[log in to unmask]

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