What kind of allergy medicine is safe when breastfeeding

Vaporizer with plain water may be beneficial in moistening the nasal passages and helping to clear the airway. Menthol products in a vaporizer should be avoided and own been identified as an irritant in nasal passages in infants.


Zinc

Zinc Gluconate,as found in Cold-eeze and Zicam is considered safe with breastfeeding although the nasal gel is recommended over the oral drops. According to Thomas Hale, PhD,” Zinc is an essential mineral that is required for your cell’s enzymatic functions and the recommended daily allowance for adults is 12-15 mg per day. While zinc does enter the breastmilk, growing newborns require zinc and as endless as supplementation does not exceed 25-50 mgs per day,….avoid zinc sulfates because those own been shown to be detrimental to proper immune system function.”


Medication

Tylenol, or acetaminophen and Advil,or ibuprofen are approved for use while breastfeeding.

Benadryl and other allergy medications may reduce your milk supply and also may make the baby drowsy. Antihistamines and decongestants, including Dimetapp and Sudafed, are not recommended while breastfeeding, as they may substantially decrease your milk supply. See Dr. Thomas Hale’s website for a thorough discussion on medications and breastfeeding. While Benadryl and older versions of antihistamines are not recommended because they may decrease milk supply, Zyrtec and Claritin are OK.


Neti Pot

A Neti Pot is recommended for people with allergies or sinus problems, and works to clear the nasal passages during the common freezing.

Since it only uses water and the mom is not actually ingesting anything, it is extremely safe for a nursing mom.


Flu

Seasonal flu treatment includes either Oseltamivir (Tamiflu) or zanamivir (Relenza). These antivirals work early on in the illness and are not indicated if fever and illness has been present for more than 48 hours. The CDC considers oseltamivir safe to use in breastfeeding mothers. At present, there is no breastfeeding data on zanamivir (Relenza).

Physicians are advised to use oseltamivir (Tamiflu) instead of zanamivir (Relenza) in breastfeeding mothers.


Environmental Control and Prevention

Patients with allergic rhinitis should avoid exposure to cigarette smoke, pets, and allergens that are known to trigger their symptoms.3 Nasal saline irrigation alone or combined with traditional treatments for allergic rhinitis has been shown to improve symptoms and quality of life while decreasing overall allergy medication use. Additional studies are needed to determine the optimal method and frequency of nasal irrigation and the preferred type of saline solution.5

Prevention has been a main focus in studies of allergic rhinitis, but few interventions own been proven effective.

Although evidence does not support measures to avoid dust mites, such as mite-proof impermeable mattresses and pillow covers, numerous guidelines continue to recommend them.2,3,6 Other examples of proposed interventions without documented effectiveness include breastfeeding, air filtration systems, and delayed exposure to solid foods in infancy or to pets in childhood.7–11


Pharmacotherapy

Pharmacologic options for the treatment of allergic rhinitis include intranasal corticosteroids, oral and intranasal antihistamines, decongestants, intranasal cromolyn, intranasal anticholinergics, and leukotriene receptor antagonists.12,13 Decongestants and intranasal cromolyn are not recommended for children.14

The International Primary Care Respiratory Group; British Society for Allergy and Clinical Immunology; and American Academy of Allergy, Asthma, and Immunology recommend intranasal corticosteroids alone for the initial treatment of persistent symptoms affecting quality of life and second-generation nonsedating antihistamines for mild intermittent disease.3,12,13,15,16 Patients with more severe disease not responding to intranasal corticosteroids with or without second-line therapies should be referred for consideration of immunotherapy.2,3,14,17Table 1 lists treatments based on symptom type.4Table 2 summarizes the treatment options.4

COMBINATION THERAPY

Although most patients should be treated with just one medication at a time, combination therapy is an option for patients with severe or persistent symptoms.

Numerous studies own looked at the combination of an intranasal corticosteroid and an oral antihistamine or leukotriene receptor antagonist, but most own concluded that combination therapy is no more effective than an intranasal corticosteroid alone.3,20,37–39 However, recent studies own found the combination of azelastine/fluticasone (Dymista) to be superior (better effectiveness and faster symptom relief) to either treatment alone in patients with more severe allergic rhinitis.40–42

IMMUNOTHERAPY

Immunotherapy should be considered for moderate or severe persistent allergic rhinitis that is not responsive to usual treatments, in patients who cannot tolerate standard therapies or who desire to avoid long-term medication use, and in patients with allergic asthma.2,3,13,16,17,31,43–46 Targeted immunotherapy, the only treatment that changes the natural course of allergic rhinitis, consists of istering a little quantity of allergen extract subcutaneously or sublingually.44

Subcutaneous injections are istered in the physician’s office at regular intervals, typically three times per week during a buildup phase, then every two to four weeks during a maintenance phase.

The first dose of sublingual immunotherapy is istered in the physician’s office so that the patient can be observed for adverse effects, and then it is istered at home daily. The optimal length of therapy has not been sure, but three to five years is thought to be the best duration.3 The effects of immunotherapy can final up to seven to 12 years after the treatment is discontinued.3,45

Subcutaneous immunotherapy has been proven effective in the treatment of adults and children with allergic rhinitis from exposure to dust mites, birch, Parietaria

Enlarge Print

Table 1.

Pharmacotherapy

Pharmacologic options for the treatment of allergic rhinitis include intranasal corticosteroids, oral and intranasal antihistamines, decongestants, intranasal cromolyn, intranasal anticholinergics, and leukotriene receptor antagonists.12,13 Decongestants and intranasal cromolyn are not recommended for children.14

The International Primary Care Respiratory Group; British Society for Allergy and Clinical Immunology; and American Academy of Allergy, Asthma, and Immunology recommend intranasal corticosteroids alone for the initial treatment of persistent symptoms affecting quality of life and second-generation nonsedating antihistamines for mild intermittent disease.3,12,13,15,16 Patients with more severe disease not responding to intranasal corticosteroids with or without second-line therapies should be referred for consideration of immunotherapy.2,3,14,17Table 1 lists treatments based on symptom type.4Table 2 summarizes the treatment options.4

COMBINATION THERAPY

Although most patients should be treated with just one medication at a time, combination therapy is an option for patients with severe or persistent symptoms.

What helpful of allergy medicine is safe when breastfeeding

Numerous studies own looked at the combination of an intranasal corticosteroid and an oral antihistamine or leukotriene receptor antagonist, but most own concluded that combination therapy is no more effective than an intranasal corticosteroid alone.3,20,37–39 However, recent studies own found the combination of azelastine/fluticasone (Dymista) to be superior (better effectiveness and faster symptom relief) to either treatment alone in patients with more severe allergic rhinitis.40–42

IMMUNOTHERAPY

Immunotherapy should be considered for moderate or severe persistent allergic rhinitis that is not responsive to usual treatments, in patients who cannot tolerate standard therapies or who desire to avoid long-term medication use, and in patients with allergic asthma.2,3,13,16,17,31,43–46 Targeted immunotherapy, the only treatment that changes the natural course of allergic rhinitis, consists of istering a little quantity of allergen extract subcutaneously or sublingually.44

Subcutaneous injections are istered in the physician’s office at regular intervals, typically three times per week during a buildup phase, then every two to four weeks during a maintenance phase.

The first dose of sublingual immunotherapy is istered in the physician’s office so that the patient can be observed for adverse effects, and then it is istered at home daily. The optimal length of therapy has not been sure, but three to five years is thought to be the best duration.3 The effects of immunotherapy can final up to seven to 12 years after the treatment is discontinued.3,45

Subcutaneous immunotherapy has been proven effective in the treatment of adults and children with allergic rhinitis from exposure to dust mites, birch, Parietaria

Enlarge Print

Table 1.

Symptom-Based Treatments for Allergic Rhinitis

Treatment Symptoms


Ocular Nasopharyngeal itching Sneezing Rhinorrhea

Intranasal corticosteroids

Oral and intranasal antihistamines

Combination intranasal corticosteroid and antihistamine

Oral and intranasal decongestants

Intranasal cromolyn

Intranasal anticholinergics

Leukotriene receptor antagonists

Immunotherapy

Table 1.

Symptom-Based Treatments for Allergic Rhinitis

Treatment Symptoms


Ocular Nasopharyngeal itching Sneezing Rhinorrhea

Intranasal corticosteroids

Oral and intranasal antihistamines

Combination intranasal corticosteroid and antihistamine

Oral and intranasal decongestants

Intranasal cromolyn

Intranasal anticholinergics

Leukotriene receptor antagonists

Immunotherapy

Enlarge Print

Table 2.

Summary of Treatments for Allergic Rhinitis

Type of therapy FDA pregnancy category Minimum age for use Mechanism/onset of action Adverse effects Cost*

Intranasal corticosteroids

Decrease the influx of inflammatory cells and inhibit the release of cytokines; onset of action is less than 30 minutes

Bitter aftertaste, burning, epistaxis, headache, nasal dryness; possible systemic absorption, rhinitis medicamentosa, stinging, throat irritation

Beclomethasone

C

4 years

NA ($150) for 1 inhaler

Budesonide (Rhinocort Aqua)

B

6 years

$120 ($160) for 1 nasal spray

Ciclesonide (Omnaris)

C

6 years

NA ($210) for 1 nasal spray

Flunisolide

C

6 years

$55 (NA) for 1 nasal spray

Fluticasone furoate (Veramyst)

C

2 years

NA ($175) for 1 nasal spray

Fluticasone propionate (Flonase)

C

4 years

$15 ($15) for 1 nasal spray

Mometasone (Nasonex)

C

2 years

NA ($230) for 1 nasal spray

Triamcinolone acetonide

C

2 years

$70 ($130) for 1 nasal spray

Oral antihistamines

Block histamine H1 receptors; onset of action is 15 to 30 minutes

Dry mouth, sedation at higher than recommended doses

Cetirizine (Zyrtec)

B

6 months

$10 ($20) for 30 tablets

Desloratadine (Clarinex)

C

6 months

$40 ($210) for 30 tablets

Fexofenadine (Allegra)

C

2 years (allergic rhinitis)

$15 ($20) for 30 tablets

Loratadine (Claritin)

B

2 years

$13 ($25) for 30 tablets

Combination intranasal corticosteroid and antihistamine

See intranasal corticosteroids and intranasal antihistamines

See intranasal corticosteroids and intranasal antihistamines

Azelastine/fluticasone (Dymista)

C

6 years

NA ($170) for 1 nasal spray

Intranasal antihistamines

Azelastine (Astelin)

C

5 years

Block H1 receptors; onset of action is 15 minutes

Bitter aftertaste, epistaxis, headache, nasal irritation, sedation

$50 ($145) for 1 nasal spray

Olopatadine (Patanol) [corrected]

C

6 years

Block H1 receptors; onset of action is 30 minutes

Bitter aftertaste, epistaxis, headache, nasal irritation, sedation

$50 ($250) for 1 nasal sprays

Oral decongestants

Pseudoephedrine

C

2 years (usually not started until 4 years)

Vasoconstriction; onset of action is 15 to 30 minutes

Headache, elevated blood pressure and intraocular pressure, tremor, urinary retention, dizziness, tachycardia, and insomnia

$5 ($10) for 24 tablets

Intranasal cromolyns

Cromolyn

B

2 years

Inhibits histamine release

Epistaxis, nasal irritation, sneezing

NA ($18) for 1 nasal spray

Intranasal anticholinergics

Ipratropium (Atrovent)

B

5 years

Block acetylcholine receptors; onset of action is 15 minutes

Epistaxis, headache, nasal dryness

$30 ($120) for 1 nasal spray

Leukotriene receptor antagonists

Montelukast (Singulair)

B

6 months

Block leukotriene receptors; onset of action is 2 hours

Elevated levels of alanine transaminase, aspartate transaminase, and bilirubin

$15 ($215) for 30 tablets

Immunotherapy

Not well understood, believed to shift immune response from immunoglobulin E mediated to immunoglobulin G mediated

Minor local mouth irritation, diarrhea, vomiting; rare anaphylaxis

Sublingual Grastek (timothy grass pollen extract, cross reactive with 6 other grass pollens)

B

5 years

NA ($260) for 30 tablets

Sublingual Oralair (5-grass pollen extract)

B

10 years

NA ($345) for 30 tablets

Sublingual Ragwitek (short ragweed pollen extract)

C

18 years

NA ($260) for 30 tablets

Subcutaneous allergen extracts: several tree, grass, weed pollens; cat and dog dander; dust mites; certain molds; and cockroaches; istered by a physician

Should not be initiated during pregnancy; maintenance therapy is considered safe

Has not been established; generally 5 years so that the kid is ancient enough to cooperate

Local injection site reactions and, less commonly, systemic allergic reactions

Varies

Table 2.

Summary of Treatments for Allergic Rhinitis

Type of therapy FDA pregnancy category Minimum age for use Mechanism/onset of action Adverse effects Cost*

Intranasal corticosteroids

Decrease the influx of inflammatory cells and inhibit the release of cytokines; onset of action is less than 30 minutes

Bitter aftertaste, burning, epistaxis, headache, nasal dryness; possible systemic absorption, rhinitis medicamentosa, stinging, throat irritation

Beclomethasone

C

4 years

NA ($150) for 1 inhaler

Budesonide (Rhinocort Aqua)

B

6 years

$120 ($160) for 1 nasal spray

Ciclesonide (Omnaris)

C

6 years

NA ($210) for 1 nasal spray

Flunisolide

C

6 years

$55 (NA) for 1 nasal spray

Fluticasone furoate (Veramyst)

C

2 years

NA ($175) for 1 nasal spray

Fluticasone propionate (Flonase)

C

4 years

$15 ($15) for 1 nasal spray

Mometasone (Nasonex)

C

2 years

NA ($230) for 1 nasal spray

Triamcinolone acetonide

C

2 years

$70 ($130) for 1 nasal spray

Oral antihistamines

Block histamine H1 receptors; onset of action is 15 to 30 minutes

Dry mouth, sedation at higher than recommended doses

Cetirizine (Zyrtec)

B

6 months

$10 ($20) for 30 tablets

Desloratadine (Clarinex)

C

6 months

$40 ($210) for 30 tablets

Fexofenadine (Allegra)

C

2 years (allergic rhinitis)

$15 ($20) for 30 tablets

Loratadine (Claritin)

B

2 years

$13 ($25) for 30 tablets

Combination intranasal corticosteroid and antihistamine

See intranasal corticosteroids and intranasal antihistamines

See intranasal corticosteroids and intranasal antihistamines

Azelastine/fluticasone (Dymista)

C

6 years

NA ($170) for 1 nasal spray

Intranasal antihistamines

Azelastine (Astelin)

C

5 years

Block H1 receptors; onset of action is 15 minutes

Bitter aftertaste, epistaxis, headache, nasal irritation, sedation

$50 ($145) for 1 nasal spray

Olopatadine (Patanol) [corrected]

C

6 years

Block H1 receptors; onset of action is 30 minutes

Bitter aftertaste, epistaxis, headache, nasal irritation, sedation

$50 ($250) for 1 nasal sprays

Oral decongestants

Pseudoephedrine

C

2 years (usually not started until 4 years)

Vasoconstriction; onset of action is 15 to 30 minutes

Headache, elevated blood pressure and intraocular pressure, tremor, urinary retention, dizziness, tachycardia, and insomnia

$5 ($10) for 24 tablets

Intranasal cromolyns

Cromolyn

B

2 years

Inhibits histamine release

Epistaxis, nasal irritation, sneezing

NA ($18) for 1 nasal spray

Intranasal anticholinergics

Ipratropium (Atrovent)

B

5 years

Block acetylcholine receptors; onset of action is 15 minutes

Epistaxis, headache, nasal dryness

$30 ($120) for 1 nasal spray

Leukotriene receptor antagonists

Montelukast (Singulair)

B

6 months

Block leukotriene receptors; onset of action is 2 hours

Elevated levels of alanine transaminase, aspartate transaminase, and bilirubin

$15 ($215) for 30 tablets

Immunotherapy

Not well understood, believed to shift immune response from immunoglobulin E mediated to immunoglobulin G mediated

Minor local mouth irritation, diarrhea, vomiting; rare anaphylaxis

Sublingual Grastek (timothy grass pollen extract, cross reactive with 6 other grass pollens)

B

5 years

NA ($260) for 30 tablets

Sublingual Oralair (5-grass pollen extract)

B

10 years

NA ($345) for 30 tablets

Sublingual Ragwitek (short ragweed pollen extract)

C

18 years

NA ($260) for 30 tablets

Subcutaneous allergen extracts: several tree, grass, weed pollens; cat and dog dander; dust mites; certain molds; and cockroaches; istered by a physician

Should not be initiated during pregnancy; maintenance therapy is considered safe

Has not been established; generally 5 years so that the kid is ancient enough to cooperate

Local injection site reactions and, less commonly, systemic allergic reactions

Varies

Observational studies

Several observational studies own suggested that early introduction of potentially allergenic foods may be associated with a decreased risk of developing food allergy.

A questionnaire-based survey conducted in 2008 found that the prevalence of peanut allergy was ten-fold higher among Jewish children in the United Kingdom (UK) compared with Jewish children in Israel [12]. This difference in prevalence was attributed to earlier and more frequent peanut exposure in the first year of life in Israel compared with the UK. A population-based, cross-sectional study (HealthNuts) that included over 2500 infants found a lower risk of egg allergy among those that were introduced to egg at 4–6 month of age compared to those introduced at 10–12 months of age or later [13].

Another observational study examining the feeding history of over 13,000 infants found the incidence of IgE-mediated cow’s milk allergy to be significantly lower in infants who were introduced to cow’s milk formula within the first 14 days of life and given it regularly thereafter, compared to those who were introduced to the formula after 3 months of age [14].

What helpful of allergy medicine is safe when breastfeeding

Similarly, a case–control study that included approximately 200 children showed that early introduction of cow’s milk formula was associated with a lower incidence of IgE-mediated cow’s milk allergy [15]. Data from a Finnish birth cohort that included 994 children found that delaying the introduction of multiple foods, including oats (> 5 months) and wheat (> 6 months), was significantly associated with an increased risk of allergic sensitization to food and inhalant allergens [16]. Another birth cohort study conducted in the United States (US) showed that introducing solid food or cow’s milk (complementary food) at less than 4 months of age was associated with a reduced risk of peanut allergy by age 2–3 years in children with a parental history of asthma or allergy [17].

A study that included approximately 1600 children observed that delaying initial exposure to cereal grains until 6 months of age may increase the risk of developing IgE-mediated wheat allergy [18].

What helpful of allergy medicine is safe when breastfeeding

More recently, data from over 2100 children included in the Canadian Healthy Baby Longitudinal Development (CHILD) birth cohort study showed that delaying the introduction of cow’s milk products, egg, and peanut beyond the first year of life significantly increased the odds of sensitization to these foods [19].

INTRANASAL ANTIHISTAMINES

Compared with oral antihistamines, intranasal antihistamines own the advantage of delivering a higher concentration of medication to a targeted area, resulting in fewer adverse effects and an onset of action within 15 minutes.2 Intranasal antihistamines FDA-approved for the treatment of allergic rhinitis are azelastine (Astelin; for patients five years and older) and olopatadine (Patanol; for patients six years and older).

They own been shown to be similar or superior to oral antihistamines in treating symptoms of conjunctivitis and rhinitis, and may improve congestion.31 Adverse effects include a bitter aftertaste, headache, nasal irritation, epistaxis, and sedation. Although intranasal antihistamines are an option if symptoms do not improve with nonsedating oral antihistamines, their use as first- or second-line therapy is limited by adverse effects, twice daily dosing, cost, and decreased effectiveness compared with intranasal corticosteroids.31–33

INTRANASAL CORTICOSTEROIDS

Intranasal corticosteroids are the mainstay of treatment for allergic rhinitis.

What helpful of allergy medicine is safe when breastfeeding

They act by decreasing the influx of inflammatory cells and inhibiting the release of cytokines, thereby reducing inflammation of the nasal mucosa.2 Their onset of action can be less than 30 minutes, although peak effect may take several hours to days, with maximum effectiveness generally noted after two to four weeks of use.18 Numerous studies own demonstrated that intranasal corticosteroids are more effective than oral and intranasal antihistamines in the treatment of persistent or more severe allergic rhinitis.2,3,12,13,19–21

There is no evidence that one intranasal corticosteroid is superior. However, numerous of the products own diverse age indications from the U.S.

Food and Drug istration (FDA), only budesonide (Rhinocort Aqua) has an FDA pregnancy category B safety rating, and only fluticasone furoate (Flonase) and triamcinolone acetonide are available over the counter.

The most common adverse effects of intranasal corticosteroids are throat irritation, epistaxis, stinging, burning, and nasal dryness.2,22 Although there has been concern about potential systemic adverse effects, including the suppression of the hypothalamic-pituitary axis, these effects own not been shown with currently available intranasal corticosteroids.23,24 The studies that specifically looked at the effects of the drugs on skeletal growth and adrenal activity did not protest a decrease in growth of children over the course of one to three years.25,26 Despite these data, every intranasal corticosteroids carry a warning that long-term use may restrict growth in children.

DECONGESTANTS

Oral and intranasal decongestants improve nasal congestion associated with allergic rhinitis by acting on adrenergic receptors, which causes vasoconstriction in the nasal mucosa, decreasing inflammation.2,12,13 The most common decongestants are phenylephrine, oxymetazoline (Afrin), and pseudoephedrine.

The abuse potential for pseudoephedrine should be weighed against its benefits.

Common adverse effects of intranasal decongestants are sneezing and nasal dryness. Use for more than three to five days is generally not recommended because patients may develop rhinitis medicamentosa, or may own rebound or recurring congestion.2,3 Oral decongestants may cause headache, elevated blood pressure and intraocular pressure, tremor, urinary retention, dizziness, tachycardia, and insomnia; therefore, these medications should be used with caution in patients with underlying cardiovascular conditions, glaucoma, or hyperthyroidism.2,12,13 Decongestants may be considered for short-term use in patients without improvement in congestion with intranasal corticosteroids.2,3

INTRANASAL ANTICHOLINERGICS

Although evidence supports the use of intranasal ipratropium (Atrovent) for severe rhinorrhea, one study showed that it may also improve congestion and sneezing in children, but to a lesser extent than intranasal corticosteroids.35 Adverse effects include dryness of the nasal mucosa, epistaxis, and headache, and the recommended istration is two to three times daily.1

LEUKOTRIENE RECEPTOR ANTAGONISTS

The leukotriene D4 receptor antagonist montelukast (Singulair) is comparable to oral antihistamines but is less effective than intranasal corticosteroids.2,16,36 It may be particularly useful in patients with coexistent asthma because it reduces bronchospasm and attenuates the inflammatory response.2

ORAL ANTIHISTAMINES

Histamine is the most studied mediator in early allergic response.

It causes smooth muscle constriction, mucus secretion, vascular permeability, and sensory nerve stimulation, resulting in the symptoms of allergic rhinitis.

First-generation antihistamines, including brompheniramine, chlorpheniramine, clemastine, and diphenhydramine (Benadryl), may cause sedation, fatigue, and impaired mental status. These adverse effects happen because the older antihistamines are more lipid soluble and more readily cross the blood-brain barrier than second-generation antihistamines. The use of first-generation sedating antihistamines has been associated with poor school performance, impaired driving, and increased automobile collisions and work injuries.27–30

Compared with first-generation antihistamines, second-generation drugs own a better adverse effect profile and cause less sedation, with the exception of cetirizine (Zyrtec).27 Second-generation nonsedating oral antihistamines include loratadine (Claritin), desloratadine (Clarinex), levocetirizine (Xyzal), and fexofenadine (Allegra).

Second-generation antihistamines own more complicated chemical structures that decrease their movement across the blood-brain barrier, reducing central nervous system adverse effects such as sedation. Although cetirizine is generally classified as a second-generation antihistamine and a more potent histamine antagonist, it does not own the benefit of decreased sedation.

In general, oral antihistamines own been shown to effectively relieve the histamine-mediated symptoms associated with allergic rhinitis (e.g., sneezing, pruritus, rhinorrhea), but they are less effective than intranasal corticosteroids at treating nasal congestion and ocular symptoms.

Because their onset of action is typically within 15 to 30 minutes and they are considered safe for children older than two years, second-generation antihistamines are useful for numerous patients with mild symptoms requiring as-needed treatment.2,3,14

INTRANASAL CROMOLYN

Intranasal cromolyn is available over the counter and is thought to inhibit the degranulation of mast cells.1 Although safe for general use, it is not considered first-line therapy for allergic rhinitis because it is less effective than antihistamines and intranasal corticosteroids and is given three or four times daily.1,2,34

Prospective clinical trials

In recent years, randomized controlled trials own provided further support for the association between early food introduction and the prevention of food allergy.

The most compelling evidence to date comes from the LEAP study, which randomized 640 high-risk infants (defined as those with severe eczema and/or egg allergy) in the UK to either early (age 4–11 months) or delayed (avoidance until age 5 years) peanut introduction. The trial showed that the early and regular (3 times per week) consumption of peanut in these high-risk infants reduced the development of peanut allergy by 86% by 5 years of age [4]. The Persistence of Oral Tolerance to Peanut extension of the LEAP study (LEAP-On) investigated whether participants who had consumed peanut in the primary trial would remain protected from peanut allergy after cessation of peanut consumption for 12 months [20].

This extension study found that the benefits of early peanut introduction persisted after 12 months of cessation of peanut consumption, supporting the concept that early peanut tolerance is not a transient phenomenon.

In the Enquiring About Tolerance (EAT) trial, 1303 exclusively breastfed infants from the general population were randomized to either early (age 3 months) or standard (age 6 months) introduction of six allergenic foods (peanut, cooked egg, cow’s milk, sesame, whitefish, and wheat) [21].

The EAT investigators hypothesized that early introduction of these allergenic foods would reduce the prevalence of food allergy by age 3 years. The intention-to-treat analysis revealed a 20% reduction in the prevalence of food allergy in the early introduction group that was not statistically significant, likely because of the high rate of non-adherence to the dietary protocol. However, in an adjusted per protocol analysis, significant reductions were seen in the rates of peanut and egg allergy in the early introduction group.

Other prospective trials own investigated the effects of early egg introduction.

What helpful of allergy medicine is safe when breastfeeding

In the Prevention of Egg Allergy with Tiny Quantity Intake (PETIT) trial, 147 Japanese infants with eczema were randomly assigned to daily consumption of heated egg powder or placebo along with aggressive treatment of eczema [22]. The study found that randomization to heated egg powder at age 6 months significantly reduced the risk of egg allergy by 78% compared with avoidance until age 12 months.

What helpful of allergy medicine is safe when breastfeeding

The trial was stopped early due to benefit. The Solids Timing for Allergy Research (STAR) randomized 86 high-risk infants with moderate-to-severe eczema to get pasteurized raw whole-egg powder or rice powder (placebo) at 4 months of age [23]. At 8 months, both groups were introduced to whole cooked egg under medical supervision. At 1-year, there was a non-significant trend toward a lower rate of egg allergy in the group who received pasteurized raw egg powder at age 4 months vs. whole cooked egg at age 8 months. However, the trial was terminated early due to the high rate of allergic reactions in the egg-sensitized children randomized to early introduction at age 4 months.

The Starting Time of Egg Protein (STEP) study, which included 820 infants without eczema but with a family history of atopy, found that early introduction of pasteurized raw egg powder at age 4–6 months was associated with a non-significant trend toward a reduced risk of egg allergy compared to introduction at age 10 months [24]. A per-protocol analysis found that significantly fewer children in the early introduction group had IgE-mediated egg allergy at 12 months of age.

In the Beating Egg Allergy Trial (BEAT), 319 infants who were SPT-negative to egg but who had a family history of atopy were randomized to get either pasteurized whole-egg powder or placebo at 4 months of age [25].

Subjects were treated until 8 months of age, at which time egg was introduced into the diet. At 1 year, egg sensitization was significantly lower in the treatment group compared with the placebo group. However, there was only a non-significant trend toward a reduced risk of developing egg allergy in the early introduction group.

What helpful of allergy medicine is safe when breastfeeding

Findings from the Hen’s Egg Allergy Prevention (HEAP) study also call into question the safety of early pasteurized raw egg introduction [26]. This trial, which included 406 infants from the general population, found no evidence that early introduction of pasteurized raw egg powder at age 4–6 months prevented either egg allergy or egg sensitization. Furthermore, among the children with baseline egg sensitization who were excluded from randomization but then challenged with egg separately (n = 23), two-thirds experienced an anaphylactic reaction upon this initial introduction.

Although the results of egg allergy studies own been conflicting or inconclusive, a recent meta-analysis of randomized controlled trials investigating the timing of allergenic food introduction and the risk of developing food allergy found “moderate certainty” evidence (based on 5 trials, including 1915 children) that introducing egg between 4 and 6 months of age reduced the risk of egg allergy (relative risk [RR], 0.56; p = 0.009) [27], showing much better efficacy with using cooked as opposed to raw egg.

This meta-analysis also found “moderate certainty” evidence (based on 2 trials [LEAP and EAT], 1550 patients) that peanut introduction between age 4–11 months reduced the risk of peanut allergy (RR, 0.29; p = 0.009).

What medicines are safe to use while breastfeeding? Stool softeners love Miralax or Dulcolax? Acid blockers love Zantac or Pepcid? What about anti-inflammatory medications or antibiotics?

To assist answer your questions, we put together a list of commonly used medications, along with safety considerations during breastfeeding. If you need additional information, the National Library of Medicine is an excellent resource concerning any additional medications.

We’ve also put together a grand list of additional articles and resources covering the top breastfeeding issues.

1) Acid blockers (Zantac, Pepcid, Prilosec, Protonix, Nexium):  Acid blockers are not found in any significant levels in breast milk and are considered safe.

In fact, Pepcid and Zantac are commonly used by pediatricians for babies.

2) Stool softeners and laxatives (Miralax, Dulcolax, Colace, Surfak):  Stool softeners are safe because they are not absorbed through the intestines to any extent, and therefore are not found in breast milk.

3) Anti-inflammatory medications (fever and/or pain):

Advil, Motrin, Ibuprofen:  These are anti-inflammatory medications of choice. There are no known problems for baby due to extremely low levels found in breast milk, much lower than amounts used for babies by pediatricians.

Aleve, Naproxen: These medications are less commonly used while breastfeeding because they are longer acting.

There are no serious complications noted with Naproxen, and levels are extremely low in breast milk, but studies are limited.

Acetaminophen:  Good choice! Extremely minimal amounts released in breast milk; Used in much lower amounts than commonly used by pediatricians in infants.

4) Freezing and Allergy Medications (Decongestants, Anti-Histamines):

Ephedrine (Pseudoephedrine):  Found in freezing and sinus medications, it’s probably safe, but may cause mild reductions in breast milk production. Because of that, it should be taken with caution if you’re having difficulty with production. Pseudoephedrine can also cause some minor irritability in the baby.

Antihistamines (Benadryl, Diphenhydramine, Claritin, Zyrtec):  These are every relatively safe during breastfeeding.

However, they may cause drowsiness in the baby and may also result in decreased milk production, especially when used with pseudoephedrine (a combination typically found in freezing medications).

E) Narcotic Pain medications, hydrocodone (Norco, Tylenol #3, Vicodin):  These are safe for breastfeeding in smaller doses. They can cause significant drowsiness and can own significant effects on baby’s ability to breastfeed. It is recommended to limit the doses used. The National Library of Medicine recommends keeping the dosage under 30mg /day, which is equivalent to six 5 mg tabs per day.

F) Birth Control Pills:  Are considered safe for breastfeeding.

Combination pills that own both estrogen and progesterone are more likely to reduce breast milk production, therefore progesterone-only pills are suggested during breastfeeding.

G) Antibiotics (Penicillins, Cephalosporins, Erythromycin, Clindamycin):  Considered safe in breastfeeding but can potentially cause diarrhea in the baby.

As always, it’s a excellent thought to check with your health care provider before you take medications if you’re breastfeeding.

It’s also recommended that you attempt to stay away from anything that’s not absolutely necessary, love vitamins with high-doses, herbal medications, or unusual supplements.

By Beverly Ann Curtis, APRN, PNP-BC, IBCLC

Colds are never enjoyment and trying to mom with a freezing can be downright hard. If you are not feeling well with runny nose and cough, lots of fluids and relax is always a excellent recipe for getting back to normal.

Cold symptoms final 6-10 days with symptoms peaking on day 4-5 and subsiding by day 7-10.

If your symptoms are worsening by 7 days into a freezing, you should see your doctor. If you run a fever beyond 3-4 days, medical care should be sought. Flu-like symptoms are not a normal part of a common freezing and may be indicative of a breast infection or other illness. Consult your physician if you experience these. Otherwise relax and sleep when baby sleeps.

If you are ill and not feeling well, you may inadvertently skip feedings or feel the need for someone else to feed your baby. This may cause a decrease in your milk supply. To maintain your supply, make certain you get plenty of relax, drink fluids, and continue to eat three meals a day and three snacks.

It is safe to continue to breastfeed even when you are ill unless your doctor advises otherwise. Your body will produce antibodies that pass into your milk and protect your baby from your infection.

What helpful of allergy medicine is safe when breastfeeding

Breastfed babies do experience illness and can pick up illness from others in their household but generally, the breastfed babies illness is less severe than formula fed infants and the baby recovers from illness sooner.


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