title: Recurrent postpartum anaphylaxis with breast-feeding.
abstract: BACKGROUND
  Anaphylaxis associated with breast-feeding is a rare but potentially life-threatening event.
  
  
  METHODS
  This woman reported anaphylaxis with three previous pregnancies while breast-feeding. With her fourth pregnancy she was treated with corticosteroids and antihistamines after delivery. Despite treatment, she developed urticaria, facial edema, and throat tightening, less severe than prior episodes. Her symptoms resolved with epinephrine and antihistamine but recurred with subsequent breast-feeding. On postpartum day 4 she had no symptoms while breast-feeding.
  
  
  CONCLUSIONS
  Three cases of postpartum breast-feeding anaphylaxis have been reported. Although the pathophysiology is unclear, it may involve the decrease in progesterone and rise of prolactin causing mast cell degranulation. Avoidance of nonsteroidal antiinflammatories and prophylaxis with corticosteroids and antihistamines may offer the best protection.
authors.affiliation: From the Departments of Obstetrics & Gynecology and Allergy & Immunology, Naval Medical Center San Diego, San Diego, California.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Shank
authors.forename: Stacey C
authors.initials: SC
authors.lastname: Olney
authors.forename: Fang L
authors.initials: FL
authors.lastname: Lin
authors.forename: Michael F
authors.initials: MF
authors.lastname: McNamara
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D001942:Breast Feeding / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011644:Puerperal Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012008:Recurrence