Dear Editor:
Irecently took care of a very interesting patient at the postpartum unit in the hospital where I work as a Lactation Consultant. The patient was a 32-year-old gravida 3 para 3 who requested my assistance with breastfeeding her third baby. She commented to me that she was concerned about going home because she was terrified of what was going to “happen when my milk comes in.” When I probed further, she related that when she went home after the birth of her first child, she had “an itchy rash all over my arms and neck” and “pressure on my back and chest. It was hard to breathe!” She was brought to the emergency room where she received intravenous Benadryl® (McNeil Consumer Healthcare), and the symptoms abated. No connection was made to breastfeeding until lactogenesis 2 occurred with her second baby, and the same thing happened, with hives and difficulty breathing. She was able to swallow the Benadryl (50 mg) that her mother gave her, and eventually the symptoms subsided. Her mother had been unaware that a similar reaction had occurred with the first baby and offered the Benadryl for the rash, not realizing that she was also experiencing chest and back pressure with difficulty breathing. The patient believed these episodes were related in some way to breastfeeding but stated that every doctor she told did not believe that a potential relationship existed. Her symptoms only occurred with lactogenesis 2, and she went on to happily nurse her children for 2 years and 1 year, respectively, without any recurrence of symptoms.
I contacted the Lactation Study Center in Rochester, NY, which recommended the patient be sent home with instructions to use Benadryl 50 mg by mouth at the earliest sign of hives and that a prescription for an EpiPen® (Mylan Inc.) be given as well. The mom was extremely appreciative to have something available to use to abort this unusual reaction.
I contacted her a few days later, and she reported that she did develop hives but that she took the Benadryl immediately after seeing “just one spot.” Before long, the rash was all over her neck and arms. She did describe some “chest pressure” but taking the Benadryl early in the reaction possibly attenuated it as she never felt the need to use the EpiPen.
