Summary of Use during Lactation

Peanuts (Arachis hypogaea) contain carbohydrate, fat, and protein. Some of the proteins in peanuts are considered to be allergens that can lead to allergic reactions. Cooked, unripe peanuts are reportedly used in Africa and Asia as a galactogogue;[1] however, no scientifically valid clinical trials support this use. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[2,3]

Peanut protein allergens have been detected in breastmilk and some case reports and series have implicated maternal ingestion of peanuts during breastfeeding to peanut allergy in their breastfed infants.[4-7] Studies to determine whether maternal peanut ingestion during breastfeeding causes infant peanut allergy have come to conflicting conclusions. In the United States and United Kingdom, mothers were advised to avoid peanuts during pregnancy and breastfeeding in the late 1990s, but these recommendations have been withdrawn because of a lack of evidence of a reduction in peanut allergy.[8,9]

Drug Levels

Maternal Levels. Twenty-three nursing mothers consumed 50 grams of dry roasted peanuts after donating a baseline milk sample. Milk samples were then collected at various times over the next 12 hours. The peanut proteins Ara h 1 and Ara h 2 were detected in the breastmilk of 11 of the 23 women, with a mean peak concentration of 222 mcg/L. In most of the women with detectable peanut protein, the peak concentration occurred in the first 2 hours and was near baseline at 3 hours post ingestion, but one woman had a peak protein level 6 hours after ingestion; she and another woman still had detectable peanut protein in their milk 8 hours after peanut ingestion. No difference between the mothers who did and did not secrete peanut allergen in their milk was found in age, time postpartum or atopic history.[10]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

In a study on the infants of atopic parents, mothers were randomized either to standard infant feeding practices (n = 185) or to avoidance of peanuts and other food allergens during the third trimester of pregnancy and breastfeeding (n = 103). Testing at 12 months of age found a slightly reduced frequency of positive skin tests for peanut allergy in the avoidance group (n = 4) compared to the control group (n = 7), and no difference between the groups in the frequency of clinical allergy to peanuts.[11]

In a case-control study, mothers of infants with peanut allergy (n = 202) or control infants (n = 201) were given a questionnaire to determine the extent of peanut ingestion during pregnancy and breastfeeding. No differences were noted in infant age, sex ratio, breastfeeding and several other variables. The mothers of peanut-allergic infants were 2.3 times more likely to have consumed peanuts during breastfeeding than mothers of the control infants, although peanut ingestion during pregnancy was a stronger predictor of peanut allergy.[12]

In a cohort study, 503 infants with food allergies, but no reported peanut allergy, were tested for peanut allergy based on IgE antibody levels against peanuts. Although a correlation was found between maternal ingestion of peanuts during pregnancy and later infant peanut allergy, no correlation was found with maternal ingestion during breastfeeding.[13]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1.

Scott CR, Jacobson H. A selection of international nutritional and herbal remedies for breastfeeding concerns. Midwifery Today Int Midwife. 2005;75:38–9. [PubMed: 16320878]

2.

Brodribb W. ABM Clinical Protocol #9. Use of galactogogues in initiating or augmenting maternal milk production, second revision 2018. Breastfeed Med. 2018;13:307–14. [PubMed: 29902083]

3.

Breastfeeding challenges: ACOG Committee Opinion, Number 820. Obstet Gynecol. 2021;137:e42–e53. [PubMed: 33481531]

4.

van Asperen PP, Kemp AS, Mellis CM. Immediate food hypersensitivity reactions on the first known exposure to the food. Arch Dis Child. 1983;58:253–6. [PMC free article: PMC1627943] [PubMed: 6847227]

5.

Gerrard JW, Perelmutter L. IgE-mediated allergy to peanut, cow's milk and egg in children with special reference to maternal diet. Ann Allergy. 1986;56:351–4. [PubMed: 3754399]

6.

Des Roches, A, Paradis L, Singer S, et al. An allergic reaction to peanut in an exclusively breastfed infant. Allergy 2005;60:266-7. Letter. PMID: 15647057. [PubMed: 15647057]

7.

Martin-Muñoz M, Pineda F, Bobolea I, et al. Hidden allergens in breast milk. Allergy 2009;64 (Suppl. 90):479. Abstract. 1253. doi: 10.1111/j.1398-9995.2009.02076.x. [CrossRef]

8.

Kmietowicz Z. Advice to pregnant women to avoid eating peanuts should be withdrawn, says Lords committee. BMJ. 2007;335:633. [PMC free article: PMC1995519] [PubMed: 17901489]

9.

Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121:183–91. [PubMed: 18166574]

10.

Vadas P, Wai Y, Burks W, et al. Detection of peanut allergens in breast milk of lactating women. JAMA. 2001;285:1746–8. [PubMed: 11277829]

11.

Zeiger RS, Heller S, Mellon MH, et al. Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy: A randomized study. J Allergy Clin Immunol. 1989;84:72–89. [PubMed: 2754147]

12.

DesRoches A, Infante-Rivard C, Paradis L, et al. Peanut allergy: Is maternal transmission of antigens during pregnancy and breastfeeding a risk factor? J Investig Allergol Clin Immunol. 2010;20:289–94. [PubMed: 20815306]

13.

Sicherer SH, Wood RA, Stablein D, et al. Maternal consumption of peanut during pregnancy is associated with peanut sensitization in atopic infants. J Allergy Clin Immunol. 2010;126:1191–7. [PMC free article: PMC3018157] [PubMed: 21035177]

Substance Name

Peanut

Scientific Name

Arachis hypogaea

Drug Class

Breast Feeding

Lactation

Complementary Therapies

Food

Galactogogues

Phytotherapy

Plants, Medicinal