Almost seven months into my pregnancy, one evening I found myself torn over whether to use my epinephrine auto-injector. This was a moment I’d feared.
I had eaten a familiar meal that I’d made myself – string beans and roasted potatoes, tossed with garlic and fresh mint. As a precaution, I had decided against eating in restaurants for the duration of my pregnancy to minimize my risk of anaphylaxis.
And yet, in the middle of this meal, I felt an itch creeping from my mouth to my throat. Was this my body flagging an intruder? I instinctively reached for my auto-injector until I began questioning the situation. Would epinephrine harm my unborn child? What if I jumped the gun and used my epinephrine when it wasn’t really needed? Could I do more harm than good?
My judgment clearly clouded, I needed to reset. I lay on the couch, popped in my earbuds, and followed a body scan meditation. This allowed me to calm down, think more clearly, and truly assess the level of reaction. I could feel my heart rate returning to normal after just a few minutes of calm.
My mouth and throat were itchy, yes, but that was the only system impacted. Knowing that anaphylaxis is a reaction of two or more bodily systems, I determined the situation did not merit epinephrine.
I chucked the rest of my dinner into the trash (good riddance!), and settled in to watch a feel-good movie, my auto-injectors within reach. The itching soon subsided. The following day, I scheduled a call with my allergist to discuss my food allergy treatment plan during pregnancy.
Myth 1: Worry About Epi in Pregnancy
For this article, I also had the opportunity to discuss when and whether to use epinephrine in pregnancy with leading allergist Dr. Scott Sicherer. “Anaphylaxis would be dangerous for the fetus, so making yourself better would be a good thing,” notes Sicherer, director of the Jaffe Food Allergy Institute at New York’s Icahn School of Medicine at Mount Sinai.
He says the idea that a pregnant allergic woman shouldn’t use her epinephrine auto-injector because it’s “too dangerous” is a myth to be busted. In this article for my “Food Allergic and Having a Baby” series, I’ll look at a few myths and misperceptions around birth and infancy. But as epinephrine use in pregnancy is a common concern for allergic women, let’s first dive further into that.
Sicherer says the baby you’re carrying has a better shot at good health if the expecting mom is not suffering through a life-threatening reaction. And he reminds of this important fact – in a severe reaction, epinephrine is the lifesaving medication.
The impact of epinephrine on the fetus during a reaction isn’t something that has been studied. There simply would be no way to ethically conduct such a study.
But here’s what we do know conclusively. Sicherer points out that the “wait and see” approach to using epinephrine when symptoms show it’s needed is a dangerous one. Without epinephrine, anaphylaxis can rapidly progress.
As well, many allergic women have safe and successful pregnancies. So an allergic woman who is cautious about avoiding allergens need not worry unduly about the off-chance of needing to use epinephrine in pregnancy.
Myth 2: Dairy Allergy and Breast Milk
There are other myths surrounding pregnancy and food allergies. When I was a tween, some kids at school suggested that if I ever became a mom, I’d be allergic to my own breast milk. I am allergic to milk, but had never considered the idea of my own breast milk to be dairy.
I had no idea if they were right, but this planted a seed of concern about breastfeeding. What if? I know other dairy-allergic women who’ve wondered the same.
Sicherer confirmed that the counsel I got from my own allergist was correct. Breast milk made by your body is not the same or similar to dairy from a cow or goat.
The composition of human breast milk changes from day to day and morning to night. It’s a complex nutritional source, with a remarkably individualized and variable formulation. A woman with a dairy allergy should not worry about experiencing anaphylaxis from breastfeeding. Though I’ll confess that pumping my milk often had me feeling like a dairy cow.
With my son, I did combination breastfeeding and pumping milk for about six months. Then I switched to a dairy-free formula that was safe for me to handle, albeit exorbitantly expensive.
Though I chose his formula based on what would pose least risk to me as an allergic mother, I did consider potential implications for him. How would he physically measure up against kids his age who drank cow’s milk? Would my child be nutritionally deficient because of my own dairy allergy?
We do know that kids with milk allergy are often “shorter and lighter in weight” than their peers. Yet, dietitian Marion Groetch, RDN, director of nutrition services at the Jaffe Food Allergy Clinic, says no specific nutritional risks have been identified “based on the diet of the breastfeeding parent.”
Myth 3: Your Baby and Nutrition
However in her research, University of Colorado dietitian Dr. Carina Venter, PhD, RD, has shown a mother’s diet during pregnancy could have an influence on whether an infant later develops food allergies. In a study of 1,315 women, eating a diverse, healthy pregnancy diet was associated with fewer food allergies by toddler age.
Groetch notes that once the infant is around six months of age, human milk alone no longer provides sufficient nutrition. From six months on, cow’s milk is typically introduced to baby’s diet in addition to breastfeeding or infant formula.
If an infant requires a dairy-free diet, parents can offer sources of iron, zinc, protein, choline, and iodine. Plant milks should not replace dairy milk in the first year of life. If seeking a dairy alternative, Venter recommends soy-based yogurt enriched with calcium and vitamin D. That has comparable protein and nutrition to cow’s milk yogurt.
An enriched plant-based yogurt will help toward developing a healthy gut microbiome. To prevent an iodine deficiency, baby’s diet will need sources of omega 3 fatty acids, such as certain fish.
For nutrition intake not to be compromised, there should be a diet plan where nutrition comes from healthy foods rather than a drinkable source. While cow’s milk is an accessible source of nutrition for most infants, it is not the only way to adequately nourish them.
Venter also stresses that the child of a milk-allergic mother need not be dairy-free. Rather they should have cow’s milk in their diet after six months of age. If you’re not comfortable with, your partner or a grandparent could help with feeding.
Myth busted? Venter says there is truth to the idea that a child could be nutritionally compromised without care going into nutrient considerations for a dairy-free, plant-based diet.
Myth 4: Pregnancy as an Allergy ‘Cure’
Finally, let’s get to the jaw-dropping myth on my list. The idea that “pregnancy will cure your food allergies.” You’ve probably heard this one, too. Even typing it out makes my ovaries cringe.
As though embarking on the journey of pregnancy and motherhood were not enough of a mental and physical transformation!
Some women are told by friends or relatives without allergies that they should “just get pregnant,” so their body can right itself. There’s a pervasive, mystical idea that pregnancy solves all, and I am here to bust this unfounded theory.
Anecdotally, neither I nor all the allergic mothers I know have been “cured” by pregnancy. Further, there is no scientific backing to the curative claim.
According to a 2022 study, pregnancy impacts your TH2 and TH1 cells, which are responsible for setting off inflammation in atopic conditions. The study and other research suggest this is why many women experience increased urticaria and eczema while carrying a child.
Let’s Not Burden Allergic Moms-to-Be
If pregnancy were a cure for food allergies, then why are there allergic moms? If curing my food allergies were a matter of childbirth, I’d be living on a farm with five children by now, milking my own dairy cow.
There are enough factors to consider when pregnant, without expecting moms-to-be to outgrow a serious condition while they’re at it.
Pregnancy and new motherhood are substantial shifts for any woman. Myths and misperceptions about food allergies do nothing to help us navigate this journey. So let’s not burden food-allergic moms with notions that their pregnancy or their care for their newborn will be compromised. Or the false hope that in creating new life they will also be cured.
Instead, let’s focus on credible information, healthy diets and actionable steps. Speaking as a mom with multiple food allergies, I can attest that’s far more helpful to making this journey as smooth as possible.
Check out the rest of my series for Allergic Living for more eye-opening information about pregnancy and motherhood as an allergic parent.
The ‘Food Allergic & Having a Baby’ Series
• Women with Food Allergies: Why Many are Afraid to Get Pregnant
• Allergic and Giving Birth: My Hospital Food Plan Goes Awry
• Allergic Women: Why to Embrace the Messy Bits of Birthing
• This article: Busting Myths on Food Allergy, Pregnancy and the Newborn
• Coming June 17: Safely Introducing Your Allergens to Your Baby
Amanda Orlando is a cookbook author, food allergy advocate at EverydayAllergenFree, and founder of the non-profit organization Free To Be Me Society.
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