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We sought to determine if clinical reactivity to food allergens via breastfeeding was associated with decreased likelihood of future tolerance. METHODS: Subjects identified from the Chicago Food Allergy Study (2005)(2006)(2007)(2008)(2009)(2010)(2011) were categorized by reactions to maternally ingested foods via breastfeeding (50/898 peanut-allergic, 69/620 egg-allergic, and 153/ 589 milk-allergic had reactions attributable to breastmilk). Data regarding reactions and allergen exposure were collected by maternal report and oral food challenge (OFC) results. The primary outcome was tolerance (passed OFC or consumption of previously implicated food). Secondary outcomes included severe reactions (anaphylaxis and/or cardiovascular/lower respiratory symptoms) and multiple food allergies. Univariate chi-square analyses assessed for association between variables, followed by logistic regression modeling. RESULTS: Of the 50 subjects with peanut-associated symptoms with breastfeeding, none gained tolerance. There were no significant associations between breastfeeding symptoms and persistent allergy for egg and milk (egg: OR 0.46, 95% CI 0.21-1.01, p50.053; milk: OR 1.13, 95% CI 0.70-1.81, p50.614). All subjects with egg-associated symptoms while breastfeeding had multiple food allergies (n569), but milk-and peanutallergic subjects were not more likely to have multiple food allergies (milk: OR 1.89, 95% CI 0.88-4.02, p50.10; peanut: OR 2.36, 95% CI 0.72-7.76, p50.16). There were no significant associations between breastfeeding symptoms and subsequent reaction severity. CONCLUSIONS: Infants with symptoms of peanut allergy during breastfeeding may be less likely to gain tolerance. Infants reactive to egg via breastmilk exposure may be more likely to have multiple food allergies. Symptomatic food allergy via breastfeeding was not associated with later severe reactions.

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