Xolair and breastfeeding

[Kiely]

I am 32 weeks pregnant, and was just informed yesterday by my injection nurse that I may not be able to breastfeed because I have been on Xolair for over a year. My allergist was hesitant to continue injections during pregnancy because he had never had a pregnant patient on Xolair before, but felt that the benefits outweighed the risks after speaking with some colleagues. However, he did not consult with them on the topic of breastfeeding. I know the data is limited, but what are your breastfeeding recommendations for someone currently on Xolair?

I found this on another site: Summary of Use during Lactation
No information is available on the clinical use of omalizumab during breastfeeding. Because omalizumab is a large protein molecule with a molecular weight of 145,058, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, omalizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.

Thank you in advance for any information you can provide. Not being able to breastfeed would be very upsetting; I hope you are able to give me some clarity on the risks.

[admin-james]

I agree with the passage you quoted. No data are available, and there are many unknowns, but theory suggests this is a safe drug to use. The BENEFITS of breastfeeding are well established and are likely to exceed the risks from this drug. The most likely side effect in breastfeeding infants is an increase in gut and respiratory infections, although this has not been reported so far. Here is what we had to say about the drug class that includes omalizumab:

http://mommymeds.com/frequently-asked-questions/monoclonal-antibodies

-James Abbey, MD

[Kiely]

Excellent

Thank you so very much. I would love to receive updates on this thread as more information becomes available.

[Kaisonsmommy]

Is there any new data on xolair and breastfeeding? My son is 2 and still breastfeeding and my Dr wants me to start injections soon.

[Sandra]

Kaisonsmommy,

There is no new data on Xolair. It is still an L3- no data-probably compatible. The molecular weight of this medication is very large, 149,000 daltons, so entry into breast milk should be minimal. We think the risk is low, but there are no studies available. Each mother needs to understand the risks of using this type of medication and the benefits of nursing. Monitor for frequent infections, fever, vomiting, poor feedings and poor weight gain.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519