A CASE OF RECURRENT HIVES WITH LACTATION

Abstract

<h3>Introduction</h3> Development of hives due to lactation is a rare phenomenon seen in the postpartum period. Lactation is influenced by oxytocin and prolactin release, which stimulates lactogenesis, and initiates milk secretion. We describe a rare case of postpartum hives that improved with the use of bromocriptine. <h3>Case</h3> A 33-year-old female presented to clinic with recurrent hives postpartum. Three years prior to presentation she delivered her first child via scheduled cesarean section. After four days of colostrum feeding, she began breastfeeding, but developed diffuse hives within 20 minutes. Although initially resolving with diphenyhradmine, she had recurrent flare of hives every 2-3 hours, resulting in two hospitalizations and intravenous diphenhydramine for persistent hives. Her hives disappeared on postpartum day nine. She delivered her second child via caesarean section. She developed severe, diffuse hives on the fourth day of hospitalization at the time of lactogenesis, refractory to intravenous diphenhydramine, H2-antagonists and methylprednisolone. She was started on bromocriptine with improvement in her hives within hours of administration. <h3>Discussion</h3> Hives with breastfeeding represents a unique phenomenon that can be debilitating postpartum. There are few case reports detailing lactation anaphylaxis, an IgE-independent reaction related to a prolactin surge at time of let-down. Similarly, our patient presents with two recurrent episodes of hives at the time of lactation initiation. This theory is supported by her rapid improvement with administration of bromocriptine, a dopamine antagonist that suppresses prolactin secretion. Early recognition of prolactin-induced hives could allow for intervention prior to delivery with antihistamines, glucocorticoids, and bromocriptine to provide future guidance with subsequent deliveries.