Is Botulinum Toxin compatible with breastfeeding? Do we have alternatives for Botulinum Toxin?

Botulinum Toxin

November 24, 2014 (Low Risk)

Botulism is a severe disease caused by bacteria called Clostridium botulinum. The bacterium produces a paralyzing toxin which is used for treatment of muscle spasticity and other disorders.

Reportedly, a woman affected of severe Botulinum disease nursed her 8 months old son during illness. Neither bacteria nor toxin were detected in both mother’s milk and stools of the infant, who did not show symptoms of disease. Also, anti-toxin medication given to the mother did not produce side-effects on the child.

A high molecular weight along with a strong and rapid adherence to muscle plaque by toxin could explain its low excretion into breast milk.

When adequately and locally administered, serum levels of toxin should be low.

An infant born at 36 weeks of gestation, who had received intra-esophagus treatment with Botulinum toxin for achalasia during the last weeks of pregnancy, appeared healthy and did not show symptoms of hypotonia.

Mother’s milk shows neutralizing capacity against Botulinum Toxin. It has been shown that the secretory IgA is able to bind the B fraction of toxin, resulting in inhibition of toxin attachment to intestinal cells and hence impairing absorption. It would explain that severity of disease is lower among breastfed infants than bottle-fed ones, with no death cases reported and delay in appearance of symptoms among breastfed infants in cases of Infant Botulism type B.

Alternatives

We do not have alternatives for Botulinum Toxin.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Botulinum A Toxin
  • Botulinum B Toxin
  • Botulism
  • Clostridium botulinum
  • Αλλαντική τοξίνη
  • 型ボツリヌス毒素A
  • 型ボツリヌス毒素B

References

  1. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014Abstract
  2. Wataganara T, Leelakusolvong S, Sunsaneevithayakul P, Vantanasiri C. Treatment of severe achalasia during pregnancy with esophagoscopic injection of botulinum toxin A: a case report. J Perinatol. 2009Abstract Full text (link to original source) Full text (in our servers)
  3. Matsumura T, Fujinaga Y, Jin Y, Kabumoto Y, Oguma K. Human milk SIgA binds to botulinum type B 16S toxin and limits toxin adherence on T84 cells. Biochem Biophys Res Commun. 2007Abstract
  4. Mari Nevas. Clostridium Botulinum in honey production with respect to infant botulism. Academic Dissertation. Faculty of Veterinary Medicine, University of Helsinki. 2006 Full text (link to original source) Full text (in our servers)
  5. [No authors listed] Botulinum toxin. Consens Statement. 1990Abstract
  6. Arnon SS. Breast feeding and toxigenic intestinal infections: missing links in crib death? Rev Infect Dis. 1984Abstract
  7. Morris JG Jr, Snyder JD, Wilson R, Feldman RA. Infant botulism in the United States: an epidemiologic study of cases occurring outside of California. Am J Public Health. 1983Abstract Full text (link to original source) Full text (in our servers)
  8. Arnon SS, Damus K, Thompson B, Midura TF, Chin J. Protective role of human milk against sudden death from infant botulism. J Pediatr. 1982Abstract
  9. Middaugh J. Botulism and breast milk. N Engl J Med. 1978Abstract
  10. Knox JN, Brown WP, Spero L. Molecular weight of type a botulinum toxin. Infect Immun. 1970Abstract
  11. Boroff DA, Dasgupta BR, Fleck US. Homogeneity and molecular weight of toxin of Clostridium botulinum type B. J Bacteriol. 1968Abstract