Pistachio and Breastfeeding

Summary of use during lactation

This record has information on Pistacia vera, which is the common edible pistachio nut, as well as Pistacia atlantica. Maternal pistachio nut consumption can cause allergies in their breastfed infants and pistachio allergy is cross-reactive with cashews. Although not widely described as a galactogogue, one woman consumed 2 to 3 cups daily of a tea made from the buds of the Pistacia vera tree for 3 to 4 weeks as a galactogogue and developed liver toxicity, possibly from the tea.[1] Pistacia atlantica ointment appeared to be more effective than expressed breastmilk in treating nipple pain and fissures.

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

A study of 912 infants in Türkiye with food allergy were evaluated before 24 months of age. During the first 6 months of life, 83.7% were exclusively breastfed, 15.8% were mixed-fed with formula, and 0.5% were exclusively formula-fed. Overall, 13.2% of the infants with food allergies were allergic to pistachio. Out of 61 exclusively breastfed infants with food allergies, 1 had an allergy to pistachio in the first 3 months of life and 3 had allergy to pistachio during the period of 4 to 6 months of age.[2] A 22-month-old girl developed facial hives on twice during breastfeeding that resolved spontaneously within 2 hours. These events were two months apart and she tolerated breastfeeding between the events. On both occasions the mother had eaten a large quantity of pistachios an hour earlier. The mother then ingested 100 grams of pistachio nuts 12, 5 and 1 hour prior to collecting 150 mL of breastmilk and a 10 mL aliquot of this was fed to the child. The patient developed facial and neck erythema and wheals, which subsided spontaneously after 20 minutes. Skin prick tests with commercial antigens were positive for pistachio, cashew and walnut, but negative with the mother’s milk collected after pistachio ingestion. After instructing the mother to follow a pistachio- and cashew-free diet, the patient had no further reactions with breast milk feedings.[3]

Effects on lactation and breastmilk

Pistacia atlantica in an ointment was studied for nipple fissure and pain in lactating women. The ointment consisted of 7 grams of beeswax, 10 grams of ghee and 7 grams of Saqez (oleoresin made from scratching the trunks of Pistacia atlantica trees). Either the ointment or expressed breastmilk was applied 3 times daily to the nipple fissure and areola. Pain and serious nipple fissures were less severe in the treatment group than in the control group who applied expressed breastmilk to their fissures.[4,5]

References

1. Altınsoy KE, Oktay MM. Acute hepatitis associated with intake of Pistacia vera L. bud tea; A case report. Arch Acad Emerg Med 2023;11:e35.37215235 PubMed
2. Kahveci M, Koken G, Şahiner ÜM, et al. Immunoglobulin E-mediated food allergies differ in east Mediterranean children aged 0-2 years. Int Arch Allergy Immunol 2020;181:365-74.32097952 PubMed
3. Villalobos V, Betancor D, Pastor-Vargas C, et al. Pistachio allergens: The long journey between mother and daughter. J Investig Allergol Clin Immunol 2023;33:64-5.35332872 PubMed
4. As'adi N, Kariman N, Mojab F, et al. The effect of Saqez (Pistacia atlantica) ointment on nipple fissure improvement in breastfeeding women during one-month follow-up. Avicenna J Phytomed 2017;7:477-85.29299430 PubMed
5. As'adi N, Kariman N, Mojab F, et al. The effect of Saqez (Pistacia atlantica) ointment on the treatment of nipple fissure and nipple pain in breastfeeding women. Electron Physician 2017;9:4952-60.28979728 PubMed