Background—Heat-treated expressed breastmilk is recommended by WHO as an option to reduce vertical HIV transmission in resource poor regions. Flash-heat (FH) is a low technology pasteurization method developed for home use, but its effect on quantity and quality of breastmilk immunoglobulins is unknown. Objective—To evaluate FH's effect on breastmilk immunoglobulin levels and antigen binding capacity. Design/Methods—Fifty HIV+ mothers in South Africa provided breastmilk. Part of each sample served as an unheated (UH) control; the remainder was Flash-heated. Total and antigen-specific IgA and IgG were measured by ELISA. Paired t-test was performed on log transformed data. Results—FH significantly decreased total IgA and IgG concentrations [geometric mean (geometric sd) 318.0 (1.9) vs. 398.2 (1.9) mcg/mL and 89.1 (2.7) vs. 133.3 (2.5) mcg/mL, p<0.001 each]. Similar decreases in anti-HIV-1 gp120 IgG, anti-pneumococcal polysaccharide and anti-poliovirus IgA occurred (p<0.001 each). Although the latter was most affected, FH retained 66% of the antigen binding ability. In contrast, binding capacity of IgA and IgG to influenza increased after FH (p=0.029 and 0.025 respectively). Conclusions—Most breastmilk immunoglobulin activity survives FH, suggesting Flash-heated breastmilk is immunologically superior to breastmilk substitutes. Clinical significance of this decreased immunoglobulin activity needs evaluation in prospective trials.