Milk Proteins and Allergy Medications

Dr. Antony Ham Pong of Ottawa has compiled some information on milk allergy and asthma/allergy medications that have trace amounts of cow's milk protein. He recommends that his patients who have cow's milk allergy not use dry powder inhalers (DPIs) with lactose because of the risk of inhaling trace amounts of milk protein causing a severe asthma attack. There are alternatives which are lactose free. “Inhaling a trace amount of milk protein is likely far more dangerous to a milk allergic asthmatic person than ingesting the same trace amount.”

With respect to milk allergy and oral meds containing lactose, the risk is far lower because the trace amounts are unlikely to cause allergic reactions except in the most severely allergic cases. Therefore, only in cases of severe milk anaphylaxis does he recommend avoiding lactose containing oral meds. However, the specific advice is up to the allergist in a specific case.

Cow's milk Allergy & Lactose - Containing Medications

• Pharmaceutical grade lactose contains trace amounts of milk protein (0.012 - 0.029% N impurities including cow's milk)
• These trace amounts can cause allergic reactions in severely milk allergic individuals if ingested or inhaled
• There are two case reports of allergic reactions to inhaled asthma meds containing lactose, one severe in a child, the other in an adult
• Advair diskus monograph now states “contraindicated in patients with IgE-mediated allergic reactions to lactose or milk”
• Cow's milk allergy usually remits by age 2-3 years, but could be lifelong

Lactose Containing Asthma/Allergy Meds

• Singulair 4 mg granules & 10 mg tabs (but not 4 & 5 mg tabs)
• Reactine, Aerius, Claritin tabs (but not liquid forms). Allegra is lactose free
• Benadryl 50 mg pink/white capsule (not caplet, chewable tabs or liquid)
• Prednisone tabs but not Pediapred

Lactose Containing Asthma Inhalers

Lactose containing dry powder inhalers	Lactose-Free DPIs
Advair diskus	Bricanyl
Flovent diskus	Pulmicort
Foradil aerolizer capsules
Oxeze turbuhaler
Spiriva capsules
Symbicort turbuhaler
Ventolin diskhaler, diskus, rotacaps

All pressurized spray asthma inhalers (MDIs) are lactose free.

Lactose Intolerance & Asthma Meds

• Lactose intolerance symptoms can occur if multiple lactose containing meds are ingested
• Lactose in DPIs is not likely an issue e.g., Advair discus contains 12.5 mg lactose but 3,000 mg are needed to provoke symptoms - the equivalent to amount found in 60 ml milk or 180 gm processed cheese

from Allergy & Asthma News, Issue 4 2006