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Allergic reactions to cow's milk proteins in medications in childhood
Angelica Santoro1, Laura Andreozzi, Giampaolo Ricci
1Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Azienda Ospedaliero-Universitaria, Università di Parma, Italy. carlo.caffarelli@unipr.it.
Insights
Children with cow's milk allergy may react to medications containing milk proteins. Caution is advised when administering pharmaceuticals with milk allergens, especially via inhalation, injection, or oral routes.
Area of Science:
- Pediatric Allergy
- Pharmacology
- Immunology
Background:
- Cow's milk is a common childhood allergen.
- Cow's milk proteins can be inadvertently included in pharmaceutical formulations as excipients.
Purpose of the Study:
- To review the pediatric literature regarding allergic reactions to cow's milk proteins in medications.
- To analyze reactions based on different routes of administration: inhaled, parenteral, and oral.
Main Methods:
- Literature review of pediatric studies.
- Focus on case reports and documented allergic reactions.
- Analysis of pharmaceutical excipients and potential milk protein contamination.
Main Results:
- Lactose, used in dry-powder inhalers, can be contaminated with milk proteins, triggering reactions in allergic children.
- Parenteral medications (e.g., methylprednisolone, vaccines) containing lactose have been linked to hypersensitivity and anaphylaxis.
- Oral medications like polio vaccine, probiotics, and lactulose syrup may also contain detectable cow's milk proteins.
Conclusions:
- Pharmaceuticals containing milk allergens pose a risk to children with cow's milk allergy.
- Careful consideration of medication composition is crucial for this patient population.
- Administration routes (inhaled, parenteral, oral) influence potential exposure and reaction severity.
Introduction:
Cow's milk is a frequent trigger of allergic reactions in childhood. Cow's milk proteins can be present in pharmaceutical excipients.
Methods:
We have analyzed paediatric literature on allergic reactions to cow's milk proteins in medication, focusing on the different routes of administration (inhaled, parental and oral).
Results:
Dry-powder inhalers may contain lactose as excipient. Lactose can be rarely contaminated with milk proteins and it may induce allergic reactions in patients with cow's milk allergy. Case reports have described immediate hypersensitivity reactions to methylprednisolone sodium succinate 40 mg injection, a formulation that contains lactose as excipient. Some cases of anaphylaxis after receiving diphteria-tetanus-pertussis vaccine injection in children allergic to milk have been reported. Cow's milk proteins can be detected also in oral polio vaccine, certain probiotics and lactulose syrup.
Conclusions:
We suggest caution in administration of pharmaceuticals containing milk allergens in children allergic to milk.