Drug or food anaphylaxis?

Area of Science:

• Allergy and Immunology
• Pediatric Medicine
• Pharmacology

Background:

• Atopic dermatitis is common in infants.
• Early introduction of foods and medications requires careful monitoring for allergies.
• Suspected food and drug allergies necessitate thorough evaluation.

Observation:

• A 9-month-old infant with atopic dermatitis had an allergic reaction after the first dose of Ferplex® (iron protein succinylate) for anemia.
• The infant was breastfed and had only consumed fruits and vegetables.
• The reaction required emergency medical attention and epinephrine treatment.

Findings:

• Skin prick tests and specific IgE confirmed sensitization to cow's milk and egg proteins.
• The infant reacted to Ferplex® due to its casein content (a cow's milk protein), despite no prior ingestion.
• The presence of succinylated casein was confirmed, but amounts were not disclosed.

Implications:

• Pharmaceutical regulations should mandate declaration of food allergens in active ingredients and excipients.
• Improved documentation of food history in infants is crucial for preventing allergic reactions.
• This case highlights the risk of hidden allergens in medications for vulnerable pediatric populations.