Allergens in Your Medicine
4 steps to make your prescriptions safer
Medications are supposed to heal, not hurt—but they have the potential to be dangerous when they contain hidden food allergens.
While the top eight allergens must be clearly labeled on food products, they don’t have to be specified on prescription or over-the-counter (OTC) medications if they’re in an inactive ingredient. And it’s often a frustrating exercise to track down the specific content of inactive ingredients.
1. Read All Labels Florida resident Libby Ilson found out about inadequately labeled medication the hard way. Ilson’s son, who is allergic to peanuts, shellfish, eggs, milk, beef, lamb, black beans, garlic and cumin, had been experiencing mysterious symptoms. Stumped as to the cause, she rechecked the labels on his medications. That’s when she realized the pharmacy had given her information about a brand name medication, not the generic medicine her son was taking.
“When I found out the lists of ingredients were for completely different medications, I felt physically ill,” says Ilson, author of the blog, The Allergic Kid. “Just like every other parent with a food-allergic child, I read labels obsessively. Discovering that I was given the wrong label by a medical professional felt like a betrayal of my trust.”
After more digging, she found that this is a common practice. Pharmacies often provide information for the brand name medication, even when the medication dispensed is generic.
Brand name and generic medications can vary in color, shape, markings and inactive ingredients, such as preservatives, sweeteners, dyes, fillers and flavor additives, says Tiffany Davis, PharmD, a pharmacist in Huntington, West Virginia, and author of the blog, Food Allergies and the Pharmacy. Generic manufacturers of the same prescription can use different inactive ingredients.
2. Track Down Ingredients Pharmacists and prescribing doctors often don’t focus on potential food allergens in medications, leaving it up to their patients to do the legwork.
Scouring labels to determine the ingredients in prescription and OTC medications is not a clear-cut task. Drug manufacturers produce medications with ever-changing formulas. And it can be difficult for patients to track down and keep track of ingredients.
“Patients have a huge stumbling block when they’re faced with a decision about taking medication to treat an illness and risking getting sick from unidentified ingredients,” says Alice Bast, president of the National Foundation for Celiac Awareness (NFCA). It can be challenging to ferret out exactly what’s in a drug.
Under the Federal Food, Drug, and Cosmetic Act (FFDCA), OTC medications must list inactive ingredients on the container, and prescription drugs must include a description of the medication, which includes inactive ingredients, in the package insert. But although inactive ingredients must be disclosed, the source of the ingredients and the potential allergens in them do not need to be clearly named. Common food allergens (like peanuts, milk, eggs, soy, gelatin and fish) can hide in a medication’s excipients, which are inactive or filler ingredients used to provide shape or bulk and sometimes to aid in absorption. These allergens don’t have to be specifically identified. For example, “starch” can be corn, potato, tapioca or wheat starch.
Milk-based ingredients are sometimes in inhaled medications. Soybean oil can be in gel cap. Soy lecithin can be in OTC vitamins. Gelatin is often used as a coating agent or thickener in medications and vaccines.
An analysis published in June 2014 in the Journal of Allergy and Clinical Immunology lists medications and vaccines that could contain food-derived excipients. Created by John Kelso, MD, of the division of Allergy, Asthma and Immunology at the Scripps Clinic in San Diego, the report includes a discussion about whether these medications are safe for food-allergic patients. It states, for example, that several probiotics contain milk and some have egg protein. Certain tablets and capsules contain lactose (a milk sugar). Peanut oil is listed as an ingredient in progesterone capsules. While the report provides a useful resource for patients and doctors alike, Kelso says it should not be viewed as a comprehensive list of medications to avoid.
So how do you determine if your medication is safe? Caution is essential, as is working closely with your healthcare professionals.
“People with food allergies should be aware of the potential for some medications to contain allergens. They should always discuss their allergy or sensitivity with their doctor to confirm whether they can use a certain medication or find an alternative,” says Michael Spigler, vice president of education at Food Allergy Research & Education.
Physicians, however, don’t usually have time to research the potential allergens in medications and to advise which drugs are safe. Patients may need to research that information on their own or with help from their pharmacist and relay it to their prescribing doctor. Then their doctor can write a prescription for the specific brand that’s safe and note that it cannot be substituted.
3. Check With Your Pharmacist
Communication is vital. In addition to working closely with your doctor, develop a relationship with your pharmacist.
“The pharmacist deals specifically with the medication and is the best person for screening it and adjusting as needed,” says Davis, adding that people should ask their pharmacist for package inserts—and read them carefully every time. The inserts list the inactive ingredients, a place to start digging. (Note that inactive ingredients can change without warning, even in trusted brands.)
Certain free websites can help you and your pharmacist track down the details. DailyMed allows you to access manufacturers to see full prescribing information. Orange Book helps determine if two products are therapeutically equivalent. GlutenFreeDrugs.com, a website maintained by pharmacist Steve Plogsted of Nationwide Children’s Hospital in Columbus, Ohio, identifies which drugs should be safe for those avoiding gluten.
4. Advocate for Better Labeling “It’s important that consumers advocate for themselves,” says NFCA’s Bast.
Frustrated that she’d received the wrong information about her son’s medication, Libby Ilson took action. She drafted a petition to the White House that would require the clear labeling of food allergens in medications. The petition didn’t garner enough signatures but Ilson isn’t discouraged. She hopes to coordinate with food allergy advocates and try again.
“Legislation and regulation can provide the path for ensuring that consumers have the information they need to make healthy choices,” says NFCA’s Bast.
Pharmacist Davis has a legislative wish list: A detailed list of inactive ingredients should be required on the handouts that accompany every prescription, not just the package inserts. Inactive ingredients of all drugs should be included in all pharmacy databases. And all products that contain any of the top eight allergens, as well as corn and gelatin, should be flagged on those databases so they’re easily spotted.
Efforts are underway in the U.S. Congress to make it easier to identify gluten in drug products. The 2013 Gluten in Medicine Disclosure Act would require the clear identification of any grain or starch in medication. Bast encourages people to contact their representatives in support.
“People deserve to know what’s included in the consumable products they purchase, including their medications,” she says.