Food Allergies and Medications

Medicines that contain food proteins, such as soy, eggs, milk, or components of shellfish, can potentially trigger allergic reactions.

Food allergies are becoming more common, with approximately 8% of children suffering from at least one food allergy. It can be difficult for people to avoid their food allergen(s), and accidental exposure resulting in allergic reactions can occur.

The U.S. Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA) requires that food labeling includes the eight most common food allergens present in packaged foods, including egg, milk, soy, wheat, peanut, tree nut, fish, and shellfish. While this legislation is helpful for identifying these allergens in foods, FALCPA does not cover prescription and over-the-counter medications.

So people with food allergies who are used to reading labels on foods to identify food allergens may erroneously assume certain medications are safe for them—but medications could contain potential food allergens, even if they aren't indicated on the label.

Pharmaceutical products contain excipients, which are inactive ingredients required for the manufacturing process and to help with the stability and function of medications. Many excipients are food products that could potentially cause allergic reactions in people who are allergic to that specific food product.

As a result, many people with food allergies commonly avoid certain medications to reduce the chances of an allergic reaction due to a hidden food allergen. The following is a list of common food allergens and related medications containing relevant excipients.

Egg

Some medications use egg lecithin as an excipient, which contains some egg protein. However, allergic reactions to egg lecithin are rare in people with egg allergies.

Intravenous (IV) lipid emulsions contain egg and soy lecithin, and allergic reactions are more likely caused by the soy component than the egg protein.

Propofol is an anesthetic used during surgery and is well known to cause allergic reactions. While propofol contains soy and egg protein, most people who have an egg allergy can safely receive the medication. Skin testing can be performed for people who have experienced an allergic reaction as a result of taking this medication.

Fish

Protamine is obtained from salmon testes, and it is used as an ingredient in some forms of insulin and to reverse the anticoagulant effects of heparin. People with a fish allergy can receive medications containing protamine; however there is higher risk of allergic reaction than those who do not have a fish allergy.

Fish oil is used to provide high levels of omega-3 fatty acids because some people believe it may help prevent heart disease.Because fish oil is refined, it does not contain fish protein. Those with a fish allergy should consult their doctor or allergist prior to consuming any fish oil supplements.

Gelatin

Gelatin is obtained from the connective tissue of cows and pigs, and it contains proteins from these animals.

Allergic reactions to gelatin are common, especially in injected medications and vaccines. Pills and capsules containing gelatin rarely cause allergic reactions in people with gelatin allergy.

Suppositories containing gelatin capsules have been known to cause allergic reactions in people with gelatin allergy, and rrythropoietin infusions containing gelatin can cause allergic reactions in people with gelatin allergy.

Gelfoam sponges, used to stop bleeding during surgery, contain gelatin and have been linked to allergic reactions in people with gelatin allergy.

Some people with alpha-gal syndrome—also called alpha gal allergy or red meat allergy—may also be sensitive to alpha-gal found in gelatin in vaccines or medications. Talk to your doctor before taking new medications or vaccines if you have alpha-gal allergy.

Milk

Some people people with milk allergies do have allergic reactions as a result of taking medications containing small amounts of milk protein. In general, these medications can be safely taken by people with a milk allergy. These medications include casein-based probiotics, lactose-containing asthma inhalers (such as Advair Diskus, Flovent Diskus, Pulmicort Flexhaler and Asmanex), and lactose found in methylprednisolone injections (a corticosteroid).

Other forms of pharmaceutical grade lactose and related molecules are rarely contaminated with milk protein, but if they contain milk protein, they have the potential to cause allergic reactions in people with a milk allergy.

Pine Nut

Pine nuts are a product of pine trees, which are the source of rosin, also known as colophony. Rosin is used as a tooth varnish, and there are not reports that it causes allergic reactions in people with a pine nut allergy.

Rosin/colophony is known to cause contact dermatitis in certain people, but this reaction would not necessarily occur in people who are allergic to pine nuts.

Sesame Seed

Many medications contain sesame oil, although medication-grade sesame oil usually doesn’t contain sesame protein, unlike food-grade sesame oil, which does.This means that medications that contain sesame oil, such as progesterone for injection, should usually be safe for people with sesame allergy.

Shellfish

Glucosamine, which has been reported in a small number of people to cause allergic reactions, is obtained from the shells of shellfish.

The protein that usually causes shellfish allergy is not present in high amounts in the shell, and glucosamine derived from the shell is not thought to elicit reactions in persons allergic to only the protein contained inside shellfish.

Iodine, which is present in shellfish and intravenous dye (IV dye), has no relationship to allergic reactions caused by eating shellfish.

Soy

The degree of allergic reaction risk for soy lecithin-containing medications is uncertain. Soy lecithin is found in some inhalers, mainly those used to treat COPD, such as Combivent and Atrovent. There have been reports of people with a history of soy allergy using these inhalers and experiencing worsening breathing symptoms.

Soy oil is contained in intravenous lipid emulsions found in total parenteral nutrition (TPN), a source of nutrition used for critically ill patients who cannot eat. While allergic reactions have occurred with TPN, it has not been proven that this was as a result of soy allergy.

Amphotericin C is an IV medication used to treat fungal infections in critically ill patients. Soy phosphatidylcholine makes up the fatty component of the medication, which allows it to enter and kill the fungus. Allergic reactions to amphotericin B have been described, although these have never been blamed on soy allergy.