Concerns for Food Allergies when Prescribing Medications
Food allergies seem like they are becoming more prevalent, either that or I was in the right field to see them day-after-day. I used to be in pediatrics, and almost every day I would see at least one child with a food or a drug allergy. Most days it’s something that I took into account as I treated and prescribed the appropriate mediation for that child, but there were a handful of patients where extra precautions had to be taken due to significant allergies.
One of my patients had a severe gluten allergy along with other things like corn, soy, and nuts to name a few. He also had multiple drug allergies including cephalosporins, amoxicillin, and sulfa drugs. I use Epocrates daily to double check medication allergies and interactions, but there isn’t anything that is quick to check for the inactive ingredients in each medication to verify the safety for food allergy sufferers. One of the problems is that you never know which manufacturer or factory was used for the specific brand of medication that the particular pharmacy uses that the patient gets their medication from. Thus, the need for consultation between provider and pharmacist and patient and pharmacist as well. These inactive ingredients can be a large issue if you have a patient who is allergic or sensitive to those inactive ingredients.
I learned to encourage my patients to use more of the family pharmacies in our area because they tended to be more willing to take the time to research the medications prescribed with me. Although this may differ depending upon the area you treat in and how your pharmacists are in your region. Many times it takes additional calls to the manufacturer to find out specifics, which ultimately delays treatment for the patient. At this time prescriptions and over the counter medications are not required to list food allergies on their labeling, unlike manufactured food, although there has been legislation proposed to mandate this.
Gluten, for example, won’t always show up in the inactive ingredient list as “gluten.” Precautions should be taken if inactive ingredients are listed as wheat, caramel coloring, dextrates, starches, and dextrin. While some of these may have their sources listed, most will not and would require a call to the manufacturer to further assess the source of the ingredient and how the product is manufactured, whether on shared lines as other gluten containing products or made in same facility as gluten products.
This process doesn’t have to be done for everyone with a gluten allergy because each patient has their own tolerance; but in patients who become symptomatic with the smallest of amounts of gluten, it is a precaution that should be taken by providers. This is a time when the provider, pharmacist, and patient must work together to find the best medication. In some cases it isn’t possible to prescribe a medication that won’t exacerbate an allergy. In that situation the risks and benefits must be discussed with the patient and documented in the chart. In cases, where there are alternatives, we (as providers) should do as much as we can to give the best care.
I also want to mention concern for a few other common allergies. Patients with a corn allergy must be aware of additional flavorings because many of the flavorings use corn syrup to sweeten them. Peanut and nut allergy patients must also proceed with caution because some medications use peanut oil in them, including topical medications; and while some people don’t react to peanut oil due to the refinery process, there are others that do. Shellfish is another allergy to consider, although less so with prescriptions than with supplements.
I had never fully known the need to consider food allergies in order to prescribe medications prior to getting into practice. I had always had it drilled into me to double check medication allergies and any interactions between prescriptions, but until getting into pediatrics I was oblivious to this additional need. Fortunately, it is a practice I continue to utilize as I see patients each day and is one that I hope other providers consider as well when prescribing and treating.
I have also encouraged each of my patients to develop a relationship with their pharmacist because this is the person who will be double checking and verifying this medication prior to the patient taking it. They will actually know more than the providers because they have the medication information and inserts from the specific medications as well as the contact information for each manufacturer. Pharmacists are my last line, my last double check that a medication is safe for a patient to take and they are the last safety check before a patient takes the medication home. I have also found that many patients don’t alert their pharmacies to food allergies, so I always encourage patients to share this information with their pharmacist. In some cases I actually write the allergy on the prescription to alert the pharmacist so that they can put alerts in their system. With food allergies becoming more prevalent, it is important to remain vigilant and utilize all of the resources we have as providers.