Oct 18, 2004: What medications should be avoided in patients with peanut allergies?

Response:    Recent epidemiologic studies suggest that nearly 4% of Americans are afflicted with food allergies, a prevalence much higher than appreciated in the past. It is estimated that peanut allergies account for 28-55% of all food allergies.  In addition, the prevalence of peanut allergy was found to have doubled in American children less than 5 years of age in the past 5 years.  This increase in prevalence has been attributed to many hypotheses, which include a family history of peanut allergy, consumption of peanut products during pregnancy, or the consumption of peanut products or oils by infants.  The use of maternal breast creams containing peanut oil and the consumption of soy milk or formula by the infant may also dispose he or she to a peanut or soy allergy.  It is important to remember that none of these hypotheses have been duplicated in clinical trials.  Also, many patients who have peanut allergies have cross-sensitivity reactions to soy products and these should be used with caution also in this population.

Some medications that should be used with caution in patients with peanut allergies include:
•    Atrovent® (Ipratropium) – Contains soya lecithin in the suspending agent
•    Combivent® (Ipratropium and Albuterol) -  Contains soya lecithin in the suspending agent
•    BAL in Oil (Dimercaprol) – Contains peanut oil
•    Derma-Smoothe/FS (Fluocinolone) – Contains peanut oil
•    Oilatum Bar Soap – Contains peanut oil
•    Prometrium (Progesterone) – Contains peanut oil
•    Progesterone in Oil – Contains peanut oil
•    Polytar Soap – Contains peanut oil
•    Schamburg’s Loition for itching – Contains peanut oil
•    Coppertone Sunscreens – Certain formulations contain peanut oil
•    Kala (Lactobacillus) – Contains soy
•    Anusol Suppositories – Contain soy bean oil
•    Promod (Protein Powder) – Contain soy

Next week’s Question will address the risk of Atrovent in patients with peanut allergies.

Journal of Allergy and Clinical Immunology 2004;113(5):805-19
New England Journal of Medicine 2003;348:977-85
Drug Facts and Comparisons Online. Accessed 9/23/04.

Thanks to Shivani Patel PharmD, Pharmacy Practice Resident at Vanderbilt University Medical Center for writing this week’s “Question of the Week”.  Dr. Patel has recently completed a clinical rotation on Drug Information and Toxicology with the TPC.

As always, contact the Tennessee Poison Center at 1(800) 222-1222 if further questions.