Robles Janie, Motheral Lesley
Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, Texas.
Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
J Pediatr Pharmacol Ther. 2014 Jul;19(3):206-11. doi: 10.5863/1551-6776-19.3.206.
Milk protein allergy-induced reactions from lactose-containing dry powder inhalers (DPIs) have not been widely described in the literature. Lactose is a common inactive ingredient in many pharmaceutical products that is used to enhance the stability of active substances in medicinal products, including asthma medications. Contamination of lactose with milk proteins has been identified in reports of inhaled corticosteroid product lot testing. Serious respiratory sequelae may follow after the inhalation of a DPI corticosteroid in a patient with milk protein allergy because DPIs that contain lactose may be contaminated with milk proteins. Lactose-containing DPIs are contraindicated in patients with milk protein allergy. Although manufacturers identify this contraindication in product package inserts, some drug references may not include this information and health care professionals may lack awareness. Clinicians should consider reviewing multiple medication resources for warnings and contraindications of medications to prevent complications. We describe a refractory asthma exacerbation secondary to a hypersensitivity reaction following administration of a lactose-containing DPI corticosteroid and long-acting β2 agonist combination in a child with a milk protein allergy.
含乳糖的干粉吸入器（DPI）引发的牛奶蛋白过敏反应在文献中尚未得到广泛描述。乳糖是许多药品中常见的惰性成分，用于提高药品（包括哮喘药物）中活性物质的稳定性。在吸入性皮质类固醇产品批次检测报告中已发现乳糖被牛奶蛋白污染。对于牛奶蛋白过敏的患者，吸入含乳糖的DPI皮质类固醇后可能会出现严重的呼吸道后遗症，因为含乳糖的DPI可能被牛奶蛋白污染。牛奶蛋白过敏患者禁用含乳糖的DPI。尽管制造商在产品包装说明书中注明了这一禁忌，但一些药物参考资料可能未包含此信息，医护人员也可能缺乏认识。临床医生应考虑查阅多种药物资源，以了解药物的警告和禁忌，防止并发症的发生。我们描述了一名牛奶蛋白过敏儿童在使用含乳糖的DPI皮质类固醇和长效β2激动剂组合后，因过敏反应继发难治性哮喘加重的病例。
