It Has What?!? Milk Protein in Asthma and Allergy Medications

I learned something new this month and it scared me.

I have always heard reminders about the importance of checking labels for not just food but everything: soaps, bird feed, fertilizer, chalk, drugs.  And I thought I had always been good about reading through labels.  However, while checking my Facebook feed, I scanned over a status update from Allergic Living that highlighted its feature on milk protein in asthma medication.  I stopped.  I reread the sentence.  Uh oh.  I've never questioned whether my own asthma management medication could be a source of danger for my kids!!

In our emergency med pack, I was toting Auvi-Q epinephrine injectors for my kids and an inhaler
for me.  Little did I know my inhaler contained milk protein that could put my kids' lives at risk.

After reading through the whole article and scouring through more information online, I discovered that Advair and Ventolin do in fact contain milk protein in the form of lactose dry milk powder.  In addition to these two products, milk derivatives are also present in popular allergy and asthma relief drugs such as Singulair, Flovent, Claritin tablets, and Prednisone -- yes, Prednisone, the drug that is often given to prevent a biphasic reaction after anaphylaxis.  Seriously, how did I not know this??  How did I miss this all these years?

Here's how:  While 2004's Food Allergen Labeling and Consumer Protection Act (FALCPA) made it mandatory for all food products to be properly labeled to identify the presence of the top 8 food allergens, the same rules do not pertain to non-food products.  Prescription drugs, over-the-counter drugs, health and beauty products, and pet supplies (including pet food) are just several of "non-food products" that fall outside of the FDA's regulatory net.  (For a more in-depth look at what the act affects, check out Kid with Food Allergies summary on FALCPA.)

So drug manufacturers are not required to label food allergens on their packaging.  The FDA does require medications to be accompanied by patient package inserts.  These inserts are written in microscopic font on a one-page, single-spaced, double-sided document that is notoriously lengthy and technical.  This information is nearly impossible to get through without a medical degree and magnifying glass, even if you are looking for your kids' allergen buzz words with eagle eyes.  What's more, patient package inserts do not have to list ingredients or food allergens.  The inserts include sections on how the drug works, indications, contraindications, warnings and side effects, and dosage recommendations, and it is the drug manufacturer's discretion to list food allergens. 

I checked the package labels of my asthma management meds which I last filled in spring, the time of the year when I endure a full-on attack by grass and tree pollens.  No mention of milk ingredients.  There was a mention of a mysterious white aerosol and instructions to rinse my mouth thoroughly after each use...These warnings should have been red flags to me to dig deeper over the ingredients.

How to find out if your asthma medication contains milk:

1. Check out this list of asthma medications that contain lactose (milk) compiled by the Allergy Asthma Information Association (AAIA).  Please keep in mind that this list is from 2006 -- most certainly there is updated information out there.  
2. Remind your physician or child's pediatrician about their food allergies when they are about to be prescribed medication.  Contact your allergist about medications you or your kids are prescribed.  Are they free of your (children's) allergens?
3. Do your homework online.  Search your medication by name to see if it is milk-free.
4. Please, please have your kids wear some sort of allergy alert identification (medical bracelets, wristbands, dog tags).  If an emergency occurs and you or they cannot advocate for themselves, these medical alerts could prevent them from receiving treatment that will make an asthma attack or anaphylactic reaction even worse.

Do you manage asthma and a milk allergy?  When did you find out that asthma treatment medications contain milk products?