Allergy to drug excipients

Abstract

Lactose (C12H22O11) is a disaccharide composed of one molecule of galactose and one glucose. In the pharmaceutical industry, lactose is used to aid in tablet formation because it has excellent compressibility properties. It is also used to form a diluent powder for dry powder inhalations. Lactose may be present as anhydrous lactose, lactose monohydrate or spray-dried lactose. High-quality pharmaceutical lactose contains traces of milk protein (0.012-0.029% impurities, including cow’s milk). These amounts may cause allergic reactions in people suffering from milk allergy if ingested or inhaled. We present the case of a 60-year-old patient who, since February 2017 reports the occurrence of chronic urticaria accompanied by sporadic palpebral angioedema and lips. The patient presents cardiovascular comorbidities (arterial hypertension under treatment), diabetes mellitus with ADO, chronic gastritis, hyperuricemia. As a result of the investigations carried out, a hypersensitivity to cow’s milk proteins was identified despite the regimen of avoiding this type of diet, the patient continued to present the symptoms aforementioned. The conjugated and correctly administered antihypertensive treatment of the patient was altered without results, and afterwards it was attempted to administer all concomitant medication with preparations that did not contain lactose as an excipient. Clinical evolution was favorable, with remission of skin eruptions, with isolated recurrence (2 episodes/3 months) of unilateral palpebral edema. With this clinical case, we want to draw the attention to the importance of allergies/intolerances to drug excipients.