Practice From Drug and Therapeutics Bulletin

Medicines, excipients, and dietary intolerances

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3468 (Published 21 August 2017) Cite this as: BMJ 2017;358:j3468
  1. Drug and Therapeutics Bulletin
  1. Drug and Therapeutics Bulletin Editorial Office, London WC1H 9JR, UK
  1. dtb{at}bmjgroup.com

What you need to know

  • A food allergy is an adverse immune response, and a food intolerance is a non-immunological reaction that can be caused by enzyme deficiencies, pharmacological agents, and naturally occurring substances

  • Excipients in medicines may not be suitable for some people with a dietary intolerance or allergy: the total exposure to expients needed to trigger symptoms may differ between people with different intolerances and allergies

  • Patients known to be allergic to peanuts should not use medicines containing peanut oil

  • The MMR vaccine is cultured in fibroblasts derived from chick embryos so the amount of egg protein is negligible, but children with documented anaphylaxis to the vaccine itself should be assessed by an allergist

Medicinal products contain not only active drugs but also other ingredients included for a variety of purposes and collectively known as excipients.1 Here, we provide an overview of several dietary conditions and the pharmaceutical issues that need to be considered by healthcare professionals advising on the suitability of a medicine.

How common are food allergies or intolerances?

A food allergy is an adverse immune response and a food intolerance is a non-immunological reaction that can be caused by enzyme deficiencies, pharmacological agents and naturally occurring substances.2 It is estimated that between 1% and 10% of adults and children have some form of food allergy or intolerance. The reason why a person has intolerance to a certain type of food is often not clear. However, as many as 20% of the population experience reactions to foods which make them believe that they have a food intolerance or hypersensitivity.3 For children, the most common food allergens include cows’ milk, chicken eggs, shellfish, fish, soy, peanuts, wheat and tree nuts. The most common type of enzymatic food intolerance is lactose intolerance.3 Excipients in medicines may not be suitable for some people with a dietary intolerance …

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