Talking Allergies

Labelling issue in Medication
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Author:  heather.finn [ Thu May 12, 2011 2:42 pm ]
Post subject:  Labelling issue in Medication

After a long night in the ER, I am a bit emotional but need to get this information out to anyone with Severe Dairy Allergies.

My daughter is Anaphylactic to all milk products and was perscribed an over the counter elixer for constipation called Lactulose. At first thought one would think LACT means Lactose so you should not take it. Her physician said it was only a sugar and not a milk product. The pharmacist also confirmed that it is only a sugar. Unfortunately the label on the bottle only said Lactulose and orange flavor. No ingredient was stated as to what was in the lactulose and the manufacterer was now closed for the evening. Against my better judgement, I gave it to her. Within 30 seconds she was reacting. It was her worst reaction ever and she has had several in her little life. Thankfully I am a quick reactor and immediately gave her Aerius and an epipen injection. My 11 year old son called 911 and within 3 minutes the ambulance/fire were by her side. The epipen had kicked in by then but she needed to go to the hospital for observation and a dose of prednisone.

I want to get word out that doctors and pharmacists do not know everything and we are our childs best advocate. Air on the side of caution ALWAYS. If the label doesn't list the ingredient-DO NOT TAKE IT.

Even the ER Physician said that Lactulose shouldn't cause this reaction! He was actually going to give her a prednisone PILL! Anyone with milk allergies knows that you cannot take pills without knowing the ingredients as they most often contain milk as a binder. If I wasn't there she may have had another reaction.

I've since called the manufacterer about the ingredients in Lactulose and sure enough, it contains Lactose which is in milk. I asked why it's not on the label and they are investigating and getting back to me! Gave me their appologies as does the pharmacist and the physician!

Daughter is 13-Anaphylactic to Milk, some hay fever and issues with cats.

Author:  alberta advocate [ Thu May 12, 2011 3:00 pm ]
Post subject:  Re: Labelling issue in Medication scary, hate that you had to learn that lesson....and so glad you shared this with us. I am so glad that she is ok. :D you are a fast reactor. :huggy to you and yours.

Author:  Julie [ Thu May 12, 2011 10:14 pm ]
Post subject:  Re: Labelling issue in Medication

:huggy to you and your daughter heather.finn. I hope you are both recovering now. What an ordeal. We've been to the ER 5 times with our son for anaphylactic reactions (3 times following the Epipen) and it is very scary and very emotional. Labelling for medication needs to be made available. This kind of thing should not be happening. I hope your daughter is feeling okay now, and that she feels better knowing the Epipen is always there for her if she needs it.

Author:  _Susan_ [ Thu May 12, 2011 10:51 pm ]
Post subject:  Re: Labelling issue in Medication

Heather, that's awful! I'm so glad that you did not hesitate to use the Epipen! Lactose is one of those ingredients where it is saidone should not react to but there usually is a contrainidcation stating do not use if you are severely allergic to dairy.

It sounds like your daughter fell through the cracks. I even looked on Health Canada's Drug Products Database but no Lactulose product has an Electronic Product Monograph available. (that's the document that tells you what is in the drug etc)

How very scary for all of you. I hope when the fog clears, you will be able to follow up with the hospital etc. Why wouldn't they suggest a glycerin suppository?

Author:  heather.finn [ Fri May 13, 2011 1:15 pm ]
Post subject:  Re: Labelling issue in Medication

Thanks for your replies. I'm starting to breathe again. Sometimes we put too much trust in doctors and pharmacists. You are correct, as I also don't understand why either of them didn't just suggest a different option since the manufacturer was closed for the day to confirm ingredients. They just assured me that no one would react to the product since it's not absorbed in the body and it's only a sugar but after further contact with the manufacturer, I find out it indeed has galactose and lactose.

I hope medical ingredients will soon be required on all medicines as in food. I'm also surprised the pharmacist wouldn't have these ingredients on hand. Hopefully this experience doesn't happen to anyone else. I would hate to think my daughter endured this for nothing.

Author:  _Susan_ [ Fri May 13, 2011 1:56 pm ]
Post subject:  Re: Labelling issue in Medication

Maybe you should report this incident. ... fo-eng.php

Author:  Momtobunches [ Fri May 13, 2011 2:31 pm ]
Post subject:  Re: Labelling issue in Medication

Glad everyone is OK now. I might have some answers for you. Technically, all the label has to say is lactulose, because that is what it is ... it is a separate sugar from lactose and galactose, although only slightly modified from either of those. It is it's own chemical entity. Lactose isn't in it - it has structurally been changed from lactose. It is not absorbed by the body so that's what makes it such a good laxative - it passes unchanged into the large bowel (most foods / medications are absorbed in the small intestine and then modified by the liver). I've researched this one in the past when I used to work in drug information and could not find any reason that it could not be given in milk allergy, and it has been safely used in milk-allergic people given that it is a sugar (not a protein), and is not absorbed into the blood. We did caution lactose-intolerant people not to use it though, and since it is such a powerful laxative, it does come with some rather "explosive" effects in some people whether they're senstive to lactose or not!

So while the medical advice you received was correct in terms of the available information, and allergists do seem to agree that lactulose is OK in milk allergy, I do think you should report it so the manufacturer can investigate. People with a milk protein allergy should not be reacting to any medical product with lactose, or derived from lactose. (The exception being Advair diskus, which you are inhaling into your lungs!) Make sure you provide the name of the manufacturer (I'm guessing it was either pms or ratio brand - should be the letters immediately before the word lactulose on the label.) It is also very helpful if the attending physican in the ER can provide some details of the reaction on the report as well.

Author:  _Susan_ [ Fri May 13, 2011 2:59 pm ]
Post subject:  Re: Labelling issue in Medication

I love this forum! While we have alot in common, we also have a diverse group of disciplines and often one member can answer another members' questions!

Thank you, Momtobunches! :huggy

Author:  walooet [ Fri May 13, 2011 3:28 pm ]
Post subject:  Re: Labelling issue in Medication

:huggy to heather.finn, your daughter and also your son. It is tough for all with a reaction but you all did the right things. I hope your daughter is feeling better soon.

:thumbsup to Momtobunches for such thorough and useful information.

By reporting it, hopefully another child will be saved from a reaction.

Author:  heather.finn [ Fri May 13, 2011 6:41 pm ]
Post subject:  Re: Labelling issue in Medication

Thank you momtobunches for that information. The doctor and pharmacist basically said the same thing and I have read other milk allergic people have been able to take other phamacy grade lactose in medications. I still don't understand how that is possible as my daughter cannot even touch milk products let alone allow any into her body. I did follow up with the manufaturer and put in my complaint. Anaphylaxis Canada suggested I contact the Medicine effects board (604-666-3350) so others can be warned which I did. I'm told to send letters to both the manufacturer and the board so they can investigate before any word of warning is sent out. Basically I'm told that there is alot of red tape. I want to make sure the labels are more informative than just stating Lactulose. It's too diverse a word. It's like saying chicken broth but not listing what's in the broth.

Thanks again for all the replies.

Author:  _Susan_ [ Fri May 13, 2011 9:52 pm ]
Post subject:  Re: Labelling issue in Medication

I'm so glad that you reported this! This is the kind of information that the government and drug companies need to keep track of.

I'm sorry that your daughter had the reaction but she sure is fortuate to have a family that can rally to her aide so quickly. I hope she's feeling better soon.

Author:  heather.finn [ Thu May 19, 2011 1:50 pm ]
Post subject:  Re: Labelling issue in Medication

Good News! The manufacturer (Pharmascience) contacted me today to say they have approval to change the label on Lactulose to list Milk ingredients. They have also sent a warning to Health Canada to notify everyone of this ingredient in Lactulose. Hopefully this never happens to anyone else and will educate those who think milk sugar is not a true milk ingredient. Those with severe Milk/lactose allergies cannot tolerate even a drop of lactose or galactose in their system. :thumbsup

Author:  alberta advocate [ Thu May 19, 2011 5:14 pm ]
Post subject:  Re: Labelling issue in Medication

:thumbsup :huggy :thanksign

Author:  walooet [ Thu May 19, 2011 7:19 pm ]
Post subject:  Re: Labelling issue in Medication

This makes me happy to see a company being proactive and to you heather.finn for taking the time to let them know so that others could be spared the reaction your child had.

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