Practitioners' Reporting News

Atrovent® & Peanut Allergy

Issued June 17, 2003

The possibility of a peanut allergy vaccine cannot come soon enough for a 4-year-old asthma patient who was prescribed Atrovent® (ipratropium bromide) Inhalation Aerosol. A report received through the USP Medication Errors Reporting Program describes a child's visit to a clinic for asthma symptoms. The patient's allergy to peanuts was documented in the clinic's notes, but neither the physician nor staff realized the connection to Atrovent. The prescription was filled and the child's asthma worsened resulting in admission to the local children's hospital where the child was placed on an asthma pathway. The child's drug allergies were checked at the time the prescription was filled, but food allergies were not asked for by the pharmacist nor did the patient's family offer this information. It was at discharge from the hospital that the patient's mother noticed an auxiliary label on the box, warning of peanut allergies, and brought it to the physician's attention. It was then that they learned that Atrovent contains a peanut-based excipient (soya lecithin).

According to The Food Allergy & Anaphylaxis Network (FAAN), a national nonprofit organization dedicated to increasing public awareness of food allergies and anaphylaxis, peanut allergy is one of the eight most common foods that account for 90 percent of all food-allergic reactions. FAAN also states that food allergies affect between 6 - 7 million Americans and that severe allergic reactions are responsible for 30,000 visits to the Emergency Department each year and between 150 - 200 deaths. There is no cure for food allergies. Avoidance of the allergen is necessary to prevent reactions.

In a May 2003 press release, Genentech, Inc., Novartis Pharmaceuticals Corporation, and Tanox, Inc. announced that the U.S. Food and Drug Administration's (FDA) Pulmonary-Allergy Drugs Advisory Committee voted that Xolair™ (omalizumab) for Injection be approved for the treatment of moderate-to-severe allergic asthma in adults and adolescents. According to the press release, the FDA generally follows the advice of it's advisory committee, although it is not bound by these recommendations. A decision by the FDA is expected in late June 2003. If approved, Xolair would be the first IgE blocker and the first biologic therapy for the treatment of moderate-to-severe allergic asthma.

A FAAN press release says that Xolair may also show benefit in treating peanut allergy and that Genentech has assured FAAN that a peanut allergy study using Xolair is in development. Clinical trials are expected to begin by the end of this year.

Until a peanut allergy vaccine becomes available, practitioners should not forget to include food allergies as part of the medication use process, and patients and family members or caregivers should be proactive in volunteering food allergy susceptibility. Wearing medical alert jewelry, maintaining written documentation of all allergies to drugs and foods, along with patient counseling by healthcare practitioners will enable all in the health care field to breathe easier knowing the patient will be protected from drug-drug and drug-food interactions. To prevent this error from occurring again, the facility in this report hung a sign over the Atrovent storage area stating "check for peanut allergy" and also advised all pharmacists of the link between Atrovent and peanuts. For recommendations and resources available by FAAN for patients with peanut allergy, visit http://www.foodallergy.org/allergens.html#peanut.

Readers are advised that official USP cautions and warnings for drugs appear in the USP–NF or USP DI. Unless otherwise indicated, any advice or opinions expressed herein reflect solely the judgment of USP staff. Such statements are intended for further consideration and evaluation and may or may not be applicable to a particular practice. The USP Medication Errors Reporting Program is presented in cooperation with the Institute for Safe Medication Practices.