can your medication make you worse?

[yaf_user681_26736]

Hi,

Just a thought on this one & would be glad of all the assistance I can get before I ask my GP & consultant the question.

I am allergic to dairy products (since a baby) & it is goats, sheep & cows milk, so think I was told it is lactose intolerance?

If so, could the fact that I am not improving whatever is being given to me, have anything to do with the fact that almost all the tablets I am on (including prednisolone) have lactose in?

My repeat has 31 items on, blood pressure tabs, diabetic (insulin & tabs),asthma tabs, blood thinning tab, calcium tabs etc! Yep, your right - not too many!!

Thanks for your help

Chris

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Lactose intolerance versus true milk allergy

Hi jovi devil,

I don't think I've said yet, welcome to Asthma UK. I'm sorry you're having so many problems at the moment - hopefully you are finding a good source of support here.

Basically, there is a big difference between lactose intolerance and true milk allergy, and to determine how likely your lactose-containing pills are to affect you, it would be useful to know which it is that you have. I'll give you a few details about both, so that you can try to make some sense of what it is that is causing you problems.

Lactose intolerance is a very common set of symptoms which is not a true allergy - ie, it is not mediated by the immune system. It occurs when the gut lacks the ability to produce the enzyme lactase, which breaks down the milk sugar lactose. Almost all children have this enzyme, but as we become adults we can lose it - it's estimated that upto 25% of Caucasians, and almost all black and Asian people lack this enzyme, although not all of them will get the clinical symptoms of lactose intolerance.

The symptoms tend to occur when a large amount of milk (typically over 240 ml - about 12g of lactose) or other lactose containing product is taken. Because the lactose cannot be broken down and digested, it passes into your colon (large intestine) where it ferments, producing hydrogen gas and acids. These produce the typical symptoms of abdominal bloating, cramps and abdominal pain, and often nausea, excessive wind and loose stools or overt diarrhoea.

Lactose intolerance can be tested for in a number of ways. A stool test can look for the presence of sugars in the stool that should have been broken down. Blood tests can be done to look at sugar levels in the blood after milk on its own has been taken - if the lactose is being broken down properly, the blood sugar should rise after taking it. The most common test used in the UK, though, is the hydrogen breath test - this involves giving the patient a set dose of lactose. If it is not digested, and is fermented to hydrogen, this hydrogen will be absorbed into the blood stream and passed out of the body via the lungs - if abnormall high levels of hydrogen are found in the breath, the person probably has lactose intolerance.

Lactose intolerance generally only causes symptoms if a large amount of lactose is taken in - few people have problems with milk in tea, for example. This means that the small amount of lactose in tablets is unlikely to be a problem. If it does seem to be causing problems, and a diagnosis of lactose intolerance is confirmed, there is an artifical lactase that can be taken - it's listed in the BNF as Colief liquid. The results are varible, but some people find it enables them to take lactose without symptoms.

Milk allergy is a different condition altogether. It is an immune system mediated response to a certain milk protein - usually due to the production of the antibody IgE in response to the protein. There are over 20 proteins in milk that can cause allergy - casein and whey are the most common causes. Lactose can cause true allergy, but it is rare. The symptoms of true milk allergy can range from gastrointestinal effects, very similar to lactose intolerance, to urticaria, rhinitis, asthma, and full-blown anaphylactic reactions. People with true milk allergy can potentially react violently to the smallest amount of milk contained within a food product. Tablets may also contain casein as a filler, as well as lactose.

It is often possible for an immunologist to do blood tests (RAST tests) to determine exactly which milk protein you are allergic to, if any. This obviously makes it a lot easier to exclude it from your diet, and to try to find alternative formulations of medications that don't contain the offending protein.

I recall from another thread that you said you are being referred to a specialist allergy centre, so I presume you are seeing an immunologist. I would suggest you raise this issue with him/her and ask for tests to clarify whether you have lactose intolerance or milk protein allergy, and exactly what proteins you are allergic to. Before you go, it might be an idea to get together a complete list of the ingredients of all the medications you are on - this is usually on the box or manufacturers instructions, but if it is not, it can be found on the internet. If you have any problems finding information about a particular medication, drop me a line and I'll see if I can find the necessary information.

Don't forget to include all the medications that you might be given in an emergency situation, too - I am allergic to a specific brand of hydrocortisone, Efcortesol, probably because it contains the preservative formaldehyde sodium bisulphite. Obviously, it is often more difficult to pick up on these allergies, as you are already having an asthma attack or allergic reaction when the drug is being given, but it can obviously have a significant effect on your response to treatment.

Hope this helps a little; please do ask if something isn't clear or you have any other questions

Take care

Em H

[yaf_user681_26736]

Thanks for the reply Em,

I remember mum saying that as a baby I couldn't gain weight & never kept her milk down or any of the substitute mixtures that were given in powder form, I always vomitted & also remember being forced to drink milk at break time at school & doing the same thing (although both my older brother & me told the teachers what would happen!).

Some tests were done many years ago at my local hospital & I was also told to try both goat's & sheep's milk - I had the same reaction to them - within 30 mins (at most) I will vomit and this will continue for up to 4 hours no matter how small a sip I have had. This also happens if I take something that has any dairy product or eggs in & my wheeze becomes more noticeable& my fingers & lips tingle and I itch all over.

The joke within my family is that I would go and take a piece of cheese or peanut butter if I was feeling unwell & the cry would go out to keep the path clear as they knew that give it usually 10 mins & I would be very ill. Surprisingly at the end of it, I felt great!!!

Still not sure whether these reactions make it intolerance or allergy - but always having the same reaction from birth, I presume that it is allergy?

Chris

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Hi,

I agree the itching and wheeze aspect does sound more like an allergy. It is possible to have lactose intolerance from birth, due to a congenital lack of lactase enzyme, but it is rare.

You would still need allergy testing to determine which specific protein in milk you are reacting to, if you are concerned about tablets.

Em