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December 24, 2012 / jeffmedic

Ipratropium Bromide and Peanut Allergies

Here is an article that I wrote for the newsletter of a local EMS agency.

3 years ago one of my students came to class after a ride out shift and told me that their preceptor had told them that Ipratropium Bromide was contraindicated in patients with an allergy to peanuts. This caught my interest because I had never heard of that issue. Ipratropium was not a drug commonly used in EMS when I trained as a paramedic so I wondered if I wasn’t as familiar with it as I should be.

I broke out my trusted ALS Field Guide and sure enough it says the Ipratropium is contraindicated in patients with peanut allergies. Then I looked at the pharmacology text that we use in my paramedic program to verify what I had found. The text also listed peanut allergy as a contraindication for giving Ipratropium. It really worried me that I had not known that before. I am confronted by things I didn’t know every day in my job but this one seemed too basic and too important to have missed.

Because it bothered me so much I started researching why Ipratropium was contraindicated. I checked to see if this contraindication applied to Ipratropium’s cousin Atropine, it didn’t. I also looked up the package insert for the Ipratropium that we used at the EMS agency I work at. There was nothing in the package insert identifying such a contraindication.

Then I turned to Dr. Google. Besides finding out that I almost certainly have cancer, I also found several sites that discussed this issue. Some of them confirmed what I had already found but a few also mentioned a substance called soy lecithin. Soy lecithin is related closely enough to peanuts that people with an allergy to peanuts can have an adverse reaction to it. Digging a little deeper I discovered that soy lecithin is an emulsifying agent that is used in a wide variety of food products and some medications. In particular, soy lecithin is used in Combivent and Atrovent Inhalation Solution metered dose inhalers.

This finding was important because I had not considered that the issue might be one of the inert ingredients of the medication and not the drug itself. I went back to the package insert for the Ipratropium and did not find mention of soy lecithin anywhere in it. Then I went back to the internet and found the package insert for Combivent. Sure enough, soy lecithin was listed as an ingredient and peanut allergy was listed as a contraindication.

I had now reached the point of diminishing returns as far as the internet was concerned. To confirm my findings I called Nephron Pharmaceuticals, the maker of the Ipratropium I used at work. I was put in contact with someone who was able to confirm that their Ipratropium does not contain soy lecithin. He also emailed me several documents related to this issue.

So after all of that, here is my conclusion. Nebulized Ipratropium Bromide is NOT contraindicated in patients with peanuts allergies. Inhaled Ipratropium Bromide delivered by metered dose inhaler under the brand names Combivent and Atrovent IS contraindicated because it contains soy lecithin. Soy Lecithin is in these preparations as a part of the delivery mechanism and not because of the medication itself. As long as EMS continues to use nebulized Ipratropium and not metered dose inhalers this should not be an issue.

Y’all stay safe out there.

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One Comment

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  1. Peanut-Free Parenting / Jan 30 2013 7:26 am

    Interesting and a bit annoying. Seems it should be contraindicated for those with SOY allergies, not peanut allergies! My kids are absolutely allergic to peanut and absolutely not allergic to soy or soy derivatives. I’d hate for them to not get an important medication because there is cross reactivity between soy and peanut and some individuals are therefore allergic to both. Thank you for this research!

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