The Institute for Safe Medication Practices (ISMP) released a safety brief on Apr. 2 highlighting the need to evaluate both active and inactive ingredients in medications and food products for patients with alpha-gal syndrome, a potentially life-threatening allergic condition.
Alpha-gal syndrome occurs after a tick bite and is triggered by exposure to galactose-alpha-1,3-galactose, a molecule found in most mammals but not humans. Symptoms can arise when affected individuals consume red meat or other mammalian products such as gelatin or dairy. The ISMP cited an incident where a patient with this allergy received beef broth despite clear dietary restrictions documented in the electronic health record (EHR), revealing gaps in how allergies are tracked and managed within hospital systems.
The investigation into this event showed that EHRs often do not link drug-food allergies to dietary restrictions or provide mechanisms to screen for problematic inactive ingredients like gelatin, glycerin, magnesium stearate, bovine extract, or animal-derived components found in some medications and vaccines. The ISMP referenced its April 2022 newsletter article about hidden pork content in Colace capsules as another example of unclear labeling: "ISMP contacted Avrio Health, the manufacturer of the brand product Colace, and confirmed that the gelatin used is sourced from pigs, which is not specified in the labeling. It appears that, under current regulations, the product label is not required to detail the animal source of the gelatin."
To improve patient safety, ISMP recommends increasing staff awareness about alpha-gal syndrome through resources like those from the Centers for Disease Control and Prevention. Hospitals are encouraged to build alerts within their EHRs to notify practitioners when patients have known food allergies or alpha-gal syndrome.
ISMP also suggests evaluating pharmacy dispensing systems for alert capabilities related to animal-derived allergens. During care transitions, healthcare providers should ask specifically about any reactions patients have had from foods or medication ingredients and document these details thoroughly. Pharmacies should check package labels or contact manufacturers if there are concerns regarding ingredient origins.
Additional resources on contraindicated medications and possible mammalian by-products present as inactive ingredients can be found at InpharmD.com and VEGANMED.org.
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