Acute Allergic Reaction due to Milk Proteins Contaminating Lactose Added to Corticosteroid for Injection

Abstract

We encountered two patients with severe cow's milk allergy who reacted strongly to an injection of methylprednisolone sodium succinate (Sol-Medrol 40 mg Pfizer, Japan). They came to our hospital because of an asthmatic attack or urticaria and were treated with Sol-Medrol 40 mg. After the injection, the allergic reaction was immediate. Skin prick tests demonstrated that the beta-lactoglobulin contaminating the lactose of the drug preparation caused the immediate allergic reaction.

Skin testing for immediate hypersensitivity to corticosteroids: a case series and literature review

“…A similar problem has been reported with carboxymethylcellulose in radiocontrast media [17]. Two patients with severe cow's milk allergy had immediate allergic reactions with Solumedrol, and subsequent skin testing was only positive to B-lactoglobulin contaminating lactose in the steroid preparation [18].…”

Hazardous Medications in Children with Egg, Red Meat, Gelatin, Fish, and Cow’s Milk Allergy

“…Consequently, an intravenous methylprednisolone sodium succinate 40 mg injection provoked anaphylactic reactions or urticaria in children with severe CMA [56,57,58,59]. Noteworthy, skin tests were positive to methylprednisolone sodium succinate 40 mg injection and negative to lactose-free methylprednisolone formulation [56,57,58,59]. The European Medical Agency has contraindicated intravenous methylprednisolone sodium succinate 40 mg in children with CMA or suspected CMA [60].…”

Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA): A summary report

“…100,101 Unusual clinical presentations of CMA Unusual clinical presentations are as much a feature of CMA as one might expect from such a ubiquitous allergen source in food and the environment as milk (Box 1). [102][103][104][105][106][107][108][109][110][111][112] The natural history of CMA CMA is primarily of pediatric onset, [113][114][115] is generally outgrown, and is often the first stage of the ''allergic march.'' The take-home message about the latest developments regarding the natural history of CMA is reviewed in Table II.…”