Cosmetics, personal care products and medicines

Always read the list of ingredients.

When you are prescribed a medicine or buy a medicine over the counter from your pharmacy or from a shop, you should see the active ingredients listed on the outer packaging.

Ingredients known as excipients are also added to the active drug to give it suitable consistency or palatability. Some medicines will list all excipients on the outer packaging along with the active ingredients. Others will list the excipients only on the patient information leaflet found inside the box. You can check the list of excipients for any drug that is licensed for use in the UK by visiting www.medicines.org.uk and using the ‘search’ facility.

We advise that people with food allergies who are seeking to avoid specific ingredients should question the pharmacist about any medicine they need to take. This is part of the pharmacist’s job and most are pleased to be asked. In some cases, the pharmacist will be able to source an alternative, similar medicine that does not contain the allergenic ingredient. The pharmacist may need to liaise with the doctor as the prescription may need to be changed. In very occasional cases, the local pharmacist may need to contact a pharmaceutical company that specialises in the preparation of excipient-free formulations if no suitable alternative can be found. This is possible for some products but not all.

If a drug contains certain allergenic ingredients – such as peanut, sesame, soya, wheat or colouring agents – there may be extra information on the outer packaging. For example, this may say “Patients with wheat allergy should not take this medicine.” Even if there is no additional information, we still advise people to check and read the patient information leaflet.

It is important to remember that even if your GP has details of your allergy on record, you should still personally check the ingredients of any medicine you are prescribed. We have heard the occasional report of a GP mistakenly prescribing a medicine containing the patient’s problem allergen.

Terms used on the label of medicines:

You are likely to see the normal English terms for food ingredients when they appear in medicines.

Massage oils

Most massage oils are classed as cosmetics. Pure essential oils (such as orange oil or lavender) are not classed as cosmetic products but as “general products” covered by the European General Products Safety Directive. This legislation is in place in the UK even though we made the decision to leave the EU. For these products, you should check to see if the product you wish to buy has a full list of ingredients declared on the label and, if it doesn’t, make further enquiries to the retailer or manufacturer.

Vaccines

If you are due to be vaccinated, always enquire whether the vaccine you are going to receive contains any allergen that you are allergic to. For example, the flu vaccine is prepared on hens’ eggs and may contain tiny amounts of egg protein. Recent research suggests that flu vaccines present a very low risk of anaphylaxis for people with egg allergy even when the allergy is severe (Greenhawt et al., 2012). In our view, people who have suffered severe reactions to egg (such as breathing difficulties or collapse) should have their case assessed by an allergy specialist before having the flu vaccine. This also applies to anyone with egg allergy whose asthma is difficult to control. In some cases, it may be decided that the benefits of being vaccinated outweigh the risk of a reaction. In these cases, either a ‘no-egg’ or ‘low-egg’ vaccine can be given and this is usually tolerated.

Recently a new flu vaccine has been introduced for children which is not injected but sprayed into the nose (Live Attenuated Influenza Vaccine – LAIV). This is the standardly used vaccine for the childhood flu programme. Although it contains minute quantities of egg protein, research has shown that it can be safely administered to children with egg allergy (Turner et al., 2015). However Public Health England (an agency of the Department of Health) has advised that children with a history of severe anaphylaxis to egg that has required intensive care should be referred to specialists for immunisation in hospital (Public Health England,2015). Egg-allergic children with asthma can receive LAIV if their asthma is well-controlled.

Condoms

Casein, a milk protein, is used in the manufacture of some condoms. An individual with milk allergy has reported anecdotally of a localised allergic reaction to a condom during sex; however there is little medical literature on this subject. This information came from the doctor who examined the patient. In our view, it’s possible that there is some risk from condoms for people with severe milk allergy and that this could apply to both partners, not just the condom wearer.

According to condom manufacturers, some condoms are produced without the use of milk protein in their production. Some organisations (such as the Vegan Society) produce details on their website of condoms that are free from any animal products including milk protein. However, because such information requires constant vigilance and possible revisions, our policy is to advise people who are concerned about this to contact individual condom manufacturers to find out which brands are milk-free.

Sensitisation is the beginning of the process in which someone becomes allergic to a food or some other substance. It occurs when the person’s immune system mistakenly registers that food or substance as a “threat”. A subsequent exposure results in an allergic reaction occurring (although not in every case).

Whilst people may become sensitised to a food by eating it, it may also be possible to become sensitised through skin contact, especially if the skin has been broken. For example, it is possible that applying preparations containing arachis oil (peanut oil) to the skin of infants with rashes could place them at increased risk of developing peanut allergy (Lack et al 2003). Those most at risk of becoming sensitised are children with allergy in the immediate family. Oat allergy (Boussault et al 2007) and wheat protein allergy (Codreanu et al 2006) have also been reported to arise in this way.

However, skin conditions such as eczema need appropriate care and the regular application of an emollient skin cream or lotion is a mainstay of treatment. A doctor’s advice should be sought on the best treatment in each case. Preparations are available that do not include food-derived oils.