2023-11-23 06:53:00
Lactose is used in 20% of prescription drugs and 6% of over-the-counter products. © Adobe Stock
Stéphanie suffered from pain in her intestines. Cramps. Kind of blows. After medical examinations, the diagnosis was made: his intestine was irritable. During stress and anxiety, the muscles of the digestive tract contract. She then feels spasms that are abnormal in their intensity and duration. A treatment exists: Spasmomen 40 mg. Except that as soon as she swallowed a pill, Stephanie ran to the bathroom. The leaflet does not mention such undesirable effects. In 1 in 100 people, gastrointestinal reactions may occur such as dry mouth, nausea or vomiting. But no diarrhea. The problem was elsewhere: in the list of ingredients. Spasmomen contains lactose. Stéphanie is intolerant to it. The notice is however clear: “If you have an intolerance to certain sugars, contact your doctor before taking the medicine”. Too much for Stéphanie who had to give up treatment. His GP hadn’t thought regarding it.
Lactose is used in 20% of prescription drugs and 6% of over-the-counter products, according to an estimate from Medipedia, a health information site run by Belgian doctors. The quantities used depend on the products. Spasmomen 40 mg contains 28 mg of lactose per tablet. Medipedia cites another example: statins, these cholesterol medications, contain 30 mg. Which is equivalent to 0.5 ml of milk. For some intolerant people, this is too much. Antiallergics or homeopathic granules can contain up to three times more. Lactose is obviously not the only problematic component. In the excipients, we find gluten, generally in the form of wheat starch, and titanium dioxide. Studies show in particular that these substances can trigger inflammation in the intestine.
“Those who are seriously intolerant to lactose or gluten should indeed be careful. Although generally speaking, the doses in most medications are quite low”, reacts the medical director of Medipedia and general practitioner Patrick de Moor. In addition, the effects must be put into perspective: at worst, patients have a bad time because of their intolerance. “It’s not pleasant, it’s uncomfortable, it should be avoided if possible, but the effects are limited”, supports the doctor. However, it is always better to announce your intolerance to health professionals. Most of the time, there is an alternative to treatment containing the allergen.
Seeing it is believing it
Some allergies have much more serious consequences than lactose and gluten. Many patients cannot tolerate aspirin, insulin, corticosteroids, anesthetics or the active ingredients of vaccines. Penicillin – the most consumed antibiotics – is also a common allergen since it affects between 5 and 10% of the population. We are not talking here regarding people who experience side effects (diarrhea, yeast infection, stomach aches, etc.). But those affected by hives and skin rashes, when the reaction is benign, or acute asthma and anaphylactic shock, sometimes fatal, when it is not.
“Unlike intolerances, a drug allergy is a reaction to the active ingredient itself. People sensitive to penicillin and derivatives such as amoxicillins should avoid them at all costs. This must be recorded in the medical record and highlighted”, attests Dr de Moor. The problem is that no preventive screening is ever carried out. “In general, the patient realizes the problem in real time, when he reacts badly to a treatment… He can go into anaphylactic shock, it’s true, and that’s a problem. But at the same time, it is difficult to systematically ensure the absence of allergies…”
At the Citadelle Hospital Center in Namur, allergist Hélène Simonis is responsible for testing medications and detecting patients’ possible allergies. She confirms: “Carrying out predictive tests is complex. If you have never had symptoms, even if there is a family history, then you cannot know until you actually experience a reaction. Even though the outcome can be catastrophic… Once an allergy is detected, the doctor and the patient question the benefit-risk balance before prescribing”.
Des cas surestimés
After an initial problematic reaction, examinations are carried out by applying a molecule in low doses to the patient via the skin. But this is never without consequences. And while France conducts drug allergy tests outside hospitals, this is not the case in Belgium. The doctor at CH Citadelle is not in favor of it. “Diagnoses are not to be placed in everyone’s hands. To test multiple drugs, one must be systematic and specific in the approach, with dilutions made the same way each time. The risk is to increase false diagnoses, which then complicate treatments for the wrong reasons. It happens that a child reacts badly to penicillin, for example, and is labeled allergic all his life when that is not the case.” The cases would therefore be overestimated. “30% of patients say they are allergic, but in reality, it is three times less.” However, overdiagnosis is not positive either for the patient who will complicate their life for nothing, nor for the doctors who have to rack their brains to find an alternative treatment, nor for the Social Security which must assume the additional cost.
Because even in the most dangerous cases, an alternative often exists, although more expensive. “This is the case for all essential medicines including antibiotics, but also anti-infectives, antidiabetics, antihypertensives. Likewise, if you are allergic to aspirin, you can take paracetamol”, concludes Doctor de Moor.
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