Atrovent and Combivent INHALERS

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These come with cautionary statements not to use if allegic to peanuts!! The SVN solution ipratropium is ok. Write if you have other rx questions related to allergies.

On Jan 8, 2006

Can you explain why we are not supposed to use them if allergic to peanuts? I have never understood that. Is there peanut protein in them or what? Also, is there some reason that they were designed so that pa people cannot use them? Since lots of pa people also have asthma, it is really a problem.

On Jan 8, 2006

Thank you for info, I responded to you in my original post but am posting again here.

If peanut is not a problem in nebules, is soy? DS is also allergic to soy though not as severely.

Also, can you tell me if there are any know allergy contraindications to beclometasone dipropionate (Becotide 50 in UK and Ireland). I'm assuming not as he's been using off and on for some years. He has too many allergies to list.

Thank you for your help.

On Jan 8, 2006

Give me a few minutes to research your answers on a web based pharmacy site to obtain the most accurate response. My son is very allergic to soy as well as peanut, and he has asthma. I feel a lot of asthma problems in the population are probably induced by food allergies that have been undiagnosed.

On Jan 8, 2006

I agree about that. There was a girl in my dd`s school who was diagnosed pa in 5th grade. She also had "asthma". Turns out when she stopped eating peanut products, the "asthma" went away.

About the Combivent and Atrovent metered dose inhalers, I would really like to know why they are contraindicated in pa. Is it only because they have soy lecthitin and soy is a legume and peanuts are a legume????? Or is there more of a reason than that? Also, did they always have this contraindication, or is there some change within the last few years in terms of how these inhalers are made? My dd was prescribed Serevent about six years ago---is this contraindicated as well? She only used it a couple of times---it had her so wired that she was up from 1 A.M. until 4 A.M.

On Jan 8, 2006

Atrovent and Combivent contain SOYA LECITHIN. So those people with a history of peanut hypersensitivity or "hypersensitivity to related foods and legumes" should not use these products! Anaphylaxis has been documented with Atrovent.

On Jan 8, 2006

Carefulmom....Serevent inhaler was withdrawn from the market because of a few deaths due to cardiac irregularities. As i recall those deaths were primarily in African Americans. Salmeterol (active ingred) was combined with a steroid (advair) and the marketing continued in full swing. I don't like salmeterol and believe it should not be on the market. Notwithstanding, our FDA permits a few deaths each year for unexplained causes with each marketed drug. If those number of deaths say reach 20 or some figure "x", then they begin their investigations that could lead to product recalls or pressure on manufacturers to remove their product as in Vioxx and Serevent inhalers. Most of what we take is probably unnecessary but look at all the ads on TV convincing us to consume more!

On Jan 8, 2006

Hello,

I know you said you'd get back to me but I was also wondering if your son uses a preventer. I promise I won't take anything you say as medical advice, just another parent's opinion.

My son (7) hasn't been taking his preventer in some years just the Ventolin as needed which isn't very often. He usually only has viral induced asthma. He has had maybe 2 severe asthma attacks in his whole life (severe meaning, bad wheezing, ribs contracted, severe shortness of breath). Hospitalized only once at 12 months (prior to me getting nebulizer). The last time I used the nebulizer was on my 3 year old who had his first case of croup in which his airway became completely obstructed when I lay him down (thankfully I had the nebulizer at hand).

His pediatrician did not see any problems with me not using a preventer on my son at his last visit but after reading posts in the archive about asthma I am concerned that I should start preventer again due to his anaphylaxis to nuts, dairy and egg.

The reason being from what I read kids who have anaphylactic reaction can weather it better if their asthma has been regularly treated.

My dilemma is that he is hyper to begin with due to his large number of allergies, plus asthma, plus eczema. The inhalers make him even more hyper though pediatrician scoffed at this as the Becotide is only 50 micrograms. Still, there it is. I don't like medicating him unless necessary so I will revisit this with pediatrician at next visit. However, I would like to hear your thoughts on the matter regarding your own son.

Thank you very much.

On Jan 8, 2006

me again,

My son also has an innocent heart murmur an added concern after reading more detailed info on various inhalers.

By lisa_marie25 on Oct 21, 2010

no. they are not okay in people with peanut allergies.

On Jan 8, 2006

Lebovitz, so if my dd is allergic peanuts and definitely not allergic to soy, then are Combivent and Atrovent okay? That is the part I don`t understand. She is not on either one, but since she has asthma the day could come that one of those might be prescribed, so I would really like to know. As long is someone is sure they are not allergic to soy, are these inhalers okay? Meaning, we don`t avoid soy foods, just because soy is a legume and peanuts are a legume.

On Jan 8, 2006

Assuming you are in the UK, the preventer you are referring to is probably a steroid spray that I would recommend. Your child should also be on a nasal steroid such as Flonase (fluticasone) and perhaps montelukast chewable tablets as a preventative that binds with certain receptors to cut down on the inflammatory reactions due to asthma. Boy, you have food allergies like mine! My son is highly allergic to peanuts and soy with great difficulty in selecting appropriate foods! Over the years he has had numerous reactions with one helicopter trip between hospitals! We are now beginning Xolair (a subcutaneous drug delivery) with hopes it may diminish unexpected exposures in the future. The key to treatment is a good allergist and I wish you and your family well! Email anytime. bquote]Originally posted by barb1123: [b]me again,

My son also has an innocent heart murmur an added concern after reading more detailed info on various inhalers. [/b][/quote]

On Jan 8, 2006

Really a good question! Being that there is only soya lecithin in the product, why would the manufacturer specifically state not to consume if PA?! Where I work our computer prints a caution lable for Atrovent that reads : DO NOT TAKE if allergic to peanuts or peanut products. Does not even mention soy...crazy huh! quote]Originally posted by Carefulmom: [b]Lebovitz, so if my dd is allergic peanuts and definitely not allergic to soy, then are Combivent and Atrovent okay? That is the part I don`t understand. She is not on either one, but since she has asthma the day could come that one of those might be prescribed, so I would really like to know. As long is someone is sure they are not allergic to soy, are these inhalers okay? Meaning, we don`t avoid soy foods, just because soy is a legume and peanuts are a legume.[/b][/quote]

On Jan 8, 2006

PMFJI, but I remember that there was a discussion(s) on this topic some time ago. I seem to remember that one of these products used peanut oil. I raised a thread about it, but I didn't do a complete board search because I'm not sure what's relevant to whom.

On Jan 8, 2006

I searched for a reference to peanut oil and understand that no one with a PA should use this product even though I can find no reference specifically to peanut. What I found was: "anaphylactoid reactions...in many cases the patients has a history of other food and drug allergies, including allergies to soybeans, legumes, or soya lecithin". The manufacturer also refers to the preservatives as being implicated in these reactions. Eh, I believe the soy part but there are preservatives in everything we touch today.

Quote:

Originally posted by Kathy L.: [b]PMFJI, but I remember that there was a discussion(s) on this topic some time ago. I seem to remember that one of these products used peanut oil. I raised a thread about it, but I didn't do a complete board search because I'm not sure what's relevant to whom. [/b]

On Jan 10, 2006

Thanks so much for your reply. Yes, my son is so allergic to everything. At 2 years of age he was down to literally 5 or 6 food substances of any type that he could tolerate. Luckily, we've come out of those dark days.

No luck for us on the allergist front however. There are no public allergist\immunologists in Ireland and the private ones number maybe 4 or 5 for the whole country. They are unbelievably expensive and I had little luck with the one we saw when my son was around 2.

Just wanted to send you this reply which I received from the company in Ireland which manufactures Combivent, Atrovent. I may also post this on other posts where enquiries were made.

Thanks again.

From: [email]Amy.Boulstridg@DBL.boehringer-ingelheim.com[/email] Add to Address Book Subject: RE: EMail for Boehringer-Ingelheim Date: Mon, 9 Jan 2006 10:29:01 +0100 Dear Ms Magee,

Thank you for your email regarding Combivent and Atrovent.

Combivent and Atrovent are both available in two forms - as a metered dose Aerosol (i.e. an inhaler) and as a unit dose vial for use with a nebuliser (i.e. nebules).

Combivent and old CFC containing Atrovent inhalers are not recommended for those with an allergy to soya lecithin or related products such as peanuts, because they contain soya lecithin as one of their ingredients. However, the nebules do not contain soya lecithin and may be used in those with a peanut allergy. This is why the package insert for the Atrovent and Combivent nebules that you have been prescribed do not contain warnings regarding use in those with peanut allergy.

Please be assured that patient information leaflets for the formulations of Combivent and Atrovent that do include soya lecithin do contain appropriate warnings. For example, the package insert for the Combivent inhaler states: "Before using Combivent metered aerosol tell your doctor or pharmacist if: you are allergic to the ingredient soya lecithin or related food products such as soya beans and peanuts." Furthermore, in the doctor's prescribing information for Combivent inhaler it states: "Combivent metered aerosol is contraindicated in patients with a history of hypersensitivity to soya lecithin or related food products such as soya bean and peanut. For such patients Combivent unit dose vials without soya lecithin can be used".

Please note that Atrovent inhalers were re-formulated approximately 18 months ago to a CFC-Free inhaler. This newer CFC-Free inhaler does not contain soya lecithin and can therefore be used in those with soya lecithin/soya bean/peanut allergy. The older CFC containing inhaler (which we have not sold in approximately 18 months, but there still may be stock in pharmacies) does contain soya lecithin and is therefore not recommended in such patients.

In summary, Atrovent and Combivent nebules and new Atrovent CFC-Free inhalers do not contain soya lecithin and may be used in those with soya lecithin/soya bean/peanut allergy. Combivent inhalers and old CFC containing Atrovent inhalers do contain soya lecithin and are not recommended those allergic to soya lecithin or related products such as soya beans and peanuts.

I hope that this information is helpful, but if you have any further questions please do not hesitate to contact me.

Yours Sincerely,

Amy Boulstridge Medical Product Support Executive Boehringer Ingelheim Ireland Ltd

On Jan 10, 2006

So basically they are saying that if you are pa and not soy allergic you can use them, right? After all, we don`t avoid soy milk just because dd is pa. So why would we need to avoid an inhaler with soy?

On Jan 12, 2006

I read this the same way!! I guess they are being "more careful on what they manufacture than most"!!

Quote:

Originally posted by Carefulmom: [b]So basically they are saying that if you are pa and not soy allergic you can use them, right? After all, we don`t avoid soy milk just because dd is pa. So why would we need to avoid an inhaler with soy?[/b]

On Jan 12, 2006

It is really confusing. Can anyone tell me the name of the pharmaceutical company that makes Atrovent and Combivent? I am going to call them. I called Dey last year with some questions regarding Epipen and at what weight to go from Junior to Regular and they were very helpful. Who makes Atrovent and Combivent? I`ll call and post what they say.

On Jan 12, 2006

boehringer-ingelheim makes Atrovent and Combivent inhalers. Atrovent nebulizer solution is mostly sold as generic.

I have been told by numerous doctors...2 pulmonologist,an internist,allergist and pharmacist that Atrovent nebulizer solution is ok. I am peanut allergic and take atrovent in my nebulizer up to 4 times a day when needed, have had no issues and will continue to take.

I also take Spiriva(tiotropium...long acting atrovent type drug) via inhaler with no problems and once again told no issues with peanut allergies as it is dry powder

The old atrovent inhalers with CFC propellant contained soya lechitin and there were reports of severe reactions by peanut allergic people. This is the same reason Flovent had started carrying that warning prior to changing its propellant

My understanding is the Atrovent HFA inhalers are not effected although Combivent still is

On Jan 12, 2006

This was posted in another thread. Looks like someone has already talked to the manufactuar

From: [email]Amy.Boulstridg@DBL.boeh[/email]ringer-Subject: RE: EMail for Boehringer-Ingelheim Date: Mon, 9 Jan 2006 10:29:01 +0100

Dear Ms Magee,

Thank you for your email regarding Combivent and Atrovent.

Combivent and Atrovent are both available in two forms - as a metered dose Aerosol (i.e. an inhaler) and as a unit dose vial for use with a nebuliser(i.e. nebules).

Combivent and old CFC containing Atrovent inhalers are not recommended for those with an allergy to soya lecithin or related products such as peanuts, because they contain soya lecithin as one of their ingredients. However, the nebules do not contain soya lecithin and may be used in those with a peanut allergy. This is why the package insert for the Atrovent and Combivent nebules that you have been prescribed do not contain warnings regarding use in those with peanut allergy.

Please be assured that patient information leaflets for the formulations of Combivent and Atrovent that do include soya lecithin do contain appropriate warnings. For example, the package insert for the Combivent inhaler states: "Before using Combivent metered aerosol tell your doctor or pharmacist if: you are allergic to the ingredient soya lecithin or related food products such as soya beans and peanuts." Furthermore, in the doctor's prescribing information for Combivent inhaler it states: "Combivent metered aerosol is contraindicated in patients with a history of hypersensitivity to soya lecithin or related food products such as soya bean and peanut. For such patients Combivent unit dose vials without soya lecithin can be used".

Please note that Atrovent inhalers were re-formulated approximately 18 months ago to a CFC-Free inhaler. This newer CFC-Free nhaler does not contain soya lecithin and can therefore be used in those with soya lecithin/soya bean/peanut allergy. The older CFC containing inhaler (which we have not sold in approximately 18 months, but there still may be stock in pharmacies) does contain soya lecithin and is therefore not recommended in such patients.

In summary, Atrovent and Combivent nebules and new Atrovent CFC-Free inhalers do not contain soya lecithin and may be used in those with soya lecithin/soya bean/peanut allergy. Combivent inhalers and old CFC containing Atrovent inhalers do contain soya lecithin and are not recommended those allergic to soya lecithin or related products such as soya beans and peanuts.

I hope that this information is helpful, but if you have any further questions please do not hesitate to contact me.

Yours Sincerely,

Amy Boulstridge Medical Product Support Executive Boehringer Ingelheim Ireland Ltd

On Jan 13, 2006

Yes, that is posted further up in this thread. That is why I am asking if someone is pa and definitely not soy allergic, then it is safe to use them, right? The only reason not to use it if you are pa is because you could be soy allergic also? It seems that is what they are saying. So since my dd is pa and not soy allergic, drinks soy milk every day, then these inhalers are safe, it sounds like. I`d really like to know if that is true.

On Jan 13, 2006

I am in full agreement with your logic! I further believe the drug manufacturers are simply covering their a...s by putting out a "general disclaimer" that covers the legume family of allegies. If my son was ten years younger and NOT allergic to soy, then I would have used the products. He slowly developed a soy allergy although he was not allergic ten yeas ago. Now he is more allergic than ever to the legume family and we avoid all such products!

Quote:

Originally posted by Carefulmom: [b]Yes, that is posted further up in this thread. That is why I am asking if someone is pa and definitely not soy allergic, then it is safe to use them, right? The only reason not to use it if you are pa is because you could be soy allergic also? It seems that is what they are saying. So since my dd is pa and not soy allergic, drinks soy milk every day, then these inhalers are safe, it sounds like. I`d really like to know if that is true.[/b]

On Jan 23, 2006

(raising the thread)

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