Can an asthmatic child with a severe peanut allergy have albuterol?

Hi Kelejo,

I have several patients that are allergic to peanut and also have a history of asthma. These patients are at higher risk of having a severe allergic reaction if peanut is accidentally ingested because they have asthma. Almost all of my peanut allergy patients that have asthma have a brand of albuterol inhaler. The answer to your question is "No". This is not true. People that are allergic to peanut should not be restricted from having albuterol.

Some reports about inhalers that have albuterol in addition to Atrovent (a bronchodilator which is a brand of ipratropium) have warned people with peanut allergy about possible reactions because of the ingredient of soya lecithin used as a suspension in these inhalers. Soya lecithin is a soybean product which is in the same family as peanut (legume family). Soya lecithin is used in Atrovent and Combivent inhalers. Combivent inhaler is a brand of inhaler that has albuterol and ipratropium in it. According to a few reports some people that are peanut allergic may react to the soya lecithin in these inhalers. In my experience this is very uncommon.

Understand that soybean, although a member of the legume family is not commonly cross-reactive with other members (for example peanut). This means many people with peanut allergy are able to safely consume beans including soybean. But some very sensitive peanut allergic people also can't have soybean or other legumes (fortunately a small subset of peanut allergic people).

Soy based lecithin has found its way into other asthma inhalants from what I have read. The package inserts may not present full disclosure of all non-active ingredients of the inhaled drug.

Brands of albuterol are recommended to have on hand, in the setting of peanut allergy and asthma (as well as in the setting of having asthma without food allergy).

Hope this clears things up for you.

J. Thompson, MD