Special Feature Gluten Content of the Top 200 Medications: Follow-Up to the Influence of Gluten on a Patient's Medication Choices

摘要

Celiac sprue is an autoimmune disease affecting the digestive system and occurs when gluten proteins, commonly found in wheat, barley, and rye, are not fully digested, stimulating an inflammatory process in the small intestine.Symptoms can appear at any point in life and can range from gastrointestinal upset, headache, low weight gain (weight loss), osteoporosis, depression, and infertility.Due to the variety of symptoms, celiac sprue is often under diagnosed.1'2 Current estimates find that the disease affects 1 out of every 100 to 133 Americans.Treatment for celiac sprue includes complete avoidance of gluten in products that are ingested or come into contact with the mouth, including medications, lip balm, and Play-Doh. Ingestion of amounts as small as 30 to 50 mg may illicit an adverse event in patients. However, identification of gluten in products can be cumbersome. For food, per the FDA Food Act 2004, identification of wheat (along with milk, egg, fish, crustacean, shellfish, tree nuts, peanuts, and soybeans) on product labels, including flavorings, colorings, or additives contaminated with such, is required. Allergen identification is not required for medications where gluten can be found within the inactive ingredients (such as starches or starch derivatives) or transferred through the manufacturing process.1 Ideally, this information would be contained in the package insert; however, inactive ingredients and manufacturing processes can change or are not fully described. Potential sources of gluten are not always recognized by health care professionals.