Hypersensitivity to supplemental lactase: another case report — but why?

Le résumé fourni par la source

Purpose: To report a rare case of IgE-mediated anaphylaxis triggered by an over-the-counter lactase supplement and highlight diagnostic, management, and pharmacovigilance challenges. Methods: A 25-year-old woman with lactose intolerance experienced immediate systemic symptoms after chewing a lactase tablet (10,000 FCC units, Lacday®). Emergency treatment included antihistamines, corticosteroids, and finally epinephrine. Outpatient evaluation included skin prick testing with the lactase preparation, healthy controls, and lactose-free products. Results: Skin prick testing confirmed IgE-mediated lactase sensitization (wheals 5–6 mm) with negative controls. Symptoms resolved only after intramuscular epinephrine. A second reaction occurred after consuming lactose-free mayonnaise containing lactase; prick testing confirmed reactivity to the product but not to milk proteins. Conclusions: OTC lactase supplements can cause severe allergic reactions. “Lactose-free” foods may pose hidden risks. Clinicians and patients must be aware, and prompt epinephrine administration is essential. Improved pharmacovigilance and labeling for enzyme-containing supplements are warranted.

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