Is Breztri (budesonide, glycopyrrolate, and formoterol) safe to use in patients with a milk or dairy allergy?

Breztri Safety in Patients with Milk or Dairy Allergy

Breztri (budesonide, glycopyrrolate, and formoterol) is generally safe for patients with milk or dairy allergy as it does not contain lactose or milk proteins that would trigger allergic reactions.

Understanding Breztri and Its Formulation

Breztri is a triple combination therapy metered dose inhaler (MDI) containing:

• Budesonide (inhaled corticosteroid)
• Glycopyrrolate (long-acting muscarinic antagonist)
• Formoterol fumarate (long-acting β2-agonist)

Unlike many dry powder inhalers (DPIs) that use lactose as a carrier, Breztri is formulated as a pressurized metered dose inhaler (pMDI) using co-suspension delivery technology, which does not rely on lactose as a carrier for the active ingredients 1.

Lactose in Inhalers and Milk Allergy Concerns

Dry Powder Inhalers vs. Metered Dose Inhalers

• Many DPIs contain lactose as a carrier for the active medication, which may be contaminated with milk proteins
• A 2022 survey found that 80.5% of pediatric pulmonologists and allergologists were aware that many DPIs contain lactose, but 45.5% were unaware that DPI package inserts list cow's milk protein allergy as a contraindication 2
• Breztri, as a pMDI, uses a different delivery mechanism that does not require lactose as a carrier

Clinical Implications

• Patients with severe milk allergy may experience allergic reactions to lactose-containing DPIs due to potential milk protein contamination
• Metered dose inhalers like Breztri do not carry this risk as they use propellants rather than lactose carriers to deliver medication

Recommendations for Patients with Milk/Dairy Allergy

For patients with milk or dairy allergy who need triple therapy for respiratory conditions:

1. Breztri is an appropriate choice as it does not contain lactose or milk proteins
2. Avoid lactose-containing DPIs if the patient has severe milk allergy
3. Consider using a spacer with Breztri if the patient has suboptimal inhalation technique, as this can improve drug delivery without introducing allergen concerns 1

Monitoring and Precautions

While Breztri is safe regarding milk allergen content, standard monitoring for any inhaler therapy should include:

• Observation for common side effects such as headache, cough, and dizziness 1
• Proper inhaler technique education to ensure optimal delivery
• Regular assessment of symptom control and lung function

Common Pitfalls to Avoid

1. Confusing delivery systems: Don't assume all inhalers carry the same allergen risks - MDIs like Breztri and DPIs have different formulations
2. Overlooking package inserts: Always verify allergen information in medication documentation
3. Ignoring technique: Poor inhaler technique can reduce effectiveness regardless of allergen status

In conclusion, Breztri can be safely prescribed to patients with milk or dairy allergy, providing an effective treatment option without the risk of triggering milk protein-related allergic reactions.