Severe lactose intolerance in a patient with coronary artery disease and ischemic cardiomyopathy

Preparation, characterization and in vitro release of β-galactosidase loaded polyelectrolyte nanoparticles

Improving encapsulation efficacy (EE) and bioavailability of β-galactosidase (β-gal) is always a challenge due to its fragility. In this work, β-gal loaded β-chitosan (CS) nanoparticles (NPs) were successfully prepared based on ionic gelation technique and electrostatic attraction for improving its EE and in vitro releasing capacity. The particle size of β-gal loaded low and high molecular weight (LMW and HMW) β-CS NPs reached 584.37 and 652.46nm, with Zeta-potential (ZP) of 26.37 and 16.46mV under the optimal conditions, respectively. In vitro release study conducted at pH4.5 and 7.4 showed that β-gal loaded LMW and HMW β-CS NPs with EE of 68.32 and 58.64% sustained the release of the β-gal over 12h. The β-gal incorporated into β-CS NPs was confirmed with the results of physicochemical and structural properties of β-gal loaded β-CS NPs, and prepared NPs had hardly any cytotoxicity in the range of 0.1-1.0mg/mL. The results indicated that β-gal loaded β-CS NPs could serve as non-toxic delivery carriers for the treatment of lactose intolerance.

The effects of probiotics in lactose intolerance: A systematic review

Over 60 percent of the human population has a reduced ability to digest lactose due to low levels of lactase enzyme activity. Probiotics are live bacteria or yeast that supplements the gastrointestinal flora. Studies have shown that probiotics exhibit various health beneficial properties such as improvement of intestinal health, enhancement of the immune responses, and reduction of serum cholesterol. Accumulating evidence has shown that probiotic bacteria in fermented and unfermented milk products can be used to alleviate the clinical symptoms of lactose intolerance (LI). In this systematic review, the effectiveness of probiotics in the treatment of LI was evaluated using 15 randomized double-blind studies. Eight probiotic strains with the greatest number of proven benefits were studied. Results showed varying degrees of efficacy but an overall positive relationship between probiotics and lactose intolerance.

Managing acute pain in patients who report lactose intolerance: the safety of an old excipient re-examined

Lactose intolerance is exceedingly common, reportedly affecting up to 70% of the world's population, leading to both abdominal and systemic symptoms. Current treatment focuses predominantly on restricting dietary consumption of lactose. Given lactose is one of the most commonly used excipients in the pharmaceutical industry, consideration must be given to the lactose content and therefore safety of pharmaceutical preparations prescribed for patients with lactose intolerance. This article summarizes the current literature examining the likelihood of inducing adverse effects through the administration of lactose-containing pharmaceutical preparations in patients reporting lactose intolerance, describes how to assess this risk on an individual patient basis and reviews suitable analgesic options for this population. A case study is presented detailing a patient reporting lactose intolerance who insists on treatment with the lactose-free product codeine/ibuprofen (Nurofen Plus) rather than other codeine-free analgesics. It is important to assess the likelihood of lactose as an excipient inducing symptoms in this scenario, as reluctance to cease codeine could suggest codeine dependence, an issue that is becoming increasingly common in countries such as Australia and Canada. Given codeine dependence is associated with serious sequelae including hospitalization and death, the patient must either be reassured the lactose component in their prescribed analgesics will not induce symptoms or an alternative treatment strategy must be confirmed. General recommendations applying theory from the literature to the management of acute pain in lactose-intolerant patients are discussed and specific treatment options are outlined. Although large inter-individual variability is reported, most lactose-intolerant patients can tolerate the small quantities of lactose found in pharmaceutical preparations. Cumulative lactose exposure can be assessed in patients taking multiple medications while also consuming lactose in the diet. In those sensitive to small quantities of lactose, lactase supplements can be trailed. Additionally, for the analgesic drug classes employed for the management of acute pain, lactose-free formulations, including most oral liquids and dispersible tablets and some oral tablets and capsules, are available.