Medicines all come with a list of constituents – strange sounding chemicals that none of us can pronounce – but it’s hard to get to grips with whether a particular medicine is compatible with your belief system. You may be practising Islam or Judaism, therefore anything that is not halal or kosher may not be acceptable, or you may accept non-halal but not any pork-based products. You may exclude certain food groups on ethical or lifestyle grounds like vegetarianism or veganism. You may have food allergies or sensitivities, such as gluten, lactose, nut, egg or shellfish. While every medicine differs, there are some common ingredients to look out for, or ask your pharmacist about. There may be alternatives available. Let’s take a look at some common hurdles.
Capsules are shells containing a medicated powder or granules. Most are made from a hard gelatine, which is usually derived from bovine (cow) or porcine (pig) sources. This may be something that many people are not aware of, and those who follow a halal or kosher diet or who are vegan or vegetarian, may wish to consider alternatives. The same medication may come as a tablet or liquid that is compatible with your beliefs. Capsules for vitamins and food supplements products often have gelatine-free versions, made from plant sources like maize starch or cellulose. This can help to give the same hard or soft properties that gelatine brings. Tablets are less likely to contain animal-derived products, but gelatine may be used to bind the tablet together. Depending on how you regard insect-derived products – and you may not have encountered this before, so may have no previous opinion – they may help to give tablets colour. Look out for E120 (also known as carmine, cochineal, crimson lake, carmine lake, natural red 4 or C.I. 75470), it’s extracted from the bodies of a red insect called Dactylopius coccus. Pre-gelatinised maize starch may cause some confusion, as it doesn’t contain gelatine. The starch or flour is pre-cooked, dried and ground into a powder or flakes and is used to stabilise or build the desired structure of a medicine.
A medicine may come as a gum-based sweet or a syrup, making it more appealing to children as it’s easier to swallow than tablets and tastes rather nice. Gum-based medicines are more likely to be vitamin supplements than prescription medications. However, most of these contain gelatine to give them their characteristic chewy consistency, which, as above, may not be acceptable for those following vegan, vegetarian, halal or kosher diets. With this in mind, many manufacturers now offer plant-based alternatives – look for labels stating they are "fruit-based" or "pectin-based". For halal diets, you may also wish to avoid any products that list alcohol in their ingredients. It’s sometimes used as a preservative in liquid formulations. Syrups and medicated sweets may contain a lot of sugar, it helps to give cough medicine syrups that thick, gloopy consistency that soothes your sore throat, and it makes it less of a struggle getting medicines into children. If you’re trying to lose weight, are concerned about your dental health or you have diabetes, do look for a sugar-free version.
While anyone can react to components in medicines and vaccines, an unwanted response may not fit the definition of an allergy. The Allergy UK support group suggests it’s rare for people to be genuinely allergic to certain medications, as this is a specific response where particular biochemicals such as histamine are released in the body – people are more likely to suffer side effects. The COVID-19 vaccine is not known to contain any common allergens, and reactions to all brands of vaccine approved so far have been remarkably rare. If you’ve had a systemic allergic reaction to one of the ingredients, or a severe allergic reaction (anaphylaxis) to anything before, you should discuss this with your doctor. They may refer you to an allergy specialist or take advice to offer an alternative class of COVID-19 vaccine. Some vaccines contain egg, such as the flu vaccine. However, it’s in such small amounts that both the adult and child versions are considered safe. The only exception, no matter your age, is if a severe allergic reaction put you on the Intensive Care Unit in the past. In this case, the flu vaccine should be given in a hospital setting in case you need urgent care. Yellow fever and hepatitis A vaccines also contain egg. Gelatine may cause an allergy. It's found in the herpes zoster vaccine (for shingles), varicella zoster vaccine (for chickenpox) and the MMR vaccine (for measles, mumps and rubella). For those with a latex (natural rubber) allergy, pre-filled syringes may contain traces of latex from the rubber plunger or the cap protecting the needle. This can prompt a reaction if you have a severe latex allergy (one that causes an anaphylactic reaction). Do talk to your doctor, as latex-free options may be available. This is only for anaphylactic reaction – if you usually suffer a mild reaction to latex gloves, for example, pre-filled vaccines shouldn’t pose a problem.
This needs to be taken on a case-by-case basis. Let’s start with the newest and most relevant: the COVID-19 vaccine. Faith leaders have come together to agree that it is entirely compatible with Islam, Judaism, Hinduism, Christianity, and it fits with vegan and vegetarian beliefs, too. It contains no animal products, animal-derived cells, foetal cells or gelatine. Where gelatine and other pork-based ingredients are concerned, there may be a difference of opinion. Gelatine is used as a stabiliser in the intranasal influenza vaccine called Fluenz (a liquid squirted into the noses of children to protect them from flu). This form of gelatine is highly purified and scientific tests show that this gelatine is so degraded that the original source cannot be identified. There is no detectable DNA material from pigs left in the vaccine. For this reason, the Islamic Legal Scholars in 2001 announced that it was permissible for consumption, and the World Health Organisation endorsed this. Some Muslim communities consider that medicines and vaccines that contain any porcine product are forbidden. If you are in any doubt about the right path forward, do speak to your local faith leader or get in touch with a national group representing your beliefs. They are there to give you further guidance or reassurance. Fluenz flu vaccine containing pork product has been ruled to be kosher by Rabbis, since according to Jewish laws they say, there is no problem with porcine or other animal-derived ingredients in non-oral products. This includes vaccines, including those administered via the nose, injections, suppositories, creams and ointments.