Isotretinoin Treatment in Patients with Known Peanut Allergies: To Give or Not to Give?

Isotretinoin can prevent the permanent scarring evolving from untreated severe acne vulgaris, it is considered a gold standard treatment. The main side effects include dryness, mood changes and muscle and joint pain. Medicines containing soya in the UK and Europe come with a warning advising against their use by patients with soya or peanut allergies due to the risk of an allergic reaction. This is mirroring the recommendation of European Medicines Agency (EMA) which applies to isotretinoin, even though the capsules lack peanut protein, which could lead to an undertreatment of this group of patients. However, Allergy experts in the UK, representing the British Association of Dermatologists, have assessed the risk and advised that individuals with a peanut allergy, but no soya allergy, can safely use isotretinoin. The current evidence for the link between peanut-allergic patients and potential cross-reactivity with soybean oil is quite poor. Manufacturers have different insights and provide in depth response upon enquiring. The aim of this paper is to help illuminate the treatment of acne vulgaris in patients with peanut allergies and provoke discussion on isotretinoin as a potential management option in these patients.