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Is it possible to use Nortase® in case of a known ABPA and CF? If not, are there alternative preparations?
The normal pancreatic enzymes are already given in a very high dosage and seem not to be sufficient, omeprazole is already taken for a longer time.
Thank you.
Hello dear questioner,
you want to know, if a CF patient with a known ABPA (allergic bronchopulmonary aspergillosis) and an exocrine insufficiency of the pancreas (impairment of the digestion of fat) can take the preparation Nortase® without the danger of developing an allergy or an ABPA relapse. In answering your question, also the medical service of the producing company helped us.
The preparation Nortase®, that is produced by the company Repha, is a preparation of digestive enzymes not of animal origin. It is used for CF patients with maldigestion due to an exocrine pancreatic insufficiency in order to control the digestion of fat, mostly in combination with other pancreatic enzyme preparations. Nortase® does not contain pancreatic enzymes of animal origin (pancreas of the pig), as it is the case with other preparations of pancreatic enzymes, but originating from mould fungi. The active substances are rhizo-lipase (lipase from rhizopus oryzae), protease and amylase from Aspergillus oryzae.
Nortase® is on the German market for around 35 years. During the process of production it is paid very much attention to the sole extraction of enzymes from the fungus. It can however not be excluded, that fractions of allergenic protein of the fungus can reach the preparation. These traces of proteins could cause allergic reactions in highly sensitized patients also in form of an ABPA. The probability of such an reaction is however very low, but cannot totally be excluded. The manufacturer can inhere report only about a small number of single cases from the last 35 years. Case reports from the literature are not known to me.
With this background information the patient has to make a decision individually and a harm/effect analysis has to be performed. In order to make the right decision in your case, please turn to your CF doctor. We cannot give you a concrete recommendation, as an individual recommendation is not possible via the internet.

I hope to have helped you with my answer and stay with my best regards,
Dr. med. Christina Smaczny