Thank you for your recent inquiry.
I have not been able to find via a literature search any case reports of severe allergic reactions to hydrofluoroalkane (HFA). My personal experience is that patients who have complained of worsening asthma upon using HFA inhalers have wrongly attributed the reaction to the HFA. When we have encountered this in the past, we have done a challenge with a steroid HFA inhaler to assess any adverse response, and uniformly there has never been a reaction. Thus, one easy way to check the validity of the patient's attribution of cause and effect is to do a challenge with a non-albuterol HFA inhaler in-office, and measure lung functions before and after. You could of course have available nebulized albuterol to treat a reaction if one did occur. If your experience is similar to those that we have had in the past, she will safely be able to take albuterol HFA.
Your other options are of course quite limited. Another option for you would be to prescribe Ventolin Rotacaps. I have looked online to see if any were still available, and did find one pharmacy who does, at least based on their website, sell the Rotacaps. The pharmacy is Eastern Drugs, website: www.easterndrugs.com; telephone: 1-916-273-3326; Monday through Friday, 9:00 a.m. until 5:00 p.m. EST.
I have not personally called this pharmacy to see if the website advertisement was still in effect, but this would represent another option for you if you did not want to investigate the possibility that her adverse response was not due to HFA by performing a challenge as noted above.
Finally, you could of course give her a compressor nebulizer with nebulized albuterol, and you could accomplish this using a small portable handheld nebulizer (several varieties are available online) to achieve portability.
In summary, my first choice would be to perform an HFA challenge under the conditions noted above, but if you do not feel that this is advisable based upon the severity of her previous reaction, you could explore the use of Ventolin Rotacaps or a portable handheld battery-powered nebulizer with albuterol solution.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.