Country-wide medical records infer increased allergy risk of gastric acid inhibition

[helvella]

A newspaper article and a paper in Nature that raise questions about the effects of Proton Pump Inhibitors (PPI - such as Omeprazole, Lansoprazole, Dexlansoprazole, Esomeprazole, Pantoprazole and Rabeprazole), Sucralfate, H2-receptor antagonists (such as Cimetidine, Ranitidine, Famotidine, Nizatidine, Roxatidine, Lafutidine, Lavoltidine and Niperotidine), and prostaglandin E2 (Dinoprostone) on allergy.

I'm taking this another step - and considering the lowered stomach acid often suggested (but rarely taken up by doctors) in hypothyroidism.

If it is lowered acid itself that causes or contributes to allergy risk, that seems an obvious possibility.

So, too, would be anything else that ends up there including bariatric surgery.

Stomach acid-reducing drugs may raise risk of future allergies – study

Lead scientist hopes findings raise awareness about proton-pump inhibitors’ side-effects

Prescription medicines to reduce stomach acid are associated with an increased risk of developing allergies, according to a study.

The research suggests people prescribed proton-pump inhibitors (PPIs) are twice as likely to be prescribed anti-allergy drugs in future years.

Scientists examined data from the health records of more than 8 million people in Austria – 97% of the population – over a four-year period.

“Previously there have been mouse studies, cellular studies and clinical observations, but this is the last brick in the whole picture,” said the study lead, Prof Erika Jensen-Jarolim, from the Medical University of Vienna.

The research, published in the journal Nature Communications, found the risks were especially heightened in women and people over 60.

Most healthy immune systems can tolerate the substances found in foods and the environment, but they can sometimes become hypersensitive, which causes allergies. Part of the initial digestion process involves stomach acid breaking down the protein molecules present in food into smaller pieces.

Patients with conditions such as gastric ulcers may be prescribed medicine to reduce the acidity in the stomach to relieve unpleasant symptoms. In this case, the normal chemical reactions involved in digestion do not work as well, meaning larger protein molecules and other potentially harmful substances are able to pass through to the intestine. This can trigger an allergic response from the immune system.

The use of acid-reducing drugs is widespread. In some cases, patients are prescribed a course covering a number of months or even years, although Jensen-Jarolim’s study shows that a potential allergic response could be brought about in patients prescribed as little as six days’ worth of acid-reducing drugs a year.

Rest of article available here:

theguardian.com/science/201...

Country-wide medical records infer increased allergy risk of gastric acid inhibition

• Galateja Jordakieva,

• Michael Kundi,

• Eva Untersmayr,

• Isabella Pali-Schöll,

• Berthold Reichardt &

• Erika Jensen-Jarolim

Nature Communicationsvolume 10, Article number: 3298 (2019)

Abstract

Gastric acid suppression promotes allergy in mechanistic animal experiments and observational human studies, but whether gastric acid inhibitors increase allergy incidence at a population level remains uncharacterized. Here we aim to assess the use of anti-allergic medication following prescription of gastric acid inhibitors. We analyze data from health insurance records covering 97% of Austrian population between 2009 and 2013 on prescriptions of gastric acid inhibitors, anti-allergic drugs, or other commonly prescribed (lipid-modifying and antihypertensive) drugs as controls. Here we show that rate ratios for anti-allergic following gastric acid-inhibiting drug prescriptions are 1.96 (95%CI:1.95–1.97) and 3.07 (95%-CI:2.89–3.27) in an overall and regional Austrian dataset. These findings are more prominent in women and occur for all assessed gastric acid-inhibiting substances. Rate ratios increase from 1.47 (95%CI:1.45–1.49) in subjects60 year olds. We report an epidemiologic relationship between gastric acid-suppression and development of allergic symptoms.

Full paper freely available here:

nature.com/articles/s41467-...

[Star13]

Interesting. Might explain why when my T4 was forced to 3 that I developed chronic urticaria and now have to take a permanent antihistamine!

[Alanna012 in reply to Star13]

Me too now Star and I was forced to live on them in my twenties. Sucks. I'm a Fexofenadine junkie now...

[Star13 in reply to Alanna012]

I was prescribed Bilastine by my consultant who is a very experianced allergist who advises Allergy UK. He said that I needed a step up and slightly different kind of antihistamine which is why he put me on that. You may want to enquire about it rather than the fexafenadine which did nothing for me.

[Alanna012 in reply to Star13]

Thank you for this, I will enquire about it, good to know. The fexofenadine doesn't seem to be doing much x

[greygoose]

If it is lowered acid itself that causes or contributes to allergy risk, that seems an obvious possibility.

One of the first things I read, when I started learning about thyroid - I think it was in Mary Shomon's book 'Living Well with Hypothyroidism' - was that developing hypothyroidism could cause you to develop new allergies, or exacerbate old ones. And, that range a bell with me. Pretty certain I've been hypo since I was a child, and I was riddled with allergies. Now I'm adequately treated, they all seem to have disappeared. So, in light of what you've just said, to my mind it implies that my stomach acid level has now risen, dissipating the allergies. Maybe jumping to conclusions, but seem logical to me.

[FAB-jellybean]

That's really interesting helvella , thank you for sharing. Hypothyroidism and it's related low stomach acid would help to explain why I never had any allergies as a child. They only developed when I was an adult after my thyroid started causing me problems (hayfever and food allergies). I was later prescribed PPI drugs for gastritis after my fibromyalgia diagnosis and took them for about 5 years before finally managing to wean myself off them (that was difficult in itself). Can only imagine the issues that may have caused me. 😳

[helvella Administrator]

I just emailed the contact author of that paper to highlight low acidity in hypothyroidism might be doing the same.

I thought it might be interesting for them to consider a non-pharmaceutical and quite common cause of reduced stomach acid.

Not actually expecting any replies but will let you know if I get one.

[Alanna012 in reply to helvella]

That's great Helvella, thank you!

[Alanna012]

Well I'm going through a nasty case of chronic urticaria and asthma. Allergy is making breathing difficult as the reaction is inflaming my lungs.

Rang Asthma & Lung charity and was advised to go on PPI due to my previous history of gastric reflux (I do still get it albeit very mildly which to me means my stomach acid is very weak)

Was casually told I could 'come off them in a month'. Umm....no.... it's bloody hard to wean yourself off them, and there is a temporary upsurge in gastric acid after stopping.

Further, hypothyroidism is implicated in chronic urticaria and I fail to see how potentially reducing the ability of my body to break down food and extract and absorb vitamins would help that. I'm struggling to keep levels up already.

It is interesting that there is a strong association between asthma, gastric reflux, allergy, and hypothyroidism. They clearly need this info.

I'm quite shocked frankly that doctors are still wheeling out the 'too much acid' theory and not coming up with something to increase stomach acid strength (but then ppi's are huge sellers). Betaine, ox bile etc isn't enough to resolve the issue completely for some of us. My highest try is 8 tablets at one time!

This article is brilliant Helvella thanks for posting. I'll be keeping it on hand.

[helvella Administrator in reply to Alanna012]

That almost never is any attempt made to assess stomach acid!

It is so obvious that stomach acid is a vital protection against many things - lots of infections. As well as a major element in digestion.

(And I still wonder if lower stomach acidity then results in lowered alkalinity in the rest of the digestive system. With its consequences.)

[LindaC]

With dreadful heartburn, docs pushing this stuff... years back the GP looked stunned when I explained to him that I'd found drinking squeezed lemon juice [in water] works great for heartburn. I then also moved onto Betaine HCI with Pepsin [yes, adding acid again!] and rarely have heartburn these days, for years. Oh, sparkling water also seems to help.

[TSH110]

Glad I shoved the two packets I was given in the cupboard, they’re still there, unopened.

[Ullallah-6]

omeprazole made me feel so ill I stopped it after 4 days. Lanzoprazole i took for 9 months at my consultants insistence even though i didnt feel it worked enough. Thus I saw no reason to continue to use it.

[Titaniumfox]

Very interesting! I definitely had low stomach acid after developing hypothyroidism, to the point where I began getting reflux. Fortunately (thanks to this forum) I knew this would not be from high stomach acid, but a deficiency. However I didn't know how to 'fix' it apart from taking Betaine HCl with pepsin, which worked very well. I also had chronic allergies to many things, I used to take an antihistamine on a daily basis for a quarter of a century. About 2 years ago I began a protocol supplementing Iodine, Selenium and Molybdenum at RDA levels. Molybdenum proved to be a game-changer as my stomach acid problem suddenly resolved and I no longer needed Betaine HCl! This summer, despite people saying it's been 'terrible' for allergies, I have had NO hayfever and have actually come off antihistamines completely! Maybe this is the connection!

[helvella Administrator in reply to Titaniumfox]

How much molybdenum do you take?

[Titaniumfox in reply to helvella]

I take it in liquid form, it's around 350 mcg per day. Less isn't enough.

[helvella Administrator in reply to Titaniumfox]

Thank you. Interesting how little is made of molybdenum in general.

Did you get any benefits from a lower dose? Or was it a case of suddenly cutting in at 350?

[Titaniumfox in reply to helvella]

It was quite a sudden effect at around 300 mcg - I had to increase the dose a bit after a few weeks.

[helvella Administrator in reply to Titaniumfox]

Thanks again.

[Charlie-Farley]

Hi helvella

You make a good point and this paper is extremely interesting. The stomach lining when compromised can lead to ‘leaky gut’ and inflammation. I’m sure that has been part of my woes in the past. I was suffering terribly with ‘acid indigestion’ when initially diagnosed with hypothyroidism, but grossly under medicated.

Thankfully, advice on here steered me away from the ‘rocks’. I instead took the safe route. I dumped omeprazole, went gluten-free and literally within two weeks no longer had to sleep sitting up (so bad had the heartburn been).

So those membranes in the stomach are for a very selective passing of nutrients from the gut to the body’s tissues. Inevitably with leaky gut all sorts of substances leach into the body and the immune system responds. I had a tremendous amount of joint pain and general discomfort before I got to full therapeutic dose of levo.

It totally stands to reason that the overwhelmed immune system will backfire and kick off when exposed to things it perhaps never reacted to before. I suppose best analogy would be in the middle of a bar brawl it is perfectly possible to accidentally ‘right hook’ a friend in the chaos. Once observed but never joined in! 😂

I know two people who have developed serious (epi-pen) allergies - one person has multiple allergies and two pens for two different things 😱.

I’m seeing one of them next month all being well. I’m going to have to flag this.

This research is yet another that will go in my dossier! Thank you so much for sharing.

😊👍