Gastric acid inhibitors tied to increased risk for developing allergies

By Megan Brooks

NEW YORK (Reuters Health) - 31/7/2019

Gastric acid inhibitors increase the risk of developing allergies, according to an analysis of more than eight million health records from Austria.

The analysis found a "highly significant increase in prescription of drugs relieving allergic symptoms in patients who were on treatment with gastric acid inhibitors of any class," the study team reported online July 30 in Nature Communications.

"Research data emerging over the last decades further indicate that anti-ulcer drugs may directly promote allergic symptoms. Our findings confirm an epidemiological association between gastric acid suppression and development of allergic symptoms, in line with previous mechanistic animal trials and human observational studies," write Dr. Erika Jensen-Jarolim from Medical University of Vienna and colleagues.

They analyzed prescription data from health insurance records covering 97% of the population of Austria between 2009 and 2013. Overall, they found that people using prescription gastric acid inhibitors were about two to three times more likely to need anti-allergy medication. These findings were more prominent in women and those over age 60 and occurred for all assessed gastric acid-inhibitor classes.

"Since all analyzed acid inhibitor drug classes (proton pump inhibitors, sucralfate, H2-receptor antagonists, prostaglandin E2) correlated with increased prescription rates for anti-allergic medication, the mechanism appears to be based on gastric pH modulation in general rather than on a particular drug-specific mode of action," write the researchers.

As few as six daily doses per year were sufficient to increase the risk for subsequent anti-allergic medication use. "This finding implies that the underlying effect is unleashed early on after first acid-inhibiting drug utilization," they note.

Results of a recent mouse study by the researchers suggest that PPIs induce type 2 hypersensitivity via an impact on microbiota. "The data suggest that by various antigen-specific, innate and adjuvant mechanisms, anti-ulcer drugs shape a Th2 environment making people prone to develop IgE-mediated hypersensitivity requiring anti-allergy medication," they write.

Overall, the findings suggest the need for caution in prescribing gastric acid inhibitors, Dr. Jensen-Jarolim told Reuters Health by email. Doctors need to "not only prescribe, but also discontinue treatments when healing is achieved," she said.

"We think that considering the high prevalence of antacid intake, there is a contribution to the allergy epidemic," she added.

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: https://go.nature.com/2K6Otgv

Nat Comm 2019.

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