Proton pump inhibitors (PPIs) are a group of medications commonly used to treat symptoms caused by excessive stomach acid. The most common PPIs available in the U.S. are Nexium (i.e., esomeprazole), Protonix (i.e., pantoprazole), Prilosec (i.e., omeprazole), Prevacid (i.e., lansoprazole), Aciphex (i.e., rabeprazole), and Dexilant (i.e., dexlansoprazole). These medications act by reducing the amount of acid secretion produced by the parietal cells in the lining of the stomach. In addition to lifestyle and dietary modifications, they are usually the first line medications prescribed to treat common conditions such as gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), erosive esophagitis, Zollinger-Ellison syndrome, and peptic ulcers (duodenal or stomach ulcers). GERD is commonly referred to as “heartburn” by the general public. These PPIs are also used in combination with corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and/or some antibiotics to protect the stomach.
These medications are considered relatively safe and some are also available over the counter. Even though they are available over the counter, there are side effects, particularly if used long-term. Some of the more common side effects may include headaches, rashes, fever, abdominal pain, nausea, vomiting, diarrhea, constipation, lightheadedness, and change in or unpleasant taste. Long-term use has been linked to osteoporosis (i.e., thinning of the bones) which may lead to bone fractures. Other more severe side effects may include acute interstitial nephritis (i.e., kidney failure), lupus, pneumonia, low magnesium levels, muscle spasms, heart palpitations, and clostridium difficile-associated diarrhea, to name a few.
In addition to the side effects of PPIs, there have been a few recent publications that have reported their association with possible allergic reactions.
In an article published in The Journal of Allergy and Clinical Immunology: In Practice, the authors reported serious allergic reactions in five patients receiving PPIs. These patients developed allergic reactions within 30 to 60 minutes of taking the medications orally. One patient developed a more rapid reaction after receiving the drug intravenously.
All patients were subsequently evaluated for sensitivity to PPIs using skin prick testing and intradermal skin testing techniques. All patients showed positive reactions indicating an immediate allergic sensitivity that was mediated by the IgE antibody.
When patients develop life-threatening anaphylactic reactions, foods and insect stings are usually thought to be the causative agents as medications other than penicillins cause anaphylaxis very rarely. However, this report highlights the need for a high index of suspicion for medications such as PPIs being the culprits in causes of anaphylaxis.
A more recent publication in the journal Nature Communications, the authors reported an increase in allergic symptoms in patients receiving PPIs on a regular basis. The data revealed that people taking PPIs for any reason had a two-to-three times higher chance of receiving prescriptions for medications used to treat allergies at a later date.
Stomach acid is needed for proper digestion of ingested food. It contains various enzymes which help break down the complex proteins in the food before they are further processed. It also protects the digestive system from infections caused by bacteria and other harmful substances.
Reducing the acid production by PPIs can impede the proper digestion of proteins. PPIs also alter the microbiome of the stomach. Consequently harmful proteins and other substances can get absorbed into the bloodstream unchallenged. This has the potential to weaken the natural defense mechanisms and can either cause or aggravate allergic sensitization to certain foods and environmental triggers.
The authors of this publication caution people not to use acid suppressor medications any longer than absolutely necessary.
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