Is my medication making me ill?

May 1, 2023 5:49 PM

I have some concerns that at least one medication is causing other issues. My doctor hand-waved my concerns away and I need to figure out if I am being one of "those" patients or if this is really worth pursuing further. You are not my doctor, etc, but if you have any advice it would be appreciated. Wall of text ahead...

I was taking Esomeprazole long-term for reflux - prescribed by a previous GP and with no obvious issues. I started taking Celecoxib two years ago after a serious fall.

About two years ago I suddenly went from having low iron (treated with over the counter supplements) to being very anemic, requiring iron infusions as the supplements stopped working. And after spending my entire life devoid of food allergies or intolerances, I also suddenly developed a fish allergy at roughly the same time.

I thought the anemia could possibly be caused by the Esomeprazole, as iron malabsorption is listed as a possible side effect. My doctor handwaved at me, per his usual MO, but has now switched me to a different anti-reflux med - nizatidine. I have had an endoscopy/colonoscopy and a variety of other tests - no cause for the anemia has been found. I'm due to have another blood test to check my iron levels shortly.

The allergy specialist I saw (who had a full list of my medications) simply said that food allergies were mysterious and could just turn up. A scratch test said that basically all fish (but mostly cod) will cause an allergic reaction - other seafood is fine. I ate fish regularly before being diagnosed and the allergist couldn't explain why I would only have a reaction to it randomly, and not every time I ate it. I now carry an Epipen at all times just in case but never had a worse reaction than vomiting (once) and hives (once).

Googling (yes, I'm aware of the problems with that) turns up at least one article referencing NSAID's like Celecoxib and increased food allergy reactions.

So my question is: Could the Celecoxib be causing one or both issues? I will be coming off it anyway due to other issues (I have inherited my fathers dodgy kidneys, apparently). And if I'm off it, is it worth seeing the allergist again and getting a second scratch test done to see if my reactions are reduced?

Or is the weird timing just a coincidence and I'm an idiot who should leave Dr Google alone?

posted by ninazer0 to Health & Fitness (11 answers total)

Not a medical expert, but to answer your question generally, there is not enough data to answer your question.

Even now, the human immune system is not fully understood. We know how it reacts in general, so we can feed it vaccines and such and have it develop antibodies, but we still don't quite understand how allergies, which are basically hypersensitivities to certain "allergens", develope, only that your immune system decided to react to it, but can't explain why it never did so before. As your allergy specialist said, food allergies are mysterious and can just turn up. Repeated exposure that was previously tolerated can flare up as we age. We've even seen cases where a tick bite turned into a meat allergy (AGS) (and how that works is still being researched).

While Celecoxib (a form of NSAID) is know for causing ulcers in stomach or intestine in some individuals, that is common with all NSAIDs, and you didn't mention any other medicine (and I assume both your pharmacist and doctor are aware of your medicines and possible interactions). Your doctor would know more about your iron intake profile and absorption profile than I would.

Given that there are no data of celecoxib could cause an allergy, and it's been on the market since 1999, I, personally doubt it could have caused your allergies.

Give that there is no consensus on the data, but more like LACK of data, there's no reason to believe that Celecoxib would have caused your allergies. There is a CHANCE that it could be causing small bleeds that's depleting your iron, but your doctor should be well aware of that and seems you're already being tested.

So I'd chalk it up to coincidence, unless you get more data that says otherwise.
posted by kschang at 6:22 PM on May 1, 2023

I developed food allergies (including a fish allergy!) after long-term Omeprazole use, and I do think the two were related. I heard a theory that the reduced acid production that occurs with a PPI means the food you’re digesting is less broken down than it was before, and you’re more likely to develop allergies. Maybe a doctor would dismiss that theory, but I didn’t need to find out — I told my doctor firmly that the Omeprazole was causing stomach pain and I wanted to switch drugs or taper off. I have found that rather than hoping my internet and/or intuition based theories will be validated I can just say I’m having side effects, this isn’t working, what else can we try.

I’m very sorry you’re having these issues, and I hope they’re resolved soon. Good luck!
posted by kate blank at 6:48 PM on May 1, 2023 [4 favorites]

Also not your medical expert but a long-time autoimmune patient who finally rolled off NSAIDs after 20+ years because I had an ER-worthy hive reaction to taking OTC NSAIDs. Allergies are mysterious things; nobody quite knows why your immune system decides to go haywire at a specific time. So agreed that there isn't enough information and you should chalk it up to coincidence unless you get more data.

Having said that I do have a suggestion for you in future: should you have the misfortune to have an allergic reaction that includes hives again, photograph the hives with your camera and show the pictures to your allergist. There's at least one other reaction that looks very similar to allergic hives but isn't and your allergist (but probably not your GP) can tell the difference by looking at the pictures.

Also unfortunately you're probably screwed on eating fish again, but I'm sure you knew that. Even if you knew what agitated your immune system to the point where it reacted to the fish, your allergist is probably going to tell you it's not safe to eat fish because once you've reacted to an allergen, you're more likely to react to it in the future. This is why I can't have any NSAIDs at all any more.
posted by gentlyepigrams at 6:49 PM on May 1, 2023 [1 favorite]

"My doctor handwaved at me, per his usual MO..."

You deserve a doctor who takes your concerns seriously and partners with you to find a solution to the issues you're experiencing. They would try different options and keep an open mind.
posted by brookeb at 7:08 PM on May 1, 2023 [7 favorites]

What kind of anemia do you have? Microcytic, macrocytic, hemolytic, etc? What iron studies have been done? IIRC NSAIDS are associated with allergy and with other immunological reactions. I doubt it caused your fish allergy. But wondering about the anemia- if there is bleeding. Yes, Cox-2 inhibitors are supposed to be easier on gi tract and associate blood loss, but they still cause an increased risk.
posted by [insert clever name here] at 7:45 PM on May 1, 2023

NYTimes a week ago, Why Do Some People Develop Allergies in Adulthood?

My doctor/ nurse practitioner are quite blasé about potential allergies, which caused me quite a bit of trouble last year, Some doctors are quite happy to prescribe meds before looking for a cause. If you have a good pharmacist, talk to them; they apecialize in medications and are a great resource.
posted by theora55 at 8:37 PM on May 1, 2023 [1 favorite]

You need your stomach acids to break down foods, break out some minerals from compounds, and to protect you from infection. Drop the meds and read up on controlling reflux with simple, mechanical diet measures, small meals, no liquid right before bed. Repair your biome, get some probiotics to retune your digestive system. You can get anemia from proton pump inhibitors because your stomach acids are too weak to break the iron out of vegetables.
posted by Oyéah at 9:21 PM on May 1, 2023 [1 favorite]

Response by poster: You deserve a doctor who takes your concerns seriously...

Yes, but this is a rural area and the choice is small and many are not taking new patients. I am trying to figure out if it's worth going back to a previous doctor near my old home, which is more more than a two hour round trip, and who doesn't do weekends.

What kind of anemia do you have?

News to me that there are flavours! However, having a look at the fine print of my last blood test I find the phrase "Hypochromic, microcytic red cells."

Drop the meds and read up on controlling reflux with simple, mechanical diet measures...

I'm trying, believe me. However the only thing that has worked so far has been the proton pump inhibitors. I'm trying to find a way forward without those but for the moment, here we are.
posted by ninazer0 at 10:28 PM on May 1, 2023

I take omeprazole long term for reflux (it hurts to eat anything if I don't take it) and I've had on and off issues with anaemia too (and issues getting doctors to give a shit or believe me - it's very frustrating and I'm sorry it's happening to you too). I don't have an answer to your medication questions, but switching from elemental iron to heme iron supplements has solved the anaemia issues for me, and given me back a lot of energy, while still taking the omeprazole.
posted by terretu at 10:40 PM on May 1, 2023 [1 favorite]

I was prescribed a similar drug (PANTOPRAZOLE) but my doctor warned me it should not be taken long term. I can't remember now exactly whats side effects it has so I don't know if this is helpful. But she definitely said I should only see it as a short term (max 6 months) fix for the reflux problems because of the long term side effects.
posted by EllaEm at 9:33 AM on May 2, 2023

Ooops, I meant to reply. So sounds like iron deficient anemia. Which can come from
- Iron loss/blood loss
- Dietary deficiencies
- Poor absorption

If you are a woman and get monthly periods, this is the most likely cause. We didn't evolve to have periods as often as we do, so the blood loss adds up.

I have had good luck with the supplement Hemaplex, and taking an additional 500mg of vitamin c on the days I take Hemaplex. I also take with fiber. I also take every other day, because pulsing like that theoretically causes the regulatory hormone (hepcidin) to go down in that intervening day, and therefore increase absorption.

Also, lots of people don't like this, but I've always found red meat to be the fastest way for me to raise my iron levels. :/

I have iron issues. I am on a PPI. I really thought it was the PPI, but I also had iron problems prior to the PPI so really, it was finding what work. It got bad when I had a copper IUD and heavy bleeding made it EXTREMELY difficult to budge my iron stores (serum ferritin). Once I had it removed, it finally started to go up a bit.

There is also a connection to thyroid and serum ferritin levels. I can't recall the mechanism now, but mumble mumble years ago, when I was hypothyroid, also could not raise my levels. Once I was diagnosed and put on thyroid meds, iron supplements worked and my serum ferritin when up.

Consider the above, but do keep in mind the other issues, it still COULD be the PPI (but probably not) and be concerned about blood loss, mostly in the form of GI bleeds.

If you are AMAB or don't have periods/suppress periods, then much of this doesn't apply and its a bigger deal that you have anemia and other causes should be looked at.

I don't actually know it has anything to do with the allergy other than what I said about NSAIDs and allergies. But I dunno.
posted by [insert clever name here] at 10:00 PM on May 2, 2023