Clinicoepidemiologic Features of Chronic Urticaria in Patients with versus without Subclinical <b><i>Helicobacter pylori</i></b> Infection: A Cross-Sectional Study of 150 Patients

Abstract

Background: The Helicobacter pylori infection is linked to chronic urticaria in nearly 60% of patients. We studied clinicoepidemiologic features in patients with chronic urticaria with and without H. pylori infection. Methods: Endoscopic antral biopsy for the rapid urease test (RUT) and histopathology, and serum IgG ELISA for H. pylori infection were performed in 150 patients (male:female ratio 1:2.4) of chronic urticaria aged 18-68 years. Clinicoepidemiologic features including age, gender, age of onset and duration, frequency and distribution of wheals, urticaria severity score, and systemic symptoms were analyzed in patients with and without H. pylori. The results of serum IgG ELISA for H. pylori were compared with 106 age- and gender-matched healthy adult controls. Results: The RUT in 84 patients (56%), histopathology in 76 patients (50.6%), and H. pylori IgG ELISA in 94 patients (62.6%) were positive. H. pylori IgG ELISA was positive only in 35 (33%) controls, suggesting that chronic urticaria patients were more likely to have asymptomatic H. pylori infection than normal controls. Although not statistically significant, patients with H. pylori had a higher mean urticaria severity score, number of urticaria/angioedema episodes per year, and involvement of more body sites, particularly the scalp, palms, and soles. The constitutional or gastrointestinal symptoms were statistically higher in patients with H. pylori infection than those without it. Conclusion: A subset of chronic urticaria patients appears to have asymptomatic H. pylori infection. However, its implications in chronicity, recurrences, the severity of urticaria, other systemic manifestations, and management remains conjectural in view of 33% of controls also having positive H. pylori ELISA and the endemicity of infection in developing countries.

Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria

“…In regards to the role of helicobacter infection the precise significance of this infection in precipitating and/or aggravating CSU has oscillated over the years. More recent work suggests that asymptomatic infection is more frequent in CSU patients than in healthy controls and in helicobacter infection positive patients the severity and extent of the urticaria may be more severe [52].…”

The Effects of Antibiotics for Helicobacter pylori Eradication or Dapsone on Chronic Spontaneous Urticaria: A Systematic Review and Meta-Analysis

“…H. pylori infection is thought to have a potential trigger for CUS, and it is thus searched during the diagnostic work-up of CSU, even though the epidemiological/clinical evidence is not very strong, or at least inconsistent [30,31]. In the present systematic review and meta-analyses, antibiotic therapy for H. pylori eradication increased the remission rate and induced improvement in CSU with few adverse events.…”

Latin American chronic urticaria registry (CUR) contribution to the understanding and knowledge of the disease in the region

“…Multiple infections were associated with chronic urticaria 11, 12. From results shown in Table 1, there were minimal frequencies of association with viral infections like hepatitis and HIV, or H. pylori infection; there was a remarkable frequency of Mycoplasma spp IgG positive test in one third of tested patients.…”

“…We have previously reported 2 patients having Treponema infection and chronic urticaria, which faded out when proper antibiotics were given 14 . The importance of Helicobacter pylori presence remains controversial in CU 12 …”