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Objective: To describe a case of chronic urticaria in a female adolescent associated with Helicobacter pylori infection, confirmed in two different occasions, with improvement of urticaria after the antibacterial treatment.Case description: A 13-year-old female patient sought medical care with chronic urticaria and epigastric pain unresponsive to medical treatment. Laboratorial tests for further investigation were normal except for the upper gastrointestinal endoscopy with biopsy showing moderate chronic active gastritis associated with Helicobacter pylori. After specific and appropriate treatment, the patient had remission of the symptoms. A new upper gastrointestinal endoscopy to control the treatment after nine months was normal. After five years, the patient returned with recurrence of urticaria and epigastric pain. She was taking antihistamines, without any improvement. It was again submitted to screening protocol for chronic urticaria with normal results. She was submitted to upper gastrointestinal endoscopy, which showed positive urease test. The patient started a new treatment for Helicobacter pylori with disappearance of chronic urticaria and epigastric pain within seven days.Comments: The reported case suggests a causal relationship between the positive diagnosis of Helicobacter pylori and the occurrence of chronic urticaria, showing the remission of symptoms after the institution of effective therapy for this agent. Chronic urticaria is a disease of complex etiology, and although controversial, there is growing evidence of Helicobacter pylori involvement with extraintestinal diseases, including chronic urticaria.Key-words: urticaria; Helicobacter pylori; adolescent. RESUMOObjetivo: Descrever, em uma adolescente do sexo feminino, o caso clínico de urticária crônica associado à infecção por Helicobacter pylori confirmado em dois momentos distintos, com melhora após a terapêutica antibacteriana.Descrição do caso: Paciente do sexo feminino, 13 anos, procurou atendimento médico com urticária crônica e dores epigástricas sem resposta ao tratamento medicamentoso. Os exames solicitados para investigação complementar apresentaram-se normais, exceto a endoscopia digestiva alta com biópsia, que evidenciou gastrite crônica ativa moderada associada ao Helicobacter pylori. Foi iniciado o tratamento adequado para a bactéria em questão e a paciente apresentou remissão dos sintomas. Nova endoscopia digestiva alta para controlar o tratamento após nove meses estava normal. Cinco anos depois, a paciente procurou novamente o ambulatório queixando-se de retorno do quadro de urticária e dores epigástricas. Ela se encontrava em uso de anti-histamínico, sem melhora. Foi novamente submetida a protocolo de exames para investigar urticária crônica, com resultados dentro da normalidade. Foi submetida à endoscopia digestiva alta, que apresentou teste da urease positivo. Iniciou-se então novo tratamento para Helicobacter pylori por sete dias, com desaparecimento da urticária crônica e das dores epigástricas.Comentários: O c...
Objective: To describe a case of chronic urticaria in a female adolescent associated with Helicobacter pylori infection, confirmed in two different occasions, with improvement of urticaria after the antibacterial treatment.Case description: A 13-year-old female patient sought medical care with chronic urticaria and epigastric pain unresponsive to medical treatment. Laboratorial tests for further investigation were normal except for the upper gastrointestinal endoscopy with biopsy showing moderate chronic active gastritis associated with Helicobacter pylori. After specific and appropriate treatment, the patient had remission of the symptoms. A new upper gastrointestinal endoscopy to control the treatment after nine months was normal. After five years, the patient returned with recurrence of urticaria and epigastric pain. She was taking antihistamines, without any improvement. It was again submitted to screening protocol for chronic urticaria with normal results. She was submitted to upper gastrointestinal endoscopy, which showed positive urease test. The patient started a new treatment for Helicobacter pylori with disappearance of chronic urticaria and epigastric pain within seven days.Comments: The reported case suggests a causal relationship between the positive diagnosis of Helicobacter pylori and the occurrence of chronic urticaria, showing the remission of symptoms after the institution of effective therapy for this agent. Chronic urticaria is a disease of complex etiology, and although controversial, there is growing evidence of Helicobacter pylori involvement with extraintestinal diseases, including chronic urticaria.Key-words: urticaria; Helicobacter pylori; adolescent. RESUMOObjetivo: Descrever, em uma adolescente do sexo feminino, o caso clínico de urticária crônica associado à infecção por Helicobacter pylori confirmado em dois momentos distintos, com melhora após a terapêutica antibacteriana.Descrição do caso: Paciente do sexo feminino, 13 anos, procurou atendimento médico com urticária crônica e dores epigástricas sem resposta ao tratamento medicamentoso. Os exames solicitados para investigação complementar apresentaram-se normais, exceto a endoscopia digestiva alta com biópsia, que evidenciou gastrite crônica ativa moderada associada ao Helicobacter pylori. Foi iniciado o tratamento adequado para a bactéria em questão e a paciente apresentou remissão dos sintomas. Nova endoscopia digestiva alta para controlar o tratamento após nove meses estava normal. Cinco anos depois, a paciente procurou novamente o ambulatório queixando-se de retorno do quadro de urticária e dores epigástricas. Ela se encontrava em uso de anti-histamínico, sem melhora. Foi novamente submetida a protocolo de exames para investigar urticária crônica, com resultados dentro da normalidade. Foi submetida à endoscopia digestiva alta, que apresentou teste da urease positivo. Iniciou-se então novo tratamento para Helicobacter pylori por sete dias, com desaparecimento da urticária crônica e das dores epigástricas.Comentários: O c...
Chronic urticaria (CU) is characterised by the recurrence of hives/angioedema for >6 weeks. It affects children and adults and has a worldwide distribution. In children, CU is substantially less common than acute urticaria but is associated with larger decrease in quality of life. The current classification divides CU into two groups: 1) chronic spontaneous urticaria, which includes idiopathic urticaria (by far the most common type), autoimmune urticaria, and those associated with drugs, food, or additives allergies; and 2) chronic inducible urticaria, constituted by cholinergic urticaria and physical urticarias. Diagnosis of CU is based on the history and characteristics of the lesions. Although laboratory and specific testing could establish the diagnosis of some subtypes of CU, frequently the aetiology is never found; therefore, an extensive workup is not recommended. Once the trigger has been identified, it must be avoided. Specific treatment may be tried, but unfortunately this is not always possible. Currently, the first-line treatment for children with CU are second generation H1-antihistamines (SG-H1AH), such as cetirizine, fexofenadine, desloratadine, and rupatadine, among others. If, after 2–4 weeks, the patient has not improved, an increment from 2 to 4-times the regular dose is recommended. Patients that fail to respond to this treatment may be switched to another SG-H1AH or a second agent, such as H2-antihistamines (e.g., cimetidine, ranitidine), ketotifen, cyclosporine, or a leukotriene receptor inhibitor (e.g., montelukast), may be added to the H1-antihistamine therapy. Recently, omalizumab, an anti-immunoglobin-E monoclonal antibody has been approved in several jurisdictions for patients 12 years or older with recalcitrant CU; however, its high cost has limited its use.
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