Prevalence of Helicobacter pylori–Associated Gastritis in Chronic Urticaria

Abstract

Background: Chronic urticaria and concurrent angioedema are frustrating problems for both physicians and patients. Methods: 100 patients with chronic urticaria (mean duration 33.3±48.2 months) attending the urticaria consulting hour of our Department of Dermatology within 1 year were carefully analyzed for pathogenesis to avoid extensive unnecessary diagnostic approach in the future. Results: In 43 cases a potential infectious trigger could be identified, 35 were of idiopathic origin, and 15 demonstrated pseudoallergic reactions to acetylsalicylic acid or food additives, 5 had antibodies to thyroid gland, and 2 had malignant diseases. Of patients with foci, 26 had Helicobacter pylori–associated gastritis, 9 chronic tonsillitis or sinusitis, 4 infections with Epstein–Barr virus or cytomegalovirus, 2 dental focal infections and 2 suffered from Yersinia infection. High prevalence of H. pylori gastritis was found since 47% of patients showed elevated H. pylori–specific IgA and/or IgG antibodies. 27 patients underwent endoscopy and in all but 1 (96%) antral H. pylori infection was found. In contrast, a prevalence rate of 37% among asymptomatic adults has been published. Disappearance (67%) or improvement of urticaria (24%) occurred in most antimicrobially treated patients after 3–12 weeks. In contrast, only 50% of untreated H. pylori–seropositive patients with chronic urticaria showed spontaneous remission or improvement within 12 weeks. Prevalence of H. pylori infection may even be underestimated since only 27/100 patients underwent endoscopy. It is suggested that H. pylori infection may be present at least in all seropositive subjects (47%). Moreover, we found H. pylori infection in 2 seronegative subjects demonstrating gastric complaints. Conclusions: Thus, measurement of H. pylori–specific antibodies and/or gastroscopy should be included in the diagnostic management of chronic urticaria to identify patients who may profit from eradication treatment with disappearance of long–standing and annoying urticaria symptomatology.

Chronic urticaria and <i>Helicobacter pylori</i>

“…This is in concordance with previous studies, which have shown resolution of urticaria after HP eradication therapy. [3,5] However the role of HP as an eliciting factor for CIU is still controversial. While several authors have suggested a possible role of HP in the pathogenesis of CIU, [3,4] other have shown no correlation between treatment and remission of urticaria.…”

“…[3,5] However the role of HP as an eliciting factor for CIU is still controversial. While several authors have suggested a possible role of HP in the pathogenesis of CIU, [3,4] other have shown no correlation between treatment and remission of urticaria. [5,6] A recent study in Japanese university students showed that allergic diseases are negatively associated with HP infection especially in men.…”

“…[3] Recent observations have suggested a possible etiopathogenic role of HP in some cases of CU. [4][5][6][7] However there has been no Indian study on possible association between HP and CU.…”

GastricHelicobacterInfection Inhibits Development of Oral Tolerance to Food Antigens in Mice

“…Indeed, the association between H. pylori infection and food allergy (8,16) as well as with other allergic diseases like chronic urticaria (12,35), atopic dermatitis (31), and hereditary angioneurotic edema was suggested, although contradictory results have been obtained (24,26). The main factor which argues against this association is the Th1/Th2 paradigm.…”

“…Data coming from follow-up studies show that, after H. pylori eradication, in a subset of patients, chronic gastritis persists for months or even years (19,39), without a satisfactory explanation for this phenomenon. On the other hand, some data suggest a positive association between H. pylori infection and the development of food allergy (8,16) and other allergic manifestations (31,35) in humans. We have previously shown that H. pylori increases absorption of antigens across the digestive epithelium in vitro (29) and also across the gastric mucosa in vivo in mice (28) and in humans (T. Matysiak-Budnik et al, submitted for publication).…”