Systematic review and meta‐analysis: Effect ofHelicobacter pylorieradication on chronic spontaneous urticaria

Abstract

Background Helicobacter pylori (HP) infection is considered to play a role in the pathogenesis of chronic spontaneous urticaria (CSU). However, the efficacy of HP eradication therapy on CSU symptom improvement has not been well established. This meta‐analysis was conducted to estimate the association between HP infection and CSU and to evaluate whether HP eradication therapy benefits patients with CSU. Material and Methods In October 2018, we searched databases for studies investigating the efficacy of HP eradication therapy for patients with CSU. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using random effects models. Results The meta‐analysis included 22 studies with a total of 1385 patients with CSU. When comparing the spontaneous remission of urticarial symptom in patients with HP‐positive to HP‐negative patients, HP‐negative patients showed significantly higher spontaneous remission of urticarial symptoms. (risk ratio 0.39; 95% confidence interval: 0.19‐0.81). Among HP‐positive CSU patients, remission of CSU was more likely shown in HP eradication therapy group compared to untreated group, aside from achieving HP elimination (risk ratio 2.10; 95% confidence interval: 1.20‐3.68). However, there was no significant difference in the remission of CSU whether antibiotic therapy was successful in eradication of HP or not (risk ratio 1.00; 95% confidence interval: 0.65‐1.54). Conclusions The results of this meta‐analysis show that HP might be associated with the occurrence and persistence of CSU. The effectiveness of HP eradication therapy in suppressing CSU symptoms was significant. Interestingly, we found that resolution of CSU was not associated with successful eradication of HP infection. CSU Patients who were undergone antibiotic therapy for HP eradication showed significant higher CSU remission with or without HP eradication. Further studies are recommended to evaluate the mechanisms associated with relation of HP with CSU.

Efficacy of Helicobacter pylori eradication on recovery of chronic urticaria

“…24 Gaig's 11 27 Kim et al deduced that patients who were undergone antibiotic therapy for H. pylori eradication showed significant higher urticaria remission with or without H. pylori eradication. 28 In the present study with participation of 120 patients of CU, 40 cases (33.3%) had H. pylori infection and 80 subjects (66.6%) tested negative for H. pylori on UBT. The 40 cases (consisting of 12 male and 28 female individuals) received anti H. pylori medications, then underwent repeat UBT.…”

Increase of tissue factor expression on the surface of peripheral monocytes of patients with chronic spontaneous urticaria

“…Skin-specific molecules, such as mas-related G-proteincoupled receptor member X2 (MRGPRX2) expressed by mast cells only in the skin, may also be necessary for wheal formation in urticaria. In any case, it is noteworthy that TF expression on endothelial cells, but not monocytes, may be inhibited by H 1 -antihistamines and, thus, may account for the pathomechanism of CSU refractory to H 1 -antihistamines.An association of chronic infection and CSU has been described for a long time, and the eradication of Helicobacter pylori may bring about resolution of urticaria 9. In this study, LPS and FLA-ST more efficiently enhanced TF expression than Pam3CSK4 and HKLM.…”

Review: Extragastric diseases andHelicobacter pylori

“…41 Another recent meta-analysis found that in H pylori-positive patients, antibiotic treatment induced chronic spontaneous urticaria remission independently of H pylori eradication. 42 In a prospective study, 57 consecutive patients (27 pityriasis versicolor, 30 telogen effluvium) screened for anti-H pylori and anti-CagA IgG, showed significantly higher rates of H pylori positivity in the pityriasis versicolor group than in the telogen effluvium group (P < .05). The number of patients with dyspeptic complaints was also higher in the pityriasis versicolor group than in the telogen effluvium group.…”

“…6 A systematic review evaluated the relationship between H pylori infection and obesity among Chinese adults. The prevalence of H pylori was 42% (95% CI, [37][38][39][40][41][42][43][44][45][46][47] and mean difference of BMI between subjects with and without H pylori infection was 0.94 (95% CI, −0.04 to 1.91). The OR value was 1.20 (95% CI, 1.13-1.…”