Urticaria and bacterial infections

Abstract

The association between urticaria and infectious diseases has been discussed for >100 years. However, a causal relationship with underlying or precipitating infection is difficult to establish. The purpose of this work was to perform a systematic analysis of the published cases of urticaria associated with bacterial infections. We give an umbrella breakdown of up-to-date systematic reviews and other important publications on the complex association of urticaria and bacterial infections. We did a Medline search, for English language articles published until January 2014, using the key words "urticaria" and "bacteria/bacterial disease"; a second analysis was performed in groups of bacteria and using each germ name as a key word. Many bacterial infections have been associated with urticaria manifestation, such as Helicobacter pylori, Streptococcus, Staphylococcus, Mycoplasma pneumonia, Salmonella, Brucella, Mycobacterium leprae, Borrelia, Chlamydia pneumonia, and Yersinia enterocolitica. In some cases the skin manifestations, described as urticaria, could be caused by the presence of the microorganism in the skin, or for the action of their toxins, or to the complement activation mediated by circulating immune complexes. Although only a weak association with urticaria of unclear pathogenesis exists, clinicians should consider these bacterial agents in the workup of the patients with urticaria. The eradication of the infection could, in fact, lead to the resolution of urticaria. Prospective studies and well-structured research are obviously needed to better clarify the real role of bacteria in the pathogenesis of urticaria and their relative prevalence.

Urticaria in children and adolescents: An updated review of the pathogenesis and management

“…Recent data also suggest that HHV‐6 and other human herpesviruses could play a role as cofactors in chronic urticaria . The link between hepatitis virus infections and episodes of acute and chronic urticaria has been confirmed and is the most frequently reported association in adults, but not in children …”

“…Only in one‐third of cases, antibiotic therapy leads to complete resolution of skin symptoms. A small amount of patients showed only partial improvement, indicating that S. aureus can be a trigger and aggravating factor …”

“…Helicobacter pylori infection is the most frequently mentioned bacterial infection in the context of chronic urticaria, although its role still remains controversial . The frequency of active H. pylori infection in children with chronic urticaria is lower than in adults and varies, according to different references, from 2% to 18% .…”

“…45 The link between hepatitis virus infections and episodes of acute and chronic urticaria has been confirmed and is the most frequently reported association in adults, but not in children. 46,47 The association with Mycoplasma pneumoniae is frequent, especially in children with acute urticaria. 48,49 Chlamydia pneumonia is less often reported as cause of acute, recurrent and chronic urticaria.…”

Allergic rhinitis: From discernment of symptoms to implementation of new therapeutic modalities

“…12,13 In particular, a causal relationship between the long-suspected role of infection with urticaria, has been difficult to establish. Minciullo et al 14 perform a systematic analysis of published cases of urticaria associated with bacterial infection and although they report finding only a weak association, recommend that clinicians should continue to consider bacterial infection in the diagnostic work-up of patients with urticaria.…”