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Prevalence of Helicobacter pylori-associated gastritis in chronic urticaria
1Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany.
Insights
Chronic urticaria may be linked to Helicobacter pylori infection. Testing for H. pylori and treating infections can significantly improve or resolve chronic urticaria symptoms.
Area of Science:
- Immunology
- Gastroenterology
- Dermatology
Background:
- Chronic urticaria and angioedema present significant challenges for clinicians and patients.
- Identifying the underlying cause of chronic urticaria is crucial for effective management.
Purpose of the Study:
- To analyze the pathogenesis of chronic urticaria in a cohort of patients.
- To determine the prevalence of potential triggers, particularly infectious agents like Helicobacter pylori.
- To evaluate the efficacy of eradication treatment for H. pylori in patients with chronic urticaria.
Main Methods:
- 100 patients with chronic urticaria were analyzed over one year.
- Diagnostic approaches included serological testing for H. pylori and gastroscopy.
- Treatment outcomes were monitored after antimicrobial therapy for identified infections.
Main Results:
- Infectious triggers were identified in 43% of patients, with Helicobacter pylori gastritis being the most common (26%).
- Elevated H. pylori-specific antibodies were found in 47% of patients, with 96% of those undergoing endoscopy showing infection.
- Antimicrobial treatment led to symptom disappearance or improvement in 91% of patients with H. pylori infection.
Conclusions:
- Measurement of H. pylori-specific antibodies and/or gastroscopy should be part of chronic urticaria diagnosis.
- Identifying and treating H. pylori infection can lead to the resolution of chronic urticaria.
- This diagnostic approach can help patients with long-standing urticaria symptoms.
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.