Positive Effect of Helicobacter pylori Treatment on Outcome of Patients With Chronic Spontaneous Urticaria

• Published in: American journal of clinical pathology 2021-02, Vol.155 (3), p.405-411
• Main Authors: Elhendawy, Mohammed, Hagras, Maha M, Soliman, Shaimaa S, Shaker, Engi Seif E
• Format: Article
• Language: English
• Subjects: Adult; Aged; Amoxicillin - therapeutic use; Anti-Bacterial Agents - therapeutic use; Chronic Urticaria - microbiology; Clarithromycin - therapeutic use; Double-Blind Method; Drug Therapy, Combination - methods; Female; Helicobacter Infections - complications; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Male; Middle Aged; Omeprazole - therapeutic use; Pilot Projects; Proton Pump Inhibitors - therapeutic use; Treatment Outcome; Young Adult
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqaa134

Abstract Objectives The association between Helicobacter pylori and chronic spontaneous urticaria (CSU) is controversial. Therefore, we aimed to directly diagnose H pylori by polymerase chain reaction (PCR) in gastric tissue from patients with CSU and to investigate the association between H pylori eradication therapy and CSU remission. Methods Twenty-seven of 72 patients with CSU who were positive for H pylori stool antigen and PCR in gastric biopsy specimens were randomized to receive either anti–H pylori treatment or placebo. Results Patients with H pylori were found to have significantly lower hemoglobin concentrations with microcytic hypochromic anemia and a significantly higher occurrence of dyspepsia symptoms. All H pylori–treated patients (except two) showed significant improvement of the urticaria itching and red wheals after 2 weeks of therapy compared with the placebo group (P < .001). The response rate to treatment was 85.7% (12 patients; 95% confidence interval, 64.3%-100.0%). The two patients who failed to eradicate H pylori had an H pylori strain resistant to amoxicillin. Conclusions An association was observed between CSU and presence of H pylori infection in the gastric tissue. Whether this is a causal relationship or not remains to be discovered, but treatment of H pylori can significantly improve the symptoms of CSU.