Role of Helicobacter pylori in chronic ordinary urticaria: a case-control and therapeutic study

Background: The term ‘urticaria’ is used to describe a disease that may present with wheals, angioedema or both. It is considered chronic when the attacks last 6 weeks. A possible association between chronic urticaria and Helicobacter pylori infection (H. pylori) was suggested by a systematic review of therapeutic studies. Aim of the study: To investigate the role of H. pylori in patients with chronic ordinary urticaria and to evaluate the effect of H. pylori eradication on the clinical course of chronic urticaria. Patients and methods: A prospective case- control and therapeutic study was conducted on 135 patients with chronic ordinary urticaria and 186 apparently normal matched controls. All subjects were tested for H. pylori stool antigen and the presence of gastrointestinal symptoms was recorded. This followed by therapeutic study on a subgroup of patients with positive stool antigen test to assess the effect of triple eradication therapy of H. pylori including amoxicillin 1gm twice daily, clarithromycin 500mg twice daily and omeprazole 20mg twice daily for two weeks on the course of chronic urticaria by following them for six months using three points rating scale and the need for H1 blocker antihistamine as rescue medicine. Results: H. pylori stool antigen test was positive in 164(51.1%) subjects of the studied population, where 86 (63%) of patients with chronic urticaria have positive stool antigen test versus 78 (41%) among the control group with astatically significant difference(p value 0.001, odd ratio 2.4). It was also observed that 91 (68.4%) %) out of 133 subjects with gastrointestinal symptoms had actually positive H. pylori infection using stool antigen test, this suggested that gastric symptoms and H. pylori infection was statistically associated (P 0.001). Only 52 patients with chronic urticaria and positive H. pylori stool antigen test were completed the six months follow up period. The response to eradication therapy (complete remission + partial remission) was evident in 42 (80.8%) patients, that was found to be statistically significant (p value = 0.019) by comparing them with 10(19.2%) patients with no objective response. In general, no significant adverse effect was reported. Conclusions 1. There is a statistically significant association of Helicobacter pylori infection with chronic urticaria 2. Eradication of H. pylori is a valid therapeutic option for patients with chronic ordinary urticaria and positive stool antigen test as it induces complete and partial remission in 80.8% of the cases.