Positive Effect of Helicobacter pylori Treatment on Outcome of Patients With Chronic Spontaneous Urticaria: A Randomized Double-Blind Pilot Study

• Published in: American journal of clinical pathology Vol. 155; no. 3; pp. 405 - 411
• Main Authors: Elhendawy, Mohammed, Hagras, Maha M, Soliman, Shaimaa S, Shaker, Engi Seif E
• Format: Journal Article
• Language: English
• Published: Chicago Oxford University Press 01-03-2021
• Subjects: Amoxicillin; Anemia; Antibiotics; Antigens; Biopsy; Care and treatment; Dyspepsia; Eradication; Helicobacter infections; Helicobacter pylori; Hemoglobin; Medical research; Medicine, Experimental; Patient outcomes; Penicillin; Placebos; Polymerase chain reaction; Pruritus; Remission; Urticaria; Egypt
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/AJCP/AQAA134

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. Key Words: Spontaneous urticaria; Stool Ag; Helicobacter pylori; PCR; Resistant strains; Amoxicillin