People with chronic urticaria have chronic hives, itching, and wheels that come and go for long periods. Chronic spontaneous urticaria (CSU) represents 80 – 90 % of chronic urticaria cases, and the release of histamine and other inflammatory mediators from mast cells and basophils may be immunoglobulin E (IgE)–mediated or non-IgE-mediated. Helicobacter pylori is a gram-negative bacterium with a high prevalence worldwide, and that persistently colonizes the stomach. Its presence is associated with an increased risk of peptic ulcer and gastric cancer.

The association between H pylori and chronic spontaneous urticaria has been controversial. A recent study assesses the relationship between H pylori eradication therapy and CSU remission.  A randomized, double-blind, placebo-controlled pilot study that included 72 patients with urticaria. From these, 27 were positive for H pylori stool antigen and PCR in gastric biopsy and were randomly assigned to receive anti-H pylori treatment or placebo.

Participants with H pylori had significantly lower hemoglobin concentrations with microcytic hypochromic anemia and a significantly higher occurrence of dyspepsia symptoms. All H pylori patients (except 2) had significant improvement of the urticaria itching and red wheals after 2weeks of therapy compared to placebo.

This study showed an association between chronic spontaneous urticaria and the presence of H pylori in the gastric tissue.

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. 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. Authors recommend that patients with urticaria who do not respond to usual chronic urticaria treatment should be tested for H pylori as therapy of H pylori showed to improve the symptoms of chronic spontaneous urticaria.

© American Society for Clinical Pathology, 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.