Skip to main content
SpringerLink
Log in

Effects of Helicobacter pylori Eradication in Chronic Spontaneous Urticaria: Results from a Retrospective Cohort Study

  • Original Research Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Background and Objective

Helicobacter pylori (Hp) infection has been hypothesised to play a major role in the pathogenesis of chronic spontaneous urticaria (CSU). Despite only weak evidence from Hp eradication studies, screening for Hp infection is still recommended in several CSU guidelines. The aim of this study was to investigate the effect of Hp eradication in combination with standard CSU treatment in Hp-positive compared with Hp-negative patients, applying the latest guidelines for both diseases.

Methods

138 consecutive patients with CSU were enrolled in this retrospective cohort study. All patients underwent gastroscopy and Hp status was determined by urease testing and histologic examination. Seventy-five patients were diagnosed as Hp negative and 47 patients fulfilled criteria for definite Hp infection, 45 of whom received eradication therapy. Sixteen patients who received eradication therapy without an appropriate indication served as the medication control. All patients received symptomatic treatment with antihistamines and/or glucocorticoids regardless of Hp status. Partial response (PR) was defined as subjective amelioration of CSU symptoms; patients returning for further CSU treatment within 6 months were considered non-responders/relapsers (NRs).

Results

The prevalence of Hp infection was comparable with Hp seroprevalence data reported for healthy western populations. Standard treatment of CSU led to relief of symptoms independent of Hp status. Hp eradication by standard triple therapy had no additional effect on PR (p = 0.32) or NR (p = 0.50).

Conclusions

Hp eradication has no discernible effect on CSU beyond that of standard CSU therapy. Therefore, Hp eradication should only be initiated in accordance with currently accepted indications of Hp treatment guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Greaves MW. Chronic urticaria. N Engl J Med. 1995;332(26):1767–72.

    Article  CAS  PubMed  Google Scholar 

  2. Maurer M, Bindslev-Jensen C, Gimenez-Arnau A, Godse K, Grattan CE, Hide M, et al. Chronic idiopathic urticaria (CIU) is no longer idiopathic: time for an update [letter]. Br J Dermatol. 2013;168(2):455–6.

    Article  CAS  PubMed  Google Scholar 

  3. Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Greaves MW. Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med. 1993;328(22):1599–604.

    Article  CAS  PubMed  Google Scholar 

  4. Kikuchi Y, Kaplan AP. Mechanisms of autoimmune activation of basophils in chronic urticaria. J Allergy Clin Immunol. 2001;107(6):1056–62.

    Article  CAS  PubMed  Google Scholar 

  5. Leznoff A, Sussman GL. Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity: a study of 90 patients. J Allergy Clin Immunol. 1989;84(1):66–71.

    Article  CAS  PubMed  Google Scholar 

  6. Grattan CE, Wallington TB, Warin RP, Kennedy CT, Bradfield JW. A serological mediator in chronic idiopathic urticaria–a clinical, immunological and histological evaluation. Br J Dermatol. 1986;114(5):583–90.

    Article  CAS  PubMed  Google Scholar 

  7. Yamanishi S, Iizumi T, Watanabe E, Shimizu M, Kamiya S, Nagata K, et al. Implications for induction of autoimmunity via activation of B-1 cells by Helicobacter pylori urease. Infect Immun. 2006;74(1):248–56.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Wotherspoon AC, Ortiz-Hidalgo C, Falzon MR, Isaacson PG. Helicobacter pylori-associated gastritis and primary B-cell gastric lymphoma. Lancet. 1991;338(8776):1175–6.

    Article  CAS  PubMed  Google Scholar 

  9. Di Campli C, Gasbarrini A, Nucera E, Franceschi F, Ojetti V, Sanz TE, et al. Beneficial effects of Helicobacter pylori eradication on idiopathic chronic urticaria. Dig Dis Sci. 1998;43(6):1226–9.

    Article  PubMed  Google Scholar 

  10. Wedi B, Wagner S, Werfel T, Manns MP, Kapp A. Prevalence of Helicobacter pylori-associated gastritis in chronic urticaria. Int Arch Allergy Immunol. 1998;116(4):288–94.

    Article  CAS  PubMed  Google Scholar 

  11. Magen E, Mishal J, Schlesinger M, Scharf S. Eradication of Helicobacter pylori infection equally improves chronic urticaria with positive and negative autologous serum skin test. Helicobacter. 2007;12(5):567–71.

    Article  CAS  PubMed  Google Scholar 

  12. Ojetti V, Armuzzi A, De Luca A, Nucera E, Franceschi F, Candelli M, et al. Helicobacter pylori infection affects eosinophilic cationic protein in the gastric juice of patients with idiopathic chronic urticaria. Int Arch Allergy Immunol. 2001;125(1):66–72.

    Article  CAS  PubMed  Google Scholar 

  13. Yadav MK, Rishi JP, Nijawan S. Chronic urticaria and Helicobacter pylori. Indian J Med Sci. 2008;62(4):157–62.

    Article  PubMed  Google Scholar 

  14. Maurer M, Magerl M, Metz M, Zuberbier T. Revisions to the international guidelines on the diagnosis and therapy of chronic urticaria. J Dtsch Dermatol Ges. 2013;11(10):971–8.

    Article  PubMed  Google Scholar 

  15. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, European Academy of Allergy and Clinical Immunology, Global Allergy and Asthma European Network, European Dermatology Forum, World Allergy Organization, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69(7):868–87.

    Article  CAS  PubMed  Google Scholar 

  16. Konstantinou GN, Asero R, Maurer M, Sabroe RA, Schmid-Grendelmeier P, Grattan CE. EAACI/GA(2)LEN task force consensus report: the autologous serum skin test in urticaria. Allergy. 2009;64(9):1256–68.

    Article  CAS  PubMed  Google Scholar 

  17. Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection–the Maastricht IV/Florence Consensus Report. Gut. 2012;61(5):646–64.

    Article  CAS  PubMed  Google Scholar 

  18. Fischbach W, Malfertheiner P, Hoffmann JC, Bolten W, Bornschein J, Gotze O, et al. S3-guideline “Helicobacter pylori and gastroduodenal ulcer disease” [in German]. Z Gastroenterol. 2009;47(1):68–102.

    Article  CAS  PubMed  Google Scholar 

  19. Everhart JE, Kruszon-Moran D, Perez-Perez GI, Tralka TS, McQuillan G. Seroprevalence and ethnic differences in Helicobacter pylori infection among adults in the United States. J Infect Dis. 2000;181(4):1359–63.

    Article  CAS  PubMed  Google Scholar 

  20. Federman DG, Kirsner RS, Moriarty JP, Concato J. The effect of antibiotic therapy for patients infected with Helicobacter pylori who have chronic urticaria. J Am Acad Dermatol. 2003;49(5):861–4.

    Article  PubMed  Google Scholar 

  21. Fukuda S, Shimoyama T, Umegaki N, Mikami T, Nakano H, Munakata A. Effect of Helicobacter pylori eradication in the treatment of Japanese patients with chronic idiopathic urticaria. J Gastroenterol. 2004;39(9):827–30.

    Article  PubMed  Google Scholar 

  22. Gaig P, Garcia-Ortega P, Enrique E, Papo M, Quer JC, Richard C. Efficacy of the eradication of Helicobacter pylori infection in patients with chronic urticaria. A placebo-controlled double blind study. Allergol Immunopathol (Madr). 2002;30(5):255–258.

  23. Giamarellos-Bourboulis EJ. Immunomodulatory therapies for sepsis: unexpected effects with macrolides. Int J Antimicrob Agents. 2008;32(Suppl 1):S39–43.

    Article  CAS  PubMed  Google Scholar 

  24. Zuberbier T, Asero R, Bindslev-Jensen C, Walter CG, Church MK, Gimenez-Arnau A, et al. EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64(10):1417–26.

    Article  CAS  PubMed  Google Scholar 

  25. Greaves MW, Tan KT. Chronic urticaria: recent advances. Clin Rev Allergy Immunol. 2007;33(1–2):134–43.

    Article  CAS  PubMed  Google Scholar 

  26. Bakos N, Fekete B, Prohaszka Z, Fust G, Kalabay L. High prevalence of IgG and IgA antibodies to 19-kDa Helicobacter pylori-associated lipoprotein in chronic urticaria. Allergy. 2003;58(7):663–7.

    Article  CAS  PubMed  Google Scholar 

  27. Amedei A, Bergman MP, Appelmelk BJ, Azzurri A, Benagiano M, Tamburini C, et al. Molecular mimicry between Helicobacter pylori antigens and H+, K+–adenosine triphosphatase in human gastric autoimmunity. J Exp Med. 2003;198(8):1147–56.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Schnyder B, Helbling A, Pichler WJ. Chronic idiopathic urticaria: natural course and association with Helicobacter pylori infection. Int Arch Allergy Immunol. 1999;119(1):60–3.

    Article  CAS  PubMed  Google Scholar 

  29. Erel F, Sener O, Erdil A, Karaayvaz M, Gur G, Caliskaner Z, et al. Impact of Helicobacter pylori and Giardia lamblia infections on chronic urticaria. J Investig Allergol Clin Immunol. 2000;10(2):94–7.

    CAS  PubMed  Google Scholar 

  30. Dauden E, Jimenez-Alonso I, Garcia-Diez A. Helicobacter pylori and idiopathic chronic urticaria. Int J Dermatol. 2000;39(6):446–52.

    Article  CAS  PubMed  Google Scholar 

  31. Hellmig S, Troch K, Ott SJ, Schwarz T, Folsch UR. Role of Helicobacter pylori infection in the treatment and outcome of chronic urticaria. Helicobacter. 2008;13(5):341–5.

    Article  CAS  PubMed  Google Scholar 

  32. Valsecchi R, Pigatto P. Chronic urticaria and Helicobacter pylori. Acta Derm Venereol. 1998;78(6):440–2.

    Article  CAS  PubMed  Google Scholar 

  33. Wustlich S, Brehler R, Luger TA, Pohle T, Domschke W, Foerster E. Helicobacter pylori as a possible bacterial focus of chronic urticaria. Dermatology. 1999;198(2):130–2.

    Article  CAS  PubMed  Google Scholar 

  34. Shakouri A, Compalati E, Lang DM, Khan DA. Effectiveness of Helicobacter pylori eradication in chronic urticaria: evidence-based analysis using the Grading of Recommendations Assessment, Development, and Evaluation system. Curr Opin Allergy Clin Immunol. 2010;10(4):362–9.

    PubMed  Google Scholar 

  35. Magen E, Schlesinger M, Hadari I. Chronic urticaria can be triggered by eradication of Helicobacter pylori. Helicobacter. 2013;18(1):83–7.

    Article  PubMed  Google Scholar 

  36. Selgrad M, Meissle J, Bornschein J, Kandulski A, Langner C, Varbanova M, et al. Antibiotic susceptibility of Helicobacter pylori in central Germany and its relationship with the number of eradication therapies. Eur J Gastroenterol Hepatol. 2013;25(11):1257–60.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

      Harald-Morten Curth, Johanna Dinter, Kerstin Nigemeier, Fabian Kütting & Hans-Michael Steffen

    2. Department of Dermatology and Venerology, University Hospital of Cologne, Cologne, Germany

      Nicolas Hunzelmann

    Authors
    1. Harald-Morten Curth
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Johanna Dinter
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Kerstin Nigemeier
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Fabian Kütting
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Nicolas Hunzelmann
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Hans-Michael Steffen
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Harald-Morten Curth.

    Ethics declarations

    Funding

    No sources of funding were used to assist in the preparation of this study.

    Conflict of interest

    H.-M. Curth, J. Dinter, K. Nigemeier, F. Kuetting, N. Hunzelmann and H.-M. Steffen declare that they have no conflicts of interest relevant to the content of this manuscript

    Ethical approval

    Written informed consent from the participants and a consent of the local ethics committee were not obtained. In accordance with German law, a votum of a local ethics committee is not required to conduct strictly retrospective studies (paragraph 15, sentence 1, Nordrhein Medical Association’s professional code of conduct from 14 November 1998 as amended on 19 November 2011). There is also no need to get written informed consent from the participants if the considered data was collected and analysed retrospectively (paragraph 6, sentence 1, Health Data Protection Act of Nordrhein-Westfalen).

    Additional information

    H.-M. Curth and J. Dinter contributed equally.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Curth, HM., Dinter, J., Nigemeier, K. et al. Effects of Helicobacter pylori Eradication in Chronic Spontaneous Urticaria: Results from a Retrospective Cohort Study. Am J Clin Dermatol 16, 553–558 (2015). https://doi.org/10.1007/s40257-015-0152-6

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s40257-015-0152-6

    Keywords

    Search

    Navigation