Chronic pruritus associated withHelicobacter pylori

  • Roshini Kandyil
  • Nadia S. Satya
  • Robert A. Swerlick
Basic/Clinical Science

Abstract

Background

Helicobacter pylori is an established cause of gastritis and has been implicated in extradigestive diseases.

Objective

To investigate the role ofH. pylori in patients with unexplained refractory pruritus.

Methods

Ten patients with severe pruritus unresponsive to conventional therapy were evaluated for activeH. pylori infection byH. pylori serology followed by either esophagogastroduodenoscopy (EGD) or urea breath test. Of the 10 patients, 8 were found to have active infection. All 10 received anti-H. pylori antibiotic therapy and were reevaluated for relief of pruritus.

Results

Of 8 patients with activeH. pylori infection, 87.5% (7/8) had some type of pruritus relief after triple therapy. Of these, 62.5% (5/8) had complete relief and 25% (2/ 8) had temporary relief of pruritus. The remaining 12.5% (1/8) did not respond. Two control patients without activeH. pylori infection had no relief of pruritus with therapy.

Conclusions

We have identified a population of patients with refractory pruritus and activeH. pylori infection whose pruritus resolved after eradication ofH. pylori.

Sommaire

Antécédents

Helicobacter pyloriest une cause confirmee de gastrite, jouant également un rôle dans des maladies non digestives.

Objectif

Explorer le rôle deH. pylori chez les patients atteints de prurit réfractaire inexpliqué.

Méthodes

Dix sujets souffrant de prurit intense et ne réagissant pas à la thérapie conventionnelle ont été évalués. Une sérologie a été effectuée pour identifier une infection active aH. pylori. Par la suite, soit une Œsophago-gastro-duodenoscopie, soit un test respiratoire à l’urée a été pratiqué. Parmi les dix sujets, huit (8) avaient une infection active. Les dix ont reçu une antibiothérapie contreH. pylori et le degré de soulagement du prurit a été évalué par la suite.

Résultats

Parmi les huit patients souffrant d’une infection active àH. pylori, 87,5% (7/ 8) ont manifesté un certain degré de soulagement du prurit à la suite d’une triple therapie. De ce nombre, 62,5% (5/8) ont été complètement guéris et 25% (2/8) temporairement soulagés de leur prurit. Le reste, soit 12,5% ou 1/8, n’a pas réagi. Deux patients témoins n’ayant pas une infection active àH. pylori n’ont pas montré des signes de soulagement du prurit.

Conclusion

Nous avons identifié une population de patients ayant une infection active àH. pylori dont le prurit réfractaire.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bohmeyer J, Heller A, Hartig C, et al. Association of chronic urticaria withHelicobacter pylori-induced antrum gastritis. Hautarzt 1996; 47:106–108CrossRefPubMedGoogle Scholar
  2. 2.
    Delpre G, Livni E, Niv Y. Urticaria during triple therapy forHelicobacter pylori infection: clinical implications. Dig Dis Sci 1997; 42:728–730CrossRefPubMedGoogle Scholar
  3. 3.
    Tebbe B, Geilen CC, Schulzke JD, et al.Helicobacter pylori infection and chronicurticaria. J Am Acad Dermatol 1996; 34:685–686CrossRefPubMedGoogle Scholar
  4. 4.
    Dooley CP, Cohen H, Fitzgibbons PL, et al. Prevalence ofHelicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med 1989; 321:1562–1566PubMedGoogle Scholar
  5. 5.
    De Lazzari F, Mancin O, Plebani M, et al. High IgE serum levels and “peptic” ulcers: clinical and functional approach. Ital J Gastroenterol 1994; 26(1):7–11PubMedGoogle Scholar
  6. 6.
    Nilsson I, Lindgren S, Eriksson S, et al. Serum antibodies toHelicobacter hepaticus and chronic liver disease. Gut 2000; 46(3): 410–414CrossRefPubMedGoogle Scholar
  7. 7.
    Christophers E. Chronic urticaria andHelicobacter pylori. Dtsch Med Wochenschr 1996; 121:885PubMedGoogle Scholar
  8. 8.
    Howden CW. No evidence for an association betweenH. pylori and idiopathic chronic urticaria. Dig Dis Sci 1999; 44:485–486CrossRefPubMedGoogle Scholar
  9. 9.
    Kalas D, Pronai L, Ferenczi K, et al. Connection betweenHelicobacter pylori infectionand chronic gastrointestinal urticaria. Orv Hetil 1996; 137:1969–1972PubMedGoogle Scholar
  10. 10.
    Valsecchi R, Pigatto P. Chronic urticaria andHelicobacter pylori. Acta Derm Venereol 1998; 78:440–442CrossRefPubMedGoogle Scholar
  11. 11.
    Wedi B, Wagner S, Werfel T, et al. Prevalence ofHelicobacter pylori-associated gastritis in chronic urticaria. Int Arch Allergy Immunol 1998; 116:288–294CrossRefPubMedGoogle Scholar
  12. 12.
    Liutu M, Kalimo K, Uksila J, et al. Etiologic aspects of chronic urticaria. Int J Dermatol 1998; 37:515–519CrossRefPubMedGoogle Scholar
  13. 13.
    Lutton D, Bamford K, O’Loughlin B, et al. Modulatory action ofHelicobacter pylori on histamine release from mast cells and basophils in vitro. J Med Microbiol 1995; 42(96):386–393CrossRefPubMedGoogle Scholar
  14. 14.
    Ozkaya-Bayazit E, Demir K, Ozguroglu E, et al.Helicobacter pylori eradication in patients with chronic urticaria. Arch Dermatol 1998; 134:1165–1166CrossRefPubMedGoogle Scholar
  15. 15.
    Schrutka-Koelbl C, Wasilewicz-Stephani G, Gschwantler M, et al. Has eradication therapy an effect in Helicobacter-positive patients with chronic urticaria? Am J Gastroenterol 1998; 93:2632–2633CrossRefPubMedGoogle Scholar
  16. 16.
    Rais M, Unzeitig J, Grant JA. Refractory exacerbations of hereditary angioedema with associatedHelicobacter pylori infection. J Allergy Clin Immunol 1999; 103:713–714CrossRefPubMedGoogle Scholar
  17. 17.
    Rebora A, Drago F, Parodi A. MayHelicobacter pylori be important for dermatologists? Dermatology 1995; 191:6–8CrossRefPubMedGoogle Scholar
  18. 18.
    Schnyder B, Helbling A, Pichler WJ. Chronic idiopathic urticaria: natural course and association withHelicobacter pylori infection. Int Arch Allergy Immunol 1999; 119:60–63CrossRefPubMedGoogle Scholar
  19. 19.
    Tebbe B, Geilen CC, Orfanos CE. Detection ofHelicobacter pylori in dermatoses. Clinical incidental finding or pathogenetic association? Hautarzt 1996; 47:587–590CrossRefPubMedGoogle Scholar
  20. 20.
    Deuell B, Arruda L, Hayden M, et al.Trichophyton tonsurans allergen. I. Characterization of a protein that causes immediate but not delayed hypersensitivity. J Immunol 1991; 147(1):96–101PubMedGoogle Scholar
  21. 21.
    Ward G, Karlsson G, Rose G, et al. Trichophyton asthma: sensitization of bronchi and upper airways to dermatophyte antigen. Lancet 1989; 1(8643):859–862CrossRefPubMedGoogle Scholar
  22. 22.
    Kurbel S, Kurbel B. The role of gastric mast cells, enterochromaffin-like cells andparietal cells in the regulation of acid secretion. Med Hypotheses 1995; 45(6):539–542CrossRefPubMedGoogle Scholar
  23. 23.
    Slunt J, Taketomi E, Platts-Mills T. Human T-cell responses toTrichopbyton tonsurans: inhibition. Clin Exp Allergy 1997; 27(10):1184–1192CrossRefPubMedGoogle Scholar
  24. 24.
    Woodfolk J, Platts-Mills T. The immune response to dermatophytes. Res Immunol 1998; 149(4-5):436–435CrossRefPubMedGoogle Scholar
  25. 25.
    Wustlich S, Brehler R, Luger TA, et al.Helicobacter pylori as a possible bacterial focus of chronic urticaria. Dermatology 1999; 198:130–132CrossRefPubMedGoogle Scholar
  26. 26.
    Woodfolk J, Slunt J, Deuell B, et al. Definition of a Trichophyton protein associated with delayed hypersensitivity to a single protein. J Immunol 1996; 156(4):1695–1701PubMedGoogle Scholar
  27. 27.
    Woodfolk J, Wheatley L, Piyasena R, et al. Trichophyton antigens associated with IgE antibodies and delayed type hypersensitivity. Sequence to two families of serineproteinases. J Biol Chem 1998; 273(45):29489–29496CrossRefPubMedGoogle Scholar
  28. 28.
    Aceti A, Celestino D, Caferro M, et al. Basophil-bound and serum immunoglobulin E directed againstHelicobacter pylori in patients with chronic gastritis. Gastroenterology 1991; 101(1):131–137PubMedGoogle Scholar
  29. 29.
    Becker H, Meyer M, Paul E. Remission ratio of chronic urticaria—“spontaneous” healing or result of eradication ofHelicobacter pylori? Hautarzt 1998; 49:907–911CrossRefPubMedGoogle Scholar
  30. 30.
    Di Campli C, Gasbarrini A, Nucera E, et al. Beneficial effects ofHelicobacter pylori eradication on idiopathic chronic urticaria. Dig Dis Sci 1998; 43:1226–1229CrossRefPubMedGoogle Scholar
  31. 31.
    Figura N, Perrone A, Gennari C, et al. CagA-positiveHelicobacter pylori infection may increase the risk of food allergy development. J Physiol Pharmacol 1999; 50(5):827–831PubMedGoogle Scholar
  32. 32.
    Bernhard J. Itch-mechanisms and management of pruritus. In: Carmichael A ed. Systemic Aspects of Pruritus. New York: McGraw-Hill, pp 217-319Google Scholar
  33. 33.
    Odom R, James W, Berger T. Pruritus and neurocutaneous diseases. In: Grekin R, Samlaska C, Vin-Christian K eds. Andrew’s Diseases of the Skin, Clinical Dermatology, 9th ed. Philadelphia: W.B. Saunders, pp 49-55Google Scholar
  34. 34.
    Greaves M, Wall P. Pathophysiology and clinical aspects of pruritus. In: Freedberg I, Eisen A, Wolff K, et al, eds. Fitzpatricks’ Dermatology in Clinical Medicine, 5th ed. New York: McGrawHill, pp 487-493Google Scholar
  35. 35.
    Barrow M, Bird E. Pruritus in hyperthyroidism. Arch Dermatol 1966; 93:237–238CrossRefPubMedGoogle Scholar
  36. 36.
    Brumpt L. Pruritus. Presse Med 1952; 60:1397–1397PubMedGoogle Scholar
  37. 37.
    Colrat A(1920-1921) L’adenie eosinophiliqueprurigene-lymphogranulomatose. These de Lyon, p 282Google Scholar
  38. 38.
    Weinberg F. Lymphogranuloma tuberculosum. Z Klin Med 1917; 85:99Google Scholar
  39. 39.
    Winkelmann R, Muller S. Pruritus. Ann Rev Med 1964; 15:53–64CrossRefPubMedGoogle Scholar
  40. 40.
    Becker S, Kahn D, Rothman S. Cutaneous manifestations of internal malignant tumors. Arch Dermatol Syph 1942; 45:1069–1080Google Scholar
  41. 41.
    Beare J. Generalized pruritus, a study of 43 cases. Clin Exp Dermatol 1976; 1:343–352CrossRefPubMedGoogle Scholar
  42. 42.
    Leontiadis G, Sharma V, Howden C, et al. Non-gastrointestinal tract associations ofHelicobacter pylori infection: what is the evidence? Arch Int Med 1999; 129(9):925–940CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Roshini Kandyil
    • 1
  • Nadia S. Satya
    • 2
  • Robert A. Swerlick
    • 2
  1. 1.University of Texas-Houston Medical SchoolHoustonUSA
  2. 2.Department of DermatologyEmory University School of MedicineAtlantaUSA

Personalised recommendations