Prevalence of Helicobacter pylori–Associated Gastritis in Chronic UrticariaWedi B.a · Wagner S.b · Werfel T.a · Manns M.P.b · Kapp A.a
Departments of aDermatology and Allergology and bGastroenterology and Hepatology, Hannover Medical University, Hannover, Germany
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Background: Chronic urticaria and concurrent angioedema are frustrating problems for both physicians and patients. Methods: 100 patients with chronic urticaria (mean duration 33.3±48.2 months) attending the urticaria consulting hour of our Department of Dermatology within 1 year were carefully analyzed for pathogenesis to avoid extensive unnecessary diagnostic approach in the future. Results: In 43 cases a potential infectious trigger could be identified, 35 were of idiopathic origin, and 15 demonstrated pseudoallergic reactions to acetylsalicylic acid or food additives, 5 had antibodies to thyroid gland, and 2 had malignant diseases. Of patients with foci, 26 had Helicobacter pylori–associated gastritis, 9 chronic tonsillitis or sinusitis, 4 infections with Epstein–Barr virus or cytomegalovirus, 2 dental focal infections and 2 suffered from Yersinia infection. High prevalence of H. pylori gastritis was found since 47% of patients showed elevated H. pylori–specific IgA and/or IgG antibodies. 27 patients underwent endoscopy and in all but 1 (96%) antral H. pylori infection was found. In contrast, a prevalence rate of 37% among asymptomatic adults has been published. Disappearance (67%) or improvement of urticaria (24%) occurred in most antimicrobially treated patients after 3–12 weeks. In contrast, only 50% of untreated H. pylori–seropositive patients with chronic urticaria showed spontaneous remission or improvement within 12 weeks. Prevalence of H. pylori infection may even be underestimated since only 27/100 patients underwent endoscopy. It is suggested that H. pylori infection may be present at least in all seropositive subjects (47%). Moreover, we found H. pylori infection in 2 seronegative subjects demonstrating gastric complaints. Conclusions: Thus, measurement of H. pylori–specific antibodies and/or gastroscopy should be included in the diagnostic management of chronic urticaria to identify patients who may profit from eradication treatment with disappearance of long–standing and annoying urticaria symptomatology.
- Champion RH, Roberts SO, Carpenter RG, Roger JH: Urticaria and angio–oedema. A review of 554 patients. Br J Dermatol 1969;81: 588–597.
- Sabroe RA, Greaves MW: The pathogenesis of chronic idiopathic urticaria. Arch Dermatol 1997;133:1003–1008.
Charlesworth EN: Urticaria and angioedema: A clinical spectrum. Ann Allergy Asthma Immunol 1996;76:484–495; quiz 495–499.
- Soter NA: Acute and chronic urticaria and angioedema. J Am Acad Dermatol 1991;25:146– 154.
- 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 (see comments). N Engl J Med 1993;328: 1599–1604.
- Leznoff A, Sussman GL: Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity: A study of 90 patients. J Allergy Clin Immunol 1989;84:66–71.
- Gruber BL, Baeza ML, Marchese MJ, Agnello V, Kaplan AP: Prevalence and functional role of anti–IgE autoantibodies in urticarial syndromes. J Invest Dermatol 1988;90:213–217.
Wedi B, Elsner J, Kapp A: In vitro diagnosis of pseudoallergic reactions – New aspects. Allergy Clin Immunol Int 1996;8:113–115.
- Zuberbier T, Chantraine–Hess S, Hartmann K, Czarnetzki BM: Pseudoallergen–free diet in the treatment of chronic urticaria. A prospective study (see comments). Acta Derm Venereol 1995;75:484–487.
- Weber RW: Food additives and allergy. Ann Allergy 1993;70:183–190.
- Gibson A, Clancy R: Management of chronic idiopathic urticaria by the identification and exclusion of dietary factors. Clin Allergy 1980: 10:699–704.
- Michaelsson G, Juhlin L: Urticaria induced by preservatives and dye additives in food and drugs. Br J Dermatol 1973;88:525–532.
- Machet L, Vaillant L, Machet MC, Buchler M, Lorette G: Schönlein–Henoch purpura associated with gastric Helicobacter pylori infection (letter). Dermatology 1997;194:86.
- Tebbe B, Geilen CC, Schulzke JD, Bojarski C, Radenhausen M, Orfanos CE: Helicobacter pylori infection and chronic urticaria. J Am Acad Dermatol 1996;34:685–686.
- Rebora A, Drago F, Parodi A: May Helicobacter pylori be important for dermatologists? Dermatology 1995;191:6–8.
- Reinauer S, Megahed M, Goerz G, Ruzicka T, Borchard F, Suasanto F, Reinauer H: Schönlein–Henoch purpura associated with gastric Helicobacter pylori infection. J Am Acad Dermatol 1995;33:876–879.
- Feldman RA, Deeks JJ, Evans SJ: Multi–laboratory comparison on eight commercially available Helicobacter pylori serology kits. Helicobacter pylori Serology Study Group. Eur J Clin Microbiol Infect Dis 1995;14:428–433.
- Andersen LP, Raskov H, Elsborg L, Holck S, Justesen T, Fischer Hansen B, Moller Nielsen C, Gaarslev K: Prevalence of antibodies against heat–stable antigens from Helicobacter pylori in patients with dyspeptic symptoms and normal persons. APMIS 1992;100:779–789.
- Wagner S, Gebel M, Haruma K, Bär W: Bismuth subsalicylate in the treatment of H2 blocker resistant duodenal ulcers: Role of Helicobacter pylori. Gut 1992;33:179–183.
- Agrèus L, Engstrand L, Svardsudd K, Nyren O, Tibblin G: Helicobacter pylori seropositivity among Swedish adults with and without abdominal symptoms. A population–based epidemiologic study. Scand J Gastroenterol 1995; 30:752–757.
- Quaranta JH, Rohr AS, Rachelefsky GS, Siegel SC, Katz RM, Spector SL, Mickey MR: The natural history and response to therapy of chronic urticaria and angioedema. Ann Allergy 1989;62:421–424.
- Zuberbier T, Ifflander J, Semmler C, Henz BM: Acute urticaria: Clinical aspects and therapeutic responsiveness. Acta Derm Venereol 1996;76:295–297.
- Pristautz H, Eherer A, Brezinschek R, Truschnig–Wilders M: Prevalence of Helicobacter pylori antibodies in the serum of gastroenterologists in Austria. Endoscopy 1994;26: 690–696.
- Halasz CLG: Helicobacter pylori antibodies in patients with psoriasis. Arch Dermatol 1996; 132:95–96.
- Blecker U, Lanciers S, Hauser B, Mehta DI: Serology as a valid screening test for Helicobacter pylori infection in asymptomatic subjects. Arch Pathol Lab Med 1995;119:30–32.
- Valle J, Seppälä K, Sipponen P, Kosunen T: Disappearance of gastritis after eradication of Helicobacter pylori. Scand J Gastroenterol 1991;26:1057–1065.
- Miehlke S, Byerdorffer E, Lehn M, Mannes GA: Two–year follow–up of duodenal ulcer patients treated with omeprazole and amoxicillin. Digestion 1995;56:187–193.
- Bagchi D, Bhattacharya G, Stohs SJ: Production of reactive oxygen species by gastric cells in association with Helicobacter pylori. Free Radic Res 1996;24:439–450.
- Crabtree JE, Farmery SM, Lindley IJ, Figura N: CagA/cytotoxic strains of Helicobacter pylori and interleukin–8 in gastric epithelial cell lines. J Clin Pathol 1994;47:945–950.
- Wagner S, Haruma K, Gladziwa U, Soudah B, Gebel M, Bleck J, Schmidt H, Manns M: Helicobacter pylori infection and serum pepsinogen A, pepsinogen C, and gastrin in gastritis and peptic ulcer: Significance of inflammation and effect of bacterial eradication. Am J Gastroenterol 1994;89:1211–1218.
- Engstrand L, Gustavsson S, Schwan A, Scheynius A: Local and systemic immune response in Helicobacter pylori–associated chronic gastritis before and after treatment. Scand J Gastroenterol 1993;28:1105–1111.
- Satoh K, Kimura K, Yoshida Y, Kasano T: Relationship between Helicobacter pylori colonization and acute inflammation of the duodenal mucosa. Am J Gastroenterol 1993;88:360– 363.
- Yoshida N, Granger DN, Evans DJ, Evans DG: Mechanisms involved in Helicobacter pylori–induced inflammation. Gastroenterology 1993; 105:1431–1440.
- Geis G, Leying H, Suerbaum S, Opferkuch W: Unusual fatty acid substitution in lipids and lipopolysaccharides of Helicobacter pylori. J Clin Microbiol 1990;28:930–932.
Bosso JV, Simon RA: Food allergy, adverse reactions to food and food additives; in Metcalfe DD, Sampson HA, Simon RA (eds): Urticaria, Angioedema and Anaphylaxis Provoked by Food Additives. Boston Blackwell, 1991, pp 288–300.
- Pollock I, Young E, Stoneham M, Slater N, Wilkinson JD, Warner JO: Survey of colourings and preservatives in drugs. BMJ 1989; 299:649–651.
Kosunen TU, Mégraud F: Diagnosis of Helicobacter pylori. Curr Opin Gastroenterol 1995; 11(suppl 1):5–10.
- Ormerod AD: Urticaria: Recognition, causes and treatment. Drugs 1994;48:717–730.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.