ABSTRACT
Urticaria is a vascular reaction characterized by transient erythematous or pale swellings of skin and/or mucous membrane representing localized edema caused by dilatation and increased permeability of capillaries and venules result in leakage of plasma into the surrounding connective tissue, marked by development of wheals. If edematous process extends through the dermis into subcutaneous or sub mucous tissue it results in angioedema. Wheats and angioedema often coexist in the same patient but may occur separately. During the last few years some authors reported their experience about cases of CIU related to presence of Helicobacter pylori [Hp] infection. Hp is a micro aerophilic gram positive bacterium, periodic infection with which is associated with reduced gastric acidity secretion where as chronic infection with Hp is associated with increased secretion of acid and pepsin. However recent study found that no relation between Hp infection autoantibody productions in CIU could be proved using direct measures of serum antibodies. Was to evaluate the role of autoimmunity and Helicobacter pylori infection in cases of chronic idiopathic urticaria. Forty patients with chronic urticaria [recurrent hives lasting 4 to 36 hours occurring at least four times/ week for six weeks] were enrolled for this study. All patients were subjected to the following: history taking included, general examination, skin examination, routine laboratory tests and specific tests included: Autologous Serum Skin Test [ASST], Antithvroicl peroxidase autoantibody test [TPO] and Helicobacter pylori IgG antibody test. Forty patients with age ranged between 17 and 58 years, the highest frequency was encountered in age group of 21- 30 years. The control subjects were age matched ranged between 18 and 50 years. Routine laboratory investigations showed no significant findings in CBC, SGPT, serum creatinine, urinalysis and stool analysis. Only ESR was significantly higher in cases of CIU than in control subjects in both first and second hour. Moreover, ESR was significantly higher in patients with positive ASST than those with negative ASST in both hours. The ASST was positive in 4 patients [10%] all of them were females, and negative in 36 patients [90%]. Serum level of TPO was significantly higher in patients with positive ASST than those with negative ASST. Hp IgG level in the sera of patients with CIU did not reveal a significant difference with that of the control subjects. The gastroscopic examination revealed that 55% of patients with CIU had Hp gastritis [only 25 out of 40 patients underwent gastroscopy]. In most patients with chronic idiopathic urticaria, no underlying disorders or cause can be discerned. Diagnostic studies should be directed by the findings elicited by the history and physical examination. There is no recommended standard diagnostic laboratory evaluation for CIU, and routine laboratory tests seems to be of limited value