Recidiva de urticária crônica decorrente de reinfecção por Helicobacter pylori / Recurrence of chronic urticaria caused by reinfection by Helicobacter pylori / Recidiva de urticaria crónica decurrente de reinfección por Helicobacter pylori

OBJETIVO: Descrever, em uma adolescente do sexo feminino, o caso clínico de urticária crônica associado à infecção por Helicobacter pylori confirmado em dois momentos distintos, com melhora após a terapêutica antibacteriana. DESCRIÇÃO DO CASO: Paciente do sexo feminino, 13 anos, procurou atendimento médico com urticária crônica e dores epigástricas sem resposta ao tratamento medicamentoso. Os exames solicitados para investigação complementar apresentaram-se normais, exceto a endoscopia digestiva alta com biópsia, que evidenciou gastrite crônica ativa moderada associada ao Helicobacter pylori. Foi iniciado o tratamento adequado para a bactéria em questão e a paciente apresentou remissão dos sintomas. Nova endoscopia digestiva alta para controlar o tratamento após nove meses estava normal. Cinco anos depois, a paciente procurou novamente o ambulatório queixando-se de retorno do quadro de urticária e dores epigástricas. Ela se encontrava em uso de anti-histamínico, sem melhora. Foi novamente submetida a protocolo de exames para investigar urticária crônica, com resultados dentro da normalidade. Foi submetida à endoscopia digestiva alta, que apresentou teste da urease positivo. Iniciou-se então novo tratamento para Helicobacter pylori por sete dias, com desaparecimento da urticária crônica e das dores epigástricas. COMENTÁRIOS: O caso relatado sugere relação causal entre o diagnóstico positivo para o Helicobacter pylori e a ocorrência do quadro de urticária crônica, com instituição de terapêutica eficaz para tal bactéria e remissão dos sintomas. A urticária crônica é uma doença de etiopatogenia complexa e, apesar das controvérsias, as evidências do envolvimento do Helicobacter pylori com doenças extraintestinais vêm crescendo, entre elas a urticária crônica.

OBJECTIVE: To describe a case of chronic urticaria in a female adolescent associated with Helicobacter pylori infection, confirmed in two different occasions, with improvement of urticaria after the antibacterial treatment. CASE DESCRIPTION: A 13-year-old female patient sought medical care with chronic urticaria and epigastric pain unresponsive to medical treatment. Laboratorial tests for further investigation were normal except for the upper gastrointestinal endoscopy with biopsy showing moderate chronic active gastritis associated with Helicobacter pylori. After specific and appropriate treatment, the patient had remission of the symptoms. A new upper gastrointestinal endoscopy to control the treatment after nine months was normal. After five years, the patient returned with recurrence of urticaria and epigastric pain. She was taking antihistamines, without any improvement. It was again submitted to screening protocol for chronic urticaria with normal results. She was submitted to upper gastrointestinal endoscopy, which showed positive urease test. The patient started a new treatment for Helicobacter pylori with disappearance of chronic urticaria and epigastric pain within seven days. COMMENTS: The reported case suggests a causal relationship between the positive diagnosis of Helicobacter pylori and the occurrence of chronic urticaria, showing the remission of symptoms after the institution of effective therapy for this agent. Chronic urticaria is a disease of complex etiology, and although controversial, there is growing evidence of Helicobacter pylori involvement with extraintestinal diseases, including chronic urticaria.

OBJETIVO: Describir, en una adolescente del sexo femenino, el caso clínico de urticaria crónica asociado a la infección por Helicobacter pylori confirmado en dos momentos distintos, con mejora después de la terapéutica antibacteriana. DESCRIPCIÓN DEL CASO: Paciente del sexo femenino, 13 años, buscó atención médica con urticaria crónica y dolores epigástricas sin respuesta al tratamiento medicamentoso. Los exámenes solicitados para investigación complementar se presentaron normales, excepto por la endoscopía digestiva alta con biopsia, que evidenció gastritis crónica activa moderada asociada al Helicobacter pylori. Se inició el tratamiento adecuado para la bacteria en cuestión, y la paciente presentó remisión de los síntomas. Nueva endoscopía digestiva alta para controlar el tratamiento después de nueve meses estaba normal. Tras cinco años, la paciente buscó nuevamente el ambulatorio quejándose de retorno del cuadro de urticaria y dolores epigástricos. Ella estaba en uso de anti-histamínicos, sin mejoría. Fue nuevamente sometida al protocolo de exámenes para investigar urticaria crónica, con resultados dentro de la normalidad. Fue sometida a la endoscopía digestiva alta, que presentó prueba de ureasa positiva. Se inició entonces nuevo tratamiento para Helicobacter pylori por siete días, con desaparición de la urticaria crónica y de los dolores epigástricos. COMENTARIOS: El caso relatado sugiere relación causal entre el diagnóstico positivo para el Helicobacter pylori y la ocurrencia del cuadro de urticaria crónica, con institución de terapéutica eficaz para tal bacteria y remisión de los síntomas. La urticaria crónica es una enfermedad de etiopatogenía compleja y, a pesar de las controversias, las evidencias de la implicación del Helicobacter pylori con enfermedades extraintestinales vienen creciendo, entre ellas la urticaria crónica.

Role of helicobacter pylori infection and autoimmunity in chronic idiopathic urticaria

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

role of helicobacter pylori infection in the pathogenesis of chronic urticaria

To determine the prevalence of H. pylori infection in patients with idiopathic chronic urticaria [ICU] and to see if eradication of the bacterium affects the course of the urticaria. Patients and One hundred patients with idiopathic chronic urticaria and 43 healthy subjects [matched for age and sex] underwent serological testing for H. pylori infection. All patients with idiopathic chronic urticaria were examined for Helicobacter pylori infection with the 13C-urea test as well as the serological testing. Gastric biopsy was obtained from 36 patients. Patients with proven Helicobacter pylori infection were given treatment for 2 weeks. Six weeks afterwards they were tested again for Helicobacter pylori infection, and their urticaria was clinically assessed. There was no significant difference in the seroprevalence of H. pylori infection between idiopathic chronic urticaria patients and healthy subjects. Helicobacter pylori was detected in 76% of patients and 69.8% of controls. Out of the 76 patients treated, only 24 showed complete remission of their urticaria after successfully eradicating Helicobacter pylori infection, the others only having some improvement in their symptoms. Patients with idiopathic chronic urticaria have similar high rates of H. pylori infection as healthy subjects. Bacterium eradication is associated with improvement of urticaria symptoms, suggesting a possible role of Helicobacter pylori in the pathogenesis of this skin disorder

Estudo sobre a associaçäo entre Helicobacter pylori e urticária crônica idiopática / Study about the association of Helicobacter pylori and idiopathic chronic urticaria

Objetivo. Analisar a possível associaçao de nexo causal entre o Hp e Urticária Crônica Idiopática (UCI). Material e Métodos. Estudo de casos e controles. Foram estudados 18 pacientes, maiores de 18 anos, com quadro clínico e laboratorial de UCI. A exposiçao prévia ao Hp foi avaliada pela realizaçao de sorologia por radioimunoensaio (IgG para Helicobacter pylori). O grupo-centrole, composto por 18 integrantes, foi emparelhado para idade, sexo, raça e condiçoes sócio-econômicas. Nos pacientes soro-reagentes, instituiu-se tratamento para a erradicaçao do Hp, com doses orais de amoxacilina, metronidazol e omeprazol sendo o seguimento realizado por dois meses. Resultados. Entre os pacientes com UCI, 12 foram soro-reagentes para Hp (66,7 por cento) e entre os controles 6 foram soro-reagentes (33,3 por cento). Dos casos tratados para a erradicaçao do Hp 6 obtiveram remissao completa, 4 obtiveram remissao parcial e 2 nao obtiveram melhora alguma. Conclusoes. As evidências de que o Hp constitui-se em um dos fatores etiológicos dos quadros urticarianos vêm se fortalecendo e, em nosso trabalho, a diferença de quase 30 por cento na exposiçao prévia ao Hp entre casos e controles, somada com os resultados na terapêutica e no seguimento, corroboram as expectativas da existência deste nexo causal.

Role of some medically important arthropods in home environment and childhood urticaria

Home environment does not only affect morbidity but also chronicity of certain disease of the reared children. Several medically important arthropods are of special concern, as well as domestic anima and pets. Fifty patients with popular urinary, compared to 50 normal controls, were tested with 5 types of mite antigens: acarus siro, dermatophagoides farinae, derratophagoides, pteronyssinus, clycophagus domesticus and tyrophaus putrescentiae. The skin reaction were recorded after 1/2 hours, 24 hours and 48 hours. This study revealed that popular urticaria is prevalent in children below 7 years. Both sexes were equally affected. Family history has no significant role in the disease. There was a significant relation between pets and the disease. Mites play an important role in the aetiology of popular urticaria. The most responsible mites are dermatophagiods farinae and yrophagus putrescentiae. Dermatophagoides pternoyssinus and glycophagus domesticus had no statistical significant relation to popular urticaria as tested by mite antigen skin reactions. However, there were actually more positive reaction in patients with popular utricaria than in the control groups. It is questionably advised that desensitization may be of real health for patients with popular urticaria which can be administered at an early phase of the disease. Also, environmerltal control of mites will be very helpful in suppressing and minimizing the attacks