The effect of antibiotic therapy for patients infected with Helicobacter pylori who have chronic urticaria

Federman, Daniel G; Kirsner, Robert S; Moriarty, John P; Concato, John

doi:10.1016/S0190-9622(03)00846-6

« Previous Next »Journal of the American Academy of Dermatology
Volume 49, Issue 5 , Pages 861-864, November 2003

The effect of antibiotic therapy for patients infected with Helicobacter pylori who have chronic urticaria☆

Daniel G Federman, MD
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Veterans Affairs, Connecticut Health Care System, West Haven, Connecticut, USA
- Reprint requests: Daniel G. Federman, MD, Department of Veterans Affairs Connecticut Health Care System, (11ACSL), 950 Campbell Ave, West Haven, CT 06516, USA.
Robert S Kirsner, MD
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA
- Department of Epidemiology, University of Miami School of Medicine, Miami, Florida, USA
John P Moriarty, MD
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Veterans Affairs, Connecticut Health Care System, West Haven, Connecticut, USA
John Concato, MD
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Veterans Affairs, Connecticut Health Care System, West Haven, Connecticut, USA

Abstract

Background

Several small trails looking at antibiotic therapy targeted at Helicobacter pylori for the treatment of chronic urticaria have peen published and have had conflicting results. We conducted a systematic review of existing studies to help answer the clinical question of whether this therapy has a role in the treatment of chronic urticaria.

Methods

We identified studies published in the English language with searches of MEDLINE, PREMEDLINE, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effectiveness, and Cochrane Libraries using the key words “Helicobacter pylori” and “urticaria.” Relevant studies from bibliography reviews were also included. Studies included met the following criteria: (1) patients had urticaria for at least 6 weeks; (2) other known causes of urticaria were excluded by appropriate testing; (3) the initial diagnosis of H pylori infection was made by either serology, urea breath test, or upper endoscopy; and (4) an adequate trial of an antibiotic with known activity against H pylori was completed.

Results

In all, 10 studies met our inclusion criteria. The rate of remission of urticaria when H pylori was eradicated was 30.9% (59/191) compared with 21.7% (18/83) when H pylori was not eradicated; the background remission rate among control subjects without H pylori infection was 13.5% (10/74). When data from the 10 studies were combined, eradication of H pylori was both quantitatively and statistically associated with remission of urticaria (odds ratio 2.9; 95% confidence interval 1.4-6.8; P = .005).

Conclusion

We found that resolution of urticaria was more likely when antibiotic therapy was successful in eradication of H pylori infection than when patients who were infected did not achieve eradication. These results suggest that clinicians, after considering other causes of urticaria, should constitute (1) testing for H pylori; (2) treating with appropriate antibiotics if H pylori is present; and (3) confirming successful eradication of infection.