Helicobacter pylori: A significant and treatable cause of chronic urticaria and angioedema.

Two outpatient medical offices evaluated 204 patients with chronic urticaria during 2012. This article presents a retrospective study showing that 10% of patients with chronic urticaria may be infected with H. pylori. Furthermore, eradication of infection can be followed by remission of urticaria, reduced morbidity from gastric ulcers, and cancer.

Streptococcal tonsillitis as a cause of urticaria

Background: The primary role of infections in chronic urticaria (CU) is controversial. We hypothesised that streptococcal tonsillitis (ST) could be a primary cause of CU or acute recurrent urticaria (ARU). Methods: Retrospective study of 14 outpatients observed between January 2000 and December 2009, with CU/ARU and clinical and/or laboratorial suspicion of an aetiopathogenic link with ST. Clinical history, objective examination and laboratorial study were looked for. Three groups were defined: spontaneous resolution of urticaria, resolution after tonsillectomy, and still symptomatic. Results: In these patients, a causal relationship between ST and urticaria is supported by: markers of streptococcal infection, the perception of a clinical relationship between tonsillitis and urticaria, the decrease of urticaria severity with early antibiotherapy to tonsillitis and urticaria resolution after tonsillectomy. Conclusions: Our study encourages the investigation of tonsillitis in these otherwise idiopathic patients, especially until young adulthood and even in the absence of any symptoms(AU)

Mantis shrimp allergy.

We report the case of a 25-year-old female who experienced two immediate episodes of labial, lingual and larynx angiodema after eating fried mantis shrimp (Squilla empusa), a crustacean belonging to the Squillidae family, and a third episode after eating shellfish pudding. Prick by prick tests to mantis shrimp and to other crustacean were positive. Serum specific IgE showed higher values than 0.35 kU/L to extracts from mantis shrimp shell, prawn, large prawn and crab. Serum specific IgE against large prawn tropomyosin were below 0.35 kU/L. Sodium dodecyl sulfate polyacrylamide gel electropheresis (SDS-PAGE) immunoblotting results with raw mantis shrimp shell revealed IgE-binding bands of 46 kDa and 25 kDa, in non reducing and reducing conditions, respectively. Cross-reactivity studies using the enzyme allergo sorbent test (EAST)-inhibition and Immunoblotting-inhibition methods showed the existence of significant cross-reactivity between the IgE-binding proteins present in mantis shrimp and those from prawn, large prawn and small crab.

[Pathogenic and clinical significance of Helicobacter pylori infection in chronic urticaria and angioedema]. / Znaczenie patogenetyczne i kliniczne zakazenia Helicobacter pylori w przewleklej pokrzywce i obrzeku naczynioruchowym.

Urticaria and angioedema are one of the most frequent skin diseases, nevertheless no etiologic factors have been found in a large number of cases. This review summarizes the available medical literature from Medline regarding Helicobacter pylori and mentioned disease. Different studies have shown a high prevalence of Helicobacter pylori infection in patients with chronic urticaria, and occasional remission of the skin lesions after eradication therapy. However there are several papers, which support lack of relationship between H. pylori infection and the course of urticaria and angioedema. Thus we need further randomized, double-blind and placebo controlled studies including adequate diagnostic schedules, sufficient eradication treatment protocols, confirmation of eradication, and adequate control groups to establish a role of H. pylori in urticaria and angioedema.

Acquired angioedema and Helicobacter pylori infection in a child.

UNLABELLED: We describe a 10-year-old boy with acquired Helicobacter pylori infection and simultaneous angioedema which is a rare but life-threatening condition. Our patient was hospitalised with generalised angioedema and severe circulatory shock due to extreme loss of fluids and proteins into interstitial tissues (weight gain 10 kg within 2 days, extreme haemoconcentration--haemoglobin 206 g/l, haematocrit 0.570, leucocytosis 18,300 /microl, high lactate 13.8 mmol/l) and simultaneous failure of the complement system (C3 <0.16 g/l, C4 <0.13 g/l, CH50 45 U/ml, i.e. 50% of normal value, C1 inhibitor 0.21 g/l at the lower limit). All possible known causes of angioedema were excluded (infection, allergy, auto-immune disease, NSAIDs, lymphoproliferative disease) except for the simultaneous H. pylori infection which was proven serologically and histologically. Eradication therapy led to a complete remission of the H. pylori infection. An absence of angioedema and the restoration of the complement system was later observed. To the best of our knowledge, no similar case report of a child has yet been published. CONCLUSION: Helicobacter pylori infection should be considered in the development of angioedema in childhood.

Eradication of Helicobacter pylori and improvement of hereditary angioneurotic oedema.

Helicobacter pylori infection is thought to be a causal factor in various dermatological disorders. We assessed the frequency of H pylori infection in 65 patients with hereditary angioneurotic oedema. We measured the serum concentration of antibodies against H pylori and did the carbon-14-urease breath test in patients with positive H pylori serology. 19 of 65 patients had H pylori infection. All patients with infection, and 11 of 46 without infection, had a history of recurrent episodes of acute abdominal pain. We successfully eradicated H. pylori infection in 18 patients. The frequency of abdominal symptoms was significantly higher in the infected group (p=0.002 after adjustment for age). In nine of 19 patients with dyspepsia, the frequency of oedematous episodes decreased from 100 over 10 months before eradication to 19 during the 10-month follow-up period. Screening for, and eradication of, H pylori infection seems to be justified in patients with hereditary angioneurotic oedema.

Acute infectious urticaria: clinical and laboratory analysis in nineteen patients.

We treated 19 Japanese patients with acute urticaria presumably caused by infection during the five years from 1994 to 1998. The patients' ages ranged from 2 to 66 years (8 males and 11 females). Most of them had urticaria, angioedema, high fever, neutrophilia, and high serum levels of C reactive protein (CRP). The skin rash lasted more than 24 hours. In four patients, a flow cytometric analysis revealed that the percentage of circulating T cells bearing T-cell receptor V beta 3 was decreased during the active stage and that this decrease was sustained for at least 2 to 3 weeks. This suggests that certain T-cell populations were numerically altered in association with the occurrence of the disease. A retrospective review indicated that the combination therapy with corticosteroid and antibiotics was more effective than the single use of either agent.

[Monascus purpureus: a new fungus of allergenic relevance]. / Monascus purpureus--ein neuer allergologisch relevanter Pilz. Fallbericht.

Anaphylactic reactions to food containing allergens in the consumption or preparation of food are well known. However, allergy in the preparation of sausages have rarely been described. In the present study a 26-year-old butcher was investigated who had a severe anaphylactic reaction developing sneezing, rhinitis, conjunctivitis, generalised pruritus, followed by widespread urticaria, Quincke's oedema and dyspnoe after starting to prepare sausages containing red yield rice. Red yield rice is produced from polished and washed rice by means of the fungus Monascus purpureus. It was the first time that Monascus purpureus could be shown as allergic agent by means of prick-to-prick test, Cellular Antigen Stimulation Test (CAST) and different other immunoblots.