Allergology International. 2014;63:613 DOI: 10.2332! allergolint.14-LE-0745
Dear Editor
Helicobacter Pylori Associated Urticarias I read with interest the article by Takashi Yoshimasu and Fukumi Furukawa on eradication therapy for Helicobacter pylori associated urticaria 1 and entirely agree that future guidelines on urticaria should highlight this issue with an aim to formulate separate management strategy for these patients. In fact, our last published guidelines on chronic urticaria discuss the importance of this infection in both acute and chronic (episodic) urticarias.2 Active surveillance for detection of H pylori is one of the strategies I have adopted in my practice given the high incidence of this infection and gastric cancer in this region (H pylori seroprevalence rates in Bangladesh 92%, Kuwait 84% and India at 79%). 3 I would therefore like to share my experience of H pylori associated urticaria from my clinic in eastern India. Of 25 dyspeptic patients screened for H pylori with upper GI endoscopy over last year, 6 (5 males, 1 female) were found to be positive for rapid urease test at endoscopy (mean age 42.2 years, range 29-54 years). The duration of urticaria (spontaneous, pressure and solar) ranged from 1-6 years and all patients were on multiple antihistamines including ebastine and montelukast (leukotriene receptor antagonist) at various time points and never achieved complete remission (CR, i.e., always required to be on anti-histamines). Two patients were positive for anti-thyroid peroxidase antibodies, while one had prostatomegaly. All im-
Allergology International Vol 63, No4, 2014 www.jsaweb.jp!
LETTER TO THE EDITOR proved symptomatically and achieved CR within 3 months after receiving H pylori eradication therapy (pantoprazole 40 mg, amoxicillin 750 mg, clarithromycin 500 mg for 14 days) and combination of fexofenadine 180 mg with hydroxyzine 25-50 mg. In contrast, 6 children (aged 7-15 years) with chronic episodic urticaria screened for the presence of H pylori IgG antibodies using ELISA were negative, and improved on pantoprazole and fexofenadine over 6 months. It is important that clinicians recognize that H pylori not only pose a substantial burden in terms of gastric cancer, but also in some patients with chronic ‘ idiopathic’ urticaria where directed investigations and treatment may prove beneficial. Sujoy Khan1 1Department
of Allergy & Immunology, Apollo Gleneagles Hospital, West Bengal, India Email: [email protected] Conflict of interest: No potential conflict of interest was disclosed. REFERENCES 1. Yoshimasu T, Furukawa F. Eradication therapy for urticaria with high titers of anti H. pylori IgG antibody. Allergol Int 2014;63:37-40. 2. Khan S, Maitra A, Hissaria P et al. Chronic urticaria: Indian context-challenges and treatment options. Dermatol Res Pract 2013;2013:651737. 3. Rahman R, Asombang AW, Ibdah JA. Characteristics of gastric cancer in Asia. World J Gastroenterol 2014;20: 4483-90.
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Dear Editor
Helicobacter Pylori Associated Urticarias I read with interest the article by Takashi Yoshimasu and Fukumi Furukawa on eradication therapy for Helicobacter pylori associated urticaria 1 and entirely agree that future guidelines on urticaria should highlight this issue with an aim to formulate separate management strategy for these patients. In fact, our last published guidelines on chronic urticaria discuss the importance of this infection in both acute and chronic (episodic) urticarias.2 Active surveillance for detection of H pylori is one of the strategies I have adopted in my practice given the high incidence of this infection and gastric cancer in this region (H pylori seroprevalence rates in Bangladesh 92%, Kuwait 84% and India at 79%). 3 I would therefore like to share my experience of H pylori associated urticaria from my clinic in eastern India. Of 25 dyspeptic patients screened for H pylori with upper GI endoscopy over last year, 6 (5 males, 1 female) were found to be positive for rapid urease test at endoscopy (mean age 42.2 years, range 29-54 years). The duration of urticaria (spontaneous, pressure and solar) ranged from 1-6 years and all patients were on multiple antihistamines including ebastine and montelukast (leukotriene receptor antagonist) at various time points and never achieved complete remission (CR, i.e., always required to be on anti-histamines). Two patients were positive for anti-thyroid peroxidase antibodies, while one had prostatomegaly. All im-
Allergology International Vol 63, No4, 2014 www.jsaweb.jp!
LETTER TO THE EDITOR proved symptomatically and achieved CR within 3 months after receiving H pylori eradication therapy (pantoprazole 40 mg, amoxicillin 750 mg, clarithromycin 500 mg for 14 days) and combination of fexofenadine 180 mg with hydroxyzine 25-50 mg. In contrast, 6 children (aged 7-15 years) with chronic episodic urticaria screened for the presence of H pylori IgG antibodies using ELISA were negative, and improved on pantoprazole and fexofenadine over 6 months. It is important that clinicians recognize that H pylori not only pose a substantial burden in terms of gastric cancer, but also in some patients with chronic ‘ idiopathic’ urticaria where directed investigations and treatment may prove beneficial. Sujoy Khan1 1Department
of Allergy & Immunology, Apollo Gleneagles Hospital, West Bengal, India Email: [email protected] Conflict of interest: No potential conflict of interest was disclosed. REFERENCES 1. Yoshimasu T, Furukawa F. Eradication therapy for urticaria with high titers of anti H. pylori IgG antibody. Allergol Int 2014;63:37-40. 2. Khan S, Maitra A, Hissaria P et al. Chronic urticaria: Indian context-challenges and treatment options. Dermatol Res Pract 2013;2013:651737. 3. Rahman R, Asombang AW, Ibdah JA. Characteristics of gastric cancer in Asia. World J Gastroenterol 2014;20: 4483-90.
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