La urticaria crónica espontánea es una enfermedad mediada por degranulación de mastocitos, caracterizada por la aparición de ronchas y/o angioedema por más de seis semanas, con o sin un gatillante conocido. El manejo de primera y segunda línea son los antihistamínicos, pero existen casos refractarios que requieren otras alternativas terapéuticas, dentro de las cuales destaca el omalizumab. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos cuatro revisiones sistemáticas que en conjunto incluyen cinco estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de omalizumab disminuye los síntomas y mejora la calidad de vida en pacientes con urticaria crónica espontánea.

BACKGROUND:

Different studies have shown a high prevalence of Helicobacter pylori (HP) infection in patients with chronic urticaria (CU), and occasional remission of the skin lesions after eradication therapy. Recent investigations, however, have failed to find a significant relationship between the two conditions. We designed a case-control study to assess the prevalence of HP infection and the effect of bacterium eradication on the outcome of the skin disease in patients affected by CU. The literature is reviewed.

METHODS:

Twenty-five patients diagnosed with CU were included. Information about their medical history and a complete laboratory investigation ruled out other diseases or situations suspected to cause CU. Twenty-five healthy volunteers from a census-based, randomized sample were used as controls. HP infection was assessed by the (13)C-urea breath test (UBT). Eradication therapy included oral amoxicillin, omeprazole, and clarithromycin for 1 week.

RESULTS:

The high prevalence of HP infection (68%) and mean titer of UBT (24.13) in our patients with idiopathic CU do not differ from the general population. Marked differences were observed in the mean age of the CU patients with positive UBT (45.52years) vs. those without HP infection (35.25 years). After eradication therapy, only one patient showed a complete remission of urticaria and two showed a partial remission.

CONCLUSIONS:

Our results support a lack of relationship between HP infection and the course of idiopathic CU.

Urticaria pigmentosa developed in twins at the age of 6 weeks. They have numerous round to oval shaped, discrete or confluent reddish brown colored macules over whole body surface and neither twin had vomiting, diarrhea, flushing or irritability. Their relatives are unaffected. Biopsy specimen of. back lesion showed. pooling of mast cells in the upper dermis, and electron microscopic examinattion revealed normal mast cells.

Chronic urticaria is a distressing condition with high costs. The aim of this literature review was to assess the relative frequency of causes of chronic urticaria in childhood and to provide guidance on which laboratory tests should be performed. Using PubMed, EMBASE and Cochrane databases, the literature from 1966 to 2010 (week 25) was systematically reviewed. Data from studies conducted on children who had had urticaria for at least 6 weeks, and assessing at least 3 different causes of urticaria, were analysed by reviewers using independent extraction. Six studies, all of low quality, met the inclusion criteria. Idiopathic and physical urticaria were common. Infections, autoimmunity and allergy were also reported. We conclude that children with chronic urticaria not caused by physical stimuli should undergo tests for allergy or infections only when there is a history of cause-effect correlation. High-quality trials are warranted to evaluate the causes of chronic urticaria in childhood.

INTRODUCTION:

Chronic urticaria (CU) is characterized by hives and pruritus lasting for more than 6 weeks. Almost half of CU cases are classified as idiopathic (CIU). The condition may be triggered by Helicobacter pylori (HP).

AIM:

The aim of our research was to assess anti-HP IgG titre in CIU patients compared to controls and to evaluate the effect of HP eradication on urticaria.

MATERIAL AND METHODS:

The analysis covered 62 CIU patients and 55 urticaria-free individuals. Serum anti-HP IgG was performed in 50 CIU subjects and all controls. The CIU patients with gastric complaints and anti-HP IgG(+) were divided into two subgroups, of which one received standard antiurticarial treatment (A) while the other was offered standard treatment plus HP eradication (B). After a 12-month follow-up, subgroups were reviewed for treatment response.

RESULTS:

Positive anti-HP IgG titre incidence, mean and median anti-HP IgG levels in CIU patients and in the controls were as follows: 68% vs. 67.27% (χ2 = 0.0063, p = 0.9366), 2.73 vs. 2.29 and 1.72 vs. 1.69 (p = 0.4288). AUC under the ROC curve for urticaria prediction based on anti-HP IgG level was 0.545 (SE = 0.057, 95% CI [0.434, 0.657]). On the follow-up interview, rates of improvement, no improvement and aggravation of urticaria symptoms in subgroup A were as follows: 60%, 40% and 0%, respectively, and in subgroup B: 50%, 45%, 5%, respectively (χ2 = 0.6635, p = 0.7177, Fisher’s exact test p = 1.0000).

CONCLUSIONS:

Anti-HP IgG titre is similar in CIU patients and in urticaria-free controls. Helicobacter pylori eradication has no effect on urticaria in anti-HP IgG positive CIU patients with gastric complaints.

OBJECTIVE:

To investigate the relationship between Helicobacter pylori (HP) infection and the development of chronic urticaria.

METHODS:

Published case-control studies which concerned HP infection related chronic urticaria were searched in Wanfang, CNKI, CQVIP Chinese databanks and PubMed. Meta-analysis was applied to analyze the pooled odds ratio (OR) and 95% confidence interval (CI).

RESULTS:

37 studies which comprised 2 909 cases of chronic urticaria and 1 873 persons served as controls were enrolled. When compared with the controls, HP infection significantly increased the risk of chronic urticaria development with a pooled OR of 3.20 (95% CI.: 2.31-4.43). Results from Meta-regression analyses showed that the distribution of residential areas and detection method being used were potential influential factors.

CONCLUSION:

HP infection seemed to be associated with an increased risk of developing the chronic urticaria.

Omalizumab is recombinant humanized monoclonal antibody to immunoglobulin E. Guidelines for the treatment of chronic idiopathic urticaria (also known as chronic spontaneous urticaria) recommend the use of omalizumab as third-line therapy in addition to high doses of histamine receptor type 1 (H1 ) antihistamines when they are unsuccessful as first- and second-line therapy. We performed a systematic review of the literature to identify studies that evaluated the efficacy of omalizumab for the treatment of chronic idiopathic urticaria, both in controlled and real-world settings, to assess its potential role as a preferred therapy. The PubMed, ScienceDirect, LILACS (Latin American and Caribbean Health Sciences Literature), and Google Scholar databases were searched between January 1, 2000 and November 21, 2016. The search was limited to articles published in peer-reviewed journals in the English language, and 29 studies were included in this review. Omalizumab 300 mg administered every 4 weeks appears to be the most effective and safe dosage, with a rapid response time, for the treatment of chronic idiopathic urticaria, with few minor adverse effects, and appears to be safe in the offspring of pregnant patients who received the drug. However, as published studies of omalizumab are sparse, future studies are warranted. When findings are confirmed in larger studies, due to its efficacy, safety, and increased benefit/cost ratio, omalizumab could become the preferred method of treatment for chronic idiopathic urticaria in patients unresponsive to H1 antihistamines. This article is protected by copyright. All rights reserved.

Background. Acupuncture might have effectiveness in relieving the symptoms of chronic urticaria. There are currently no systematic reviews of acupuncture for chronic urticaria published in English. Objective. We conducted a systematic review to assess the effectiveness and safety of acupuncture for chronic urticaria. Methods. A systematic review and meta-analysis of randomized, controlled trials were performed. The primary outcome was global symptom improvement. Results. We included 6 studies with 406 participants. Three trials showed significant difference between acupuncture and drugs in global symptom improvement (relative risk 1.37; 95% CI 1.11-1.70; P = 0.003). As an adjuvant to medication, acupuncture was also beneficial for global symptom improvement (relative risk 1.77; 95% CI 1.41-2.22; P < 0.01). There were no severe adverse events related to acupuncture. Limitations. Some methodological limitations were observed. The overall risk of bias in the 6 included trials was high and all included RCTs were conducted in China and published in Chinese. Besides, the lack of proper control groups and the use of different rating methods and cut-offs in the included trials also made the evidence of this review limited. Conclusions. Acupuncture might be effective and safe for chronic urticaria in relieving symptoms, based on a low level of evidence. To draw a reliable conclusion, more high quality trials are needed in the future. This trial is registered with PROSPERO CRD42015015702.

La urticaria crónica es una enfermedad frecuente, caracterizada por la presencia de ronchas y/o angioedema con una duración superior a las 6 semanas. En un número importante de pacientes se comporta como una enfermedad autoinmune asociada frecuentemente con alteraciones en la función tiroidea y com la presencia de anticuerpos antitiroideos. Presentamos una serie de 70 pacientes consecutivos con diagnóstico de urticaria crónica a los cuales les investigamos la función tiroidea y la presencia de anticuerpos antiperoxidasa tiroidea. Siete (10%) tenían diagnóstico de enfermedad tiroidea previa al momento de la consulta. A los 63 pacientes restantes se les estudió los niveles de tirotrofina sérica, 11 de los cuales (17%) presentaron valores anormales, que sumados a los 7 con enfermedad previa llegan a 18 (26%) con función tiroidea alterada. A 61 pacientes se les investigo anticuerpos antiperoxidasa tiroidea, 22 (36%) fueron positivos. De 57 pacientes sin diagnóstico de patología tiroidea previa al momento de la consulta por urticaria, a los que se les estudió tanto los niveles de tirotrofina sérica como la presencia de anticuerpos antiperoxidasa tiroidea, 24 (42%) presentaron alguno de los estudios alterados. El alto porcentaje de alteraciones tiroideas en nuestra serie de pacientes resalta la necesidad de estudiar la función tiroidea y la presencia de anticuerpos antiperoxidasa tiroidea en pacientes con urticaria crónica.

Los autores presentan un caso inusitado de prurito y urticaria asociado al hipertiroidismo tomando como base los hallazgos clínicos, de laboratorio, falla a la terapéutica tradicional y respuesta dramática al uso del propanolol y propiltiouracilo