الفهرس 
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Abstract
Chronic urticaria (CU) is defined as the occurrence of daily or almost daily wheals and itching for at least 6 weeks that affects up to 1% of the general population with variable duration.
Approximately 15% to 25% of the population will experience at least one episode of urticaria in their lifetime, and an estimated one fourth of these people will have chronic urticaria.
Chronic idiopathic urticaria (CIU) is defined as the occurrence of CU with no obvious cause, constituting up to 70% of cases.
Both children and adults can develop CU, although it is more common in adults. Women are affected twice as often as men, and the condition typically begins in the third to fifth decade of life.
None of the theories of pathogenesis of CU has been fully established, the best developed hypotheses include the autoimmune theory The factors that have been identified as possibly being important in the pathogenesis of chronic urticaria include infections, food additives, medications, malignancy, physical factors, and vasculitis.
The aetiology of chronic urticaria is unknown in 50% to 70% of cases, and this group is defined as chronic idiopathic urticaria (CIU). Patients having demonstrable histamine-releasing autoantibodies are classified as CIU and they have very strong association with autoimmune diseases such as thyroiditis, vitiligo, insulin-dependent diabetes mellitus, rheumatoid arthritis, and pernicious anemia.
Attempts have been made to associate some common chronic infections with CU including Helicobacter pylori. Urticaria has been reported to be associated with a number of infections; Infectious agents reported to cause urticaria include hepatitis B virus (HBV), Streptococcus and Mycoplasma species, Helicobacter pylori, Mycobacterium tuberculosis, and herpes simplex virus (HSV) and hepatitis A, and hepatitis C.
Helicobacter pylori is a Gram-negative, microaerophilic bacterium found in the stomach, Helicobacter pylori, previously was known as Campylobacter pylori, is a Gram-negative, microaerophilic bacterium found in the stomach. H. pylori is helical in shape (from which the genus name is derived) and is thought to have evolved to penetrate the mucosal lining of the stomach.
Helicobacter pylori was first discovered in the stomachs of patients with gastritis and ulcers in 1982 by Drs. Barry Marshall and Robin Warren of perth ,At least half the world’s population is infected by the bacterium, making it the most widespread infection in the world. Actual infection rates vary from nation to nation; the developing world has much higher infection rates than the West where rates are estimated to be around 25%.
Epidemiological and experimental data points to a strong relation of H.pylori infection and the development of many extra gastric diseases, including several allergic and autoimmune diseases. H. pylori antigens activate cross-reactive T cells and induce autoantibodies production. Eradication of H. pylori infection has been shown to be effective in some patients with chronic autoimmune urticaria, psoriasis, alopecia areata and Henoch-Schoenlein purpura.
An association between HP and CIU has been proposed. One of the suggested pathogenic mechanisms is an increase in gastric vascular permeability during infection resulting in increased exposure of the host to alimentary allergens. The other one is immunological stimulation by chronic infection, through mediator release leading to a non-specific increase in sensitivity of the cutaneous vasculature to vasopermeability-enhancing agents.
Once H. pylori is detected in a person with a peptic ulcer, the normal procedure is to eradicate it and allow the ulcer to heal. The standard first-line therapy is a one-week ”triple therapy” consisting of proton pump inhibitors such as omeprazole and the antibiotics clarithromycin and amoxicillin.
Alternative strategies, such as a quadruple therapy, which adds a bismuth colloid, such as bismuth subsalicylate. For the treatment of clarithromycin-resistant strains of H. pylori, the use of levofloxacin as part of the therapy has been suggested.
This study aims to assess the impact of successful eradication of H.pylori on activity of CIU in CIU patients who were proven to be H.pylori infected to determine if it plays a rule in the pathogenesis of CIU.
This study was done in dermatology department in co-operation with medical biochemistry department in Menoufia university hospital from December 2014 to December 2015.
A primary diagnosis of chronic idiopathic urticaria was made according to the definition of both chronic urticaria and chronic idiopathic urticaria.
All participants were subjected to:
Ι- Full history taking.
We have used the CU-Q2Ol published by Baiardini et al., with modification.
ΙΙ-Good clinical examination:
1-General examination: to detect any excluding factor.
2-Dermatological examination to detect:
• Number and size of wheals.
• Surface area affected.
• Associated angioedema.
• Any residual bruising after disappearance of wheals to exclude urticarial vasculitis.
3- Clinical reevaluation of the patients 3 months after treatment.
ΙΙΙ- Laboratory investigations:
Routine lab investigations including CBC, stool and urine analysis, liver and renal function tests.
Anti H. pylori IgM antibodies in the serum were detected:
1- To confirm the diagnosis and selection of cases.
2-The test was rpeated after 6 weeks from the end of anti H-pylori therapy in group I.
In patients with chronic spontaneous urticaria, the disease activity may be determined using the urticaria activity score (UAS).
For determining disease activity in patients with angioedema, along with the UAS, the angioedema activity score is recommended.
The “Chronic Urticaria Quality of Life” (CU-Q2oL) questionnaire and the “Angioedema Quality of Life” (AE-QoL) questionnaire are recommended.
Out of 70 CIU patients, we chose 30 patients who proved to be H. pylori +ve. They were selected from the Dermatology outpatient clinic of Menoufia university hospitals from December 2014 to December 2015.
They were 18 female (60%) and 12(40%) male with a female to male ratio of 1.5:1, Their ages ranged from 16 to 50 years with mean age of 32.70± 10.7 years. The duration of urticaria in all patients ranged from 6 weeks to 18years with mean duration of 4.81±5.25 years.
The studied cases were divided into 2 groups of age and sex matched group Ι and group ΙΙ:
group Ι: 15 chronic idiopathic urticaria patients who were given anti H pylori eradication therapy and antihistamine, their ages ranged from 16 to 50 years with mean age of 31.40±10.21 years they were 9 female (60%) and 6 male (40%) with a female to male ratio of 1.5:1.
The duration of their urticaria ranged from 6 weeks to 11years with mean duration of 3.48± 2.81 years. Regarding the severity of itching 3patients (20%) suffered from mild itching, 7 (46.7%) suffered from moderate itching and 5 (33.3%) suffered from severe itching.
The surface area affected was <25% of the body surface area in 8 patients (53.4%), 25%-50% of the body surface area in 2patients (13.3%) and >50% of the body surface area in 5 patients 33.3%.
The number of wheals was <20 wheal in 9 patients (60%), 20-50 wheal in 4 patients and >50 wheal or confluent in 2 patients 2(13.3%).
After 6 weeks of the end of eradication therapy the anti-Helicobacter pylori IgM antibody become negative in 13 patients (86.7%) and still positive in 2 patients (13.3%).
group ΙΙ: 15 chronic urticaria patients who were given antihistamine only, they wear 9 female (60%) and 6 male (40%) with a female to male ratio of 1.5:1. Their ages ranged from 16 to 50 years with mean age of 34.00±11.38 years.
The duration of urticaria ranged from 6 weeks to 18 years with mean duration of 6.13± 6.23 years. 5 (33.3%) of them suffered from mild itching, 3 (20%) suffered from moderate itching and the other 7 (46.7%) cases suffered from severe itching.
The surface area affected by wheals was <25% in 10 patients (66.6%), 25%-50% in 1patients (6.7%) and >50% in 4 patients 26.7%.
The number and % of wheals were <20 in 7 patients (46.7%), 20-50 in 5 patients (33.3%) and >50 or confluent in 3patients (20%).
In group Ι showed base line serum level of IgM ranged from (32.23-50.60 AU/ml) with mean and SD of 41.09±6.40 AU/ml while the repeated Elisa titre of serum IgM ranged from (3.10-40.2 AU/ml) with mean and SD of 40.87-7.61 AU/ml.
The effectiveness of the therapy was assessed 3 months after the end of treatment, using a 3 point rating scale, that is complete remission, partial remission (50% or more), or no improvement.
In group Ι: The 13 patient responded to eradication therapy showed complete remission in 6 patients (46.15%), partial remission in 3 patients (23.08%) , no improvement in 4 patients (30.77%).
group ΙΙ: showed no improvement in 10 patients (66.67%) and partial remission in 5 patients (33.33%)