Reappraisal of the role of Helicobacter pylori in chronic spontaneous urticaria

Aims: Chronic spontaneous urticaria (CSU) is one of the most prevalent skin disorders. Helicobacter pylori (HP) infection has been linked to CSU, and HP eradication therapy has been questioned as a viable treatment option. However, studies have produced contradictory results. In addition, recent studies suggest that gastritis, rather than HP bacteria, may be responsible for CSU symptoms. Herein, we aimed to ascertain the prevalence of HP infection in CSU, explore associations between HP infection, gastritis, and CSU severity or treatment response in CSU, and investigate the impact of HP eradication therapy on the CSU course. Methods: We retrospectively analyzed CSU patients who were investigated for HP infection. Patient characteristics, in-clinic urticaria activity scores (ic-UAS) and urticaria control test (UCT) scores, and CSU treatment responses were compared across different patient groups. Results: The study included 325 CSU patients, of whom 57.2% were HP-positive and 60.9% had gastritis. The mean baseline ic-UAS showed no difference between HP-positive and HP-negative patients (2.55±2 vs 2.45±1.98, p>0.05) or between patients with and without gastritis (2.33±2 vs 2.51±2, p>0.05). HP-positive patients had higher rates of elevated CRP levels (45% vs 29.9%, p=0.023) and ASST positivity (54.8% vs 29.8%, p0.05). Conclusion: Over half of CSU patients have been found to be infected with HP. However, the HP bacterium itself, the eradication of HP, or gastritis have no significant effect on CSU severity or treatment response.