The puzzle of spontaneous (idiopathic) urticaria possibly is solved!

 

 

 -                 What do you complain for?

 

-                 Allergy! – An upset patient is demonstrating hives. Even doctors often call urticaria “allergy”. However, allergists are aware, of course, that true allergy is as rare cause of chronic urticaria, as only 1-2% of cases. On the other hand, type I allergy is not so rare in acute urticaria, where it can be found in already 50% of cases. And this is absolutely not surprising – type I allergy often can be diagnosed by a patient himself, after what he will certainly stop contact with the allergen, and urticaria will not relapse. The examples of type I allergy are bee-venom allergy and sensibilization to penicillin/cephalosporins. It can be supposed that some pseudoallergic reactions (such as group B vitamins injection, radiopaques infusion and non-steroid anti-inflammatory drugs intolerance) were also put into those 50% by mistake, but here we will not discuss it. Instead, let us talk about the “unexplained” and “unexplored” type of urticaria – that is chronic spontaneous (formely idiopathic) urticaria.

 

-                 I assume that readers of this page already know about the spontaneous urticaria everything that international guidelines and most famous scientists have to suggest. What you can find here is the list of the questions, the answers to which you can find in the full version of our paper “Gastritis Can Cause and Trigger Chronic Spontaneous Urticaria Independent of the Presence of Helicobacter pylori”.

 

-                 You may be disappointed by the fact that the title of the paper does not resemble that at the top of this page. Perhaps, you will find the abstract not so interesting as well. Unfortunately, it is not scientific journals’ policy to print everything in abstracts and titles. However, you will undoubtedly find everything you were looking here for in the full version of the paper. It is a pity though that I could not let you know everything before the publication, as it took us five years to get published. If I let you know earlier, you would not believe me anyway.

 

-                 So what is there exactly? If you open “The EAACI/GA²LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. The 2017 Revision and Update”, you will notice a list of the diseases associated with chronic spontaneous (idiopathic) urticaria. They are: Helicobacter Pylori infection, parasites, viral hepatitis, autoimmune diseases (i.e. autoimmune thyroiditis), non-infectious inflammatory disorders of upper digestive tract (i.e. gastritis and reflux oesophagitis), diseases of gall bladder and biliary system. Besides, in the paper “Low B12 levels in chronic idiopathic urticaria” (J Investig Allergol Clin Immunol. 2004;14(4):292-9.) it is discussed, that serum B12 level is decreased in chronic spontaneous (idiopathic) urticaria patients.

 

-                 A rather wide range of the diseases, isn’t it? Moreover, they are not present in every patient, so routine diagnostic tests include only differential blood count, ESR and/ or CRP measurement (The EAACI/GA²LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. The 2017 Revision and Update). But it can be easily discovered that the majority of the pathologies are diseases of the digestive system. This fact is not unfamiliar – even Hippocrates knew about digestive system disturbances in urticaria patients. Really strange is the thing that for such a long period we knew about spontaneous urticaria not much more than Hippocrates! He only was not aware of antihistamines, gastroscopy, Helicobacter and that smart phrase “autoimmune urticaria”! Generally, that is all.

 

-                 So let me repeat that list of the diseases: Helicobacter Pylori infection, parasites, viral hepatitis, autoimmune diseases (i.e. autoimmune thyroiditis), non-infectious inflammatory disorders of upper digestive tract (i.e. gastritis and reflux oesophagitis), diseases of gall bladder and biliary system and low B12 levels. What is the connection between them? And is there any connection at all? It is very possible to answer that there is no connection, but, on the other hand, if those diseases often accompany chronic spontaneous (idiopathic) urticaria, there must be connection! Or not?

 

-                 Let us look at Helicobacter. This infection is present in stomach of the majority of people in many countries of the world, but not each of those people develop urticaria! Almost the same thing with viral hepatitis – although it is not the infection of the majority of people (fortunately), absolutely not everyone affected by viral hepatitis develops urticaria! Parasites can be thoroughly looked for and treated even unfound – relapses of chronic spontaneous (idiopathic) urticaria continue to occur! Thyroiditis can also be found only in minority of chronic spontaneous (idiopathic) urticaria patients, but even when a patient has it, you will not get additional options to cure urticaria, just because hormones levels are usually normal. Pathologic biliary system – who has a healthy one?! And what could be regarded as pathologic? You will not find gall bladder stones in even 10% of chronic spontaneous (idiopathic) urticaria patients. Gall bladder dyskinesia – who does not have it?! The only thing in the rest is that smart phrase “autoimmune urticaria”. And antihistamines, although they are regarded to be not so good in the “autoimmune” form of the disease. But do we have another option? We will not use steroids, and plasmapheresis is expensive (and did it help to anyone? Seriously?). Additionally, we remember about low B12 levels. But what an option does it give? Probably not more than the phrase “autoimmune urticaria”. Also because hemoglobin level stays normal. Of course, you can advice vitamins to patients. But if it gave them any benefit, you would certainly know it before. Oh, sorry! I forgot about omalizumab! Have you tried it? And how was it? I am sorry, I have not tried yet.

 

-                 Helicobacter Pylori infection, parasites, viral hepatitis, autoimmune diseases (i.e. autoimmune thyroiditis), non-infectious inflammatory disorders of upper digestive tract (i.e. gastritis and reflux oesophagitis), diseases of gall bladder and biliary system and low B12 levels. What a strange list! Do you give up? Do you think I also do not know the answer? Of course I do know. But let me explain.

 

-                 Let me begin from what is written in the abstract of the above mentioned paper of mine and my coauthors – actually, just the same as in its title, but slightly more. It is written there, that gastric erosions cause and trigger chronic spontaneous (idiopathic) urticaria independent of Helicobacter Pylori. Gastric erosions – because we can find gastric erosions frequency in the literature, so we can compare. But it is not very difficult to understand, that erosions of oesophagus, duodenum and especially ulcers also need to be healed and probably cause chronic spontaneous (idiopathic) uricaria as well. Want to write it without “probably”? Then a new study is needed (but do not forget about control group)! But how often upper gastrointestinal tract erosions can be found in chronic spontaneous (idiopathic) urticaria patients? We found them in 50% (gastric erosions – 41,7%)! Compare with 8% in healthy Europeans. But the paper would be not so interesting, if it could not answer to the question: “How can upper gastrointestinal erosions cause urticaria?” And there is such an answer! Of course, with such words as “probably” and “maybe” (just because we did another study), but there is an answer! As well as about the other above-mentioned diseases (I did not forget)!

 

-                 So what now? The paper has been published, but the copyright belongs to the journal, and the full version is only for charge. The last author is professor Torsten Zuberbier – you probably heard about him, if you are an allergist. If you have not heard yet, just look at the authors list of the above mentioned international guidelines – you will find him there. One day new guidelines will be published, where our data may be included. However, as the last guidelines have been published this year, the new ones may appear not so soon. But if I find any legal way to shortly describe here the full version of our paper – it will be done immediately!

 

-                  

 

Yours sincerely,

 

Semen Zheleznov.

 

01 May 2018.