INTRODUCTION:

Urticaria is characterized by the appearance of a wheal or angioedema after exposure to different stimuli. In most of these patients, no triggering agent is found, though in some cases it has been associated with viral infection, autoimmune disease, thyroid disease, drug ingestion and bacterial infection¹.

Urticaria occurs continuously on most days for longer than 6 weeks and is called chronic². The clinical symptoms are caused by the release of histamine and other vasoactive mediators induced by the binding of an allergen to the specific receptors on most cells³.

Helicobacter pylori is a highly prevalent bacterium, with an estimated 50% of the global population being infected. The risk of transmission is increased when food is prepared under unhygienic conditions or becomes exposed to contaminated water or soil. In addition, poor sanitation practices, low socioeconomic status, and crowded or high-density living environments are significantly associated with a higher prevalence of Helicobacter pylori infection. Clinically, Helicobacter pylori is a well-established risk factor for several gastrointestinal diseases. Many infections are asymptomatic, but chronic colonisation can result in gastritis and peptic ulcer disease⁴.

Commercial IgG serology is considered a reliable tool for the assessment and screening of Helicobacter pylori infection, demonstrating high sensitivity and specificity in large-scale, multicenter surveys⁵. Chronic urticaria has been reported to demonstrate the prevalence of Helicobacter pylori infection⁶.

The aim of this study was to investigate the association between Helicobacter pylori infection and chronic urticaria among patients attending Yangon General Hospital. Specifically, the study sought to determine the socio-demographic characteristics of patients with chronic urticaria, describe their clinical patterns, and compare the serological status of Helicobacter pylori infection between patients with chronic urticaria, and an age and sex matched healthy control group.

MATERIALS AND METHODS:

This hospital-based, cross-sectional comparative study was conducted from 2020 to 2021 in the Department of Dermatology, Yangon General Hospital. The study population included all patients with chronic urticaria who attended the dermatology outpatient clinic during the study period. A total of 46 patients with chronic urticaria were enrolled. An equal number of age and sex matched healthy individuals served as controls. Patients with a diagnosis of chronic urticaria were included, whereas those with acute urticaria were excluded.

After obtaining informed consent, the socio-demographic data and clinical history of patients with chronic urticaria were recorded. A structured questionnaire was administered to collect information on the presence or absence of angioedema, frequency and duration of urticarial episodes, distribution of lesions, and potential triggering factors.

Serological testing for Helicobacter pylori infection was performed using the ABON One-step Helicobacter pylori Test Device (serum/plasma), a rapid, one-step immunoassay for the qualitative detection of antibodies to Helicobacter pylori in human serum or plasma.

Data were analysed using SPSS software version 16.0. The Chi-square test and Student’s t-test were used to compare categorical and continuous variables, respectively. A p-value of <0.05 was considered statistically significant.

Ethical approval for this study was obtained from the Institutional Ethics Review Committee of Yangon General Hospital. Written informed consent was obtained from all participants prior to enrollment.

RESULTS:

A total of 92 participants were included in this study (46 chronic urticaria patients and 46 controls). The mean age of patients with chronic urticaria was 35.57±15.39 years, while that of the control group was 36.63±14.18 years. There was no statistically significant difference in age between the two groups (p=0.0767). Female participants were predominant in both groups. Most participants had secondary or tertiary education (Table 1).

Table 1: Socio-Demographic Characteristics of Study Participants

Variable	Chronic Urticaria Group (n=45)	Control Group (n=45)	P=value
Age (years)	35.57 ±15.39	36.63 ± 14.18	p=0.767
≤ 10 years	1 (2,17%)	1 (2.17%)
11 to 30 years	20 (43.48%)	18 (39.13%)
31 to 50 years	18 (39.13%)	20 (43.48%)
51 to 70 years	7 (15.22%)	7 (15.22%)
Sex
Male	14 (30.44%)	16 (35.55%)	p==0.624
Female	32 (69.56%)	29 (64.65%)
Education Level
Primary	13 (28.26%)	13 (28.26%)	P=0.883
Secondary	18 (39.13%)	20 (43.48%)
Tertiary	15 (32.61)	13 (28.26%)
Occupation
Dependent (homemaker)	16 (34.78%)	15 (32.61%)
Manual worker	11 (23.92%)	12 (26.09%)
Employees	10 (21.74%)	8 (17.39%)
Professional	6 (13.04%)	7 (15.22%)
Others	3 (6.52%)	4 (8.69%)

Urticarial Wheals Occurring at Forearm Depicted In Figure 1 and Angioedema at Eye Figure 2:


Figure 1: Urticarial Wheals Occurring at Forearm	Figure 2: Angioedema at Eye

Seasonal variation revealed that chronic urticaria was most common in the summer season (19 patients, 41.31%), followed by the rainy season (16 patients, 34.78%) and winter season (11 patients, 23.91%). With respect to clinical morphology, 43 patients (93.48%) presented with wheals, (Figure 1) 2(4.35%) had angioedema alone, (Figure 2) and 1 patient (2.17%) had both wheals and angioedema. The most common distribution sites were the upper limbs (39 patients, 84.78%) and lower limbs (34 patients, 73.91%). Lesions were also noted on the trunk in 12 patients, (26.09%), abdomen in 6(13.04%), buttock in 4(8. 70%), and face and neck in 2 (4.35%).

Figure 3: Graphic Representation of Serological Status for Helicobacter Pylori in Chronic Urticaria and Control

Serological testing for Helicobacter pylori showed a significantly higher seropositivity rate among patients with chronic Urticaria compared with controls (p=0.007). The odds of H pylori seropositivity were 3.65 times higher in the chronic Urticaria group. (95% CI 1.399 - 9.540) (Figure 3).

DISCUSSION:

Urticaria is a common disease with diverse clinical presentations. In the present study, the mean age of patients with chronic urticaria was 35.57±15.39 years, and females were more frequently affected. The adjusted prevalence in women was 310 (95% confidence interval [CI] 307-312) cases/100,000 adults, more than twice that of men (146 [95% CI 143-148] cases/100,000 adults, P< .001). Chronic urticaria prevalence was highest among patients aged 40-49 years (256 [95% CI 252-261] cases/100,000 adults)⁷. The findings of this study agree with previous literature, indicating that chronic urticaria is more common among individuals in the reproductive age group. Furthermore, female preponderance has been consistently reported across multiple studies.

Manual workers and employees were nearly equally distributed in this study. Most participants were dependent (homemakers). Sixty-five percent of patients had attained at least a high school level of education, and among them, 32.61% were university graduates. This finding may be attributed to the greater accessibility of more educated individuals to tertiary-level healthcare facilities. Workers at highest risk of occupational contact dermatitis and urticaria include those in agriculture, beauticians, chemical workers, cleaners, construction workers, cooks and caterers, electronics workers, farmers, hairdressers, health and social care workers, machine operators, mechanics, and metalworkers⁸.

Y Nie reported that chronic urticaria predominantly occurred during the summer season, particularly at the beginning of summer⁹. In the present study, chronic urticaria was also found to be most common in the summer season, with a nearly similar percentage of cases observed during the rainy season, whereas it was rarely reported in the winter season.

An autoimmune basis of most of the ‘idiopathic’ forms is now hypothesised. Histamine released from mast cells is the major effector in pathogenesis and it is clinically characterised by wheals that tend to recur¹⁰. In the present study, a higher proportion of patients had wheals, with 43 out of 46 chronic urticaria patients (93.48%) affected.

In this study, the most common site of lesion distribution was the upper limb (84.78%), whereas the face was the least commonly affected site, observed in only two patients (4.35%). Lesions on the lower limb were found in 34 patients (73.9%). These findings are consistent with the observation by Sachdeva (2011) that lesions can appear anywhere on the body, including the palms and soles, although in our study, upper limb involvement was particularly predominant¹⁰.

Asero studied 205 patients with chronic urticaria, of whom 205 were tested for the presence of H pylori IgG using an autologous serum skin test¹¹. Similarly, Fukuda reported that Helicobacter pylori infection was diagnosed in 50 out of 26 patients with chronic urticaria and 24 out of normal healthy persons¹². In the present study, out of 46 healthy controls, 8 individuals (17.39%) were serologically positive for Helicobacter pylori, whereas 20 patients with chronic urticaria (43.48%) tested positive. This difference was statistically significant (p=0.007), with H. pylori seropositivity being 3.653 times higher among chronic urticaria patients compared to controls (95% CI: 1.399-9.540). These findings, in line with previous studies, suggest H. pylori infection may play a contributory role in the pathogenesis of chronic urticaria.

CONCLUSION:

The current study has investigated the association between Helicobacter pylori infection and chronic urticaria. Basing on its findings, this research has drawn the conclusion that chronic urticaria was more common in females and showed a seasonal predominance during the summer months. The most frequently affected site was the upper limb, followed by the lower limb, with face and neck involvement being rare. A significant association was observed between H pylori seropositivity and the healthy control group (p=0.007).

Screening and eradication therapy for Helicobacter pylori could be considered in selected patients, though further large-scale studies are

CONFLICT OF INTEREST:

There is no conflict of interest between authors

AUTHORS’ CONTRIBUTIONS:

MN conceptualized the study, designed the methodology, performed data analysis, and wrote and edited the manuscript.

KTY assisted in data entry, statistical analysis, and drafting of the results section.

NZT collected patients’ data and contributed interpretation of clinical findings.

WMA reviewed the manuscript for intellectual content and provided final approval of the version to be published.

ACKNOWLEDGMENT:

We would like to express our sincere gratitude to the consultant dermatologists from Yangon General Hospital for their guidance and support throughout this study. We are deeply grateful to all the patients who participated in this study and to the control group volunteers for their kind cooperation, without whom this research would not have been possible.

DECLARATION:

I hereby declare that this research was conducted independently, and I did not receive any financial support, funding or sponsorship from any institution or individual for the completion of this study.

REFERENCE:

1. Kayiran MA, Akdeniz N. Diagnosis and treatment of urticaria in primary care. Northern Clinics of Istanbul. 2019 Feb 14; 6(1):93.

2. Sánchez-Borges M, Asero R, Ansotegui IJ, Baiardini I, Bernstein JA, Canonica GW, Gower R, Kahn DA, Kaplan AP, Katelaris C, Maurer M. Diagnosis and treatment of urticaria and angioedema: a worldwide perspective. World Allergy Organization Journal. 2012 Dec; 5(11):125-47.

3. Kulthanan K, Church MK, Grekowitz EM, Hawro T, Kiefer LA, Munprom K, Nanchaipruek Y, Rujitharanawong C, Terhorst-Molawi D, Maurer M. Evidence for histamine release in chronic inducible urticaria–a systematic review. Frontiers in Immunology. 2022 Jul 28; 13:901851.

4. Daschner A, Cuéllar C. The hidden sense of symptoms: urticaria can be beneficial. Medical hypotheses. 2010 Dec 1; 75(6):623-6.

5. Eckman JA, Hamilton RG, Saini SS. Independent evaluation of a commercial test for “autoimmune” urticaria in normal and chronic urticaria subjects. Journal of Investigative Dermatology. 2009 Jun 1; 129(6):1584-6.

6. Yim JY, Kim N, Choi SH, Kim YS, Cho KR, Kim SS, Seo GS, Kim HU, Baik GH, Sin CS, Cho SH. Seroprevalence of helicobacter pylori in South Korea. Helicobacter. 2007 Aug; 12(4): 333-40.

7. Wertenteil S, Strunk A, Garg A. Prevalence estimates for chronic urticaria in the United States: a sex-and age-adjusted population analysis. Journal of the American Academy of Dermatology. 2019 Jul 1; 81(1): 152-6.

8. Nicholson PJ, Llewellyn D, editors. Occupational contact dermatitis and urticaria. London: British Occupational Health Research Foundation; 2010. http://www.bohrf.org.uk/downloads/OccupationalContactDermatitisEvidenceReview-Mar2010.pdf (accessed 12 May 2010) [Google Scholar]

9. Nie Y, Liu L, Xue S, Yan L, Ma N, Liu X, Liu R, Wang X, Wang Y, Zhang X, Zhang X. The association between air pollution, meteorological factors, and daily outpatient visits for urticaria in Shijiazhuang, Hebei Province, China: a time series analysis. Environmental Science and Pollution Research. 2023 Jan; 30(4): 10664-82.

10. Sachdeva S, Gupta V, Amin SS, Tahseen M. Chronic urticaria. Indian Journal of Dermatology. 2011 Nov 1; 56(6): 622-8.

11. Asero R, Tedeschi A, Lorini M, Salimbeni R, Zanoletti T, Miadonna A. Chronic urticaria: novel clinical and serological aspects. Clinical & Experimental Allergy. 2001 Jul; 31(7): 1105-10.

12. Fukuda S, Shimoyama T, Umegaki N, Mikami T, Nakano H, Munakata A. Effect of Helicobacter pylori eradication in the treatment of Japanese patients with chronic idiopathic urticaria. Journal of gastroenterology. 2004 Sep; 39(9): 827-30. https://doi.org/10.1007/s00535-004-1397-7, 2-s2.0-6944253416.

Received on 09.10.2025 Revised on 19.12.2025

Accepted on 22.01.2026 Published on 10.02.2026

Available online from February 16, 2026

Research J. Pharmacy and Technology. 2026;19(2):561-564.

DOI: 10.52711/0974-360X.2026.00082

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