Comorbidity of viral hepatitis and chronic spontaneous urticaria: A systematic review

Abstract

Chronic viral infections including those by hepatitis B (CHB) virus and hepatitis C (CHC) virus have been reported to be comorbidities of chronic spontaneous urticaria (CSU). Here, we performed the first comprehensive review of the peer-reviewed literature (PubMed, Web of Science and Google Scholar) on the prevalence of CHB and CHC in patients with CSU and vice versa. The prevalence of CHB and CHC in CSU does not appear to be increased. Less than 5% and 2% of patients with CSU have markers of CHB and CHC, respectively, according to most of the 32 studies reviewed. Urticarial rash including CSU occurs in ≤3% of patients with CHC as reported by most of 20 studies analysed. Very few patients have been assessed for the effects of antiviral hepatitis treatment on their CSU, and two but not all reportedly showed improvement. Hepatitis B/C infections appear unlikely to be linked to CSU. We suggest that routine screening for these infections in patients with CSU is not relevant or cost-effective and should not be performed unless liver function tests are abnormal, risk factors or symptoms of viral hepatitis are present, or urticarial vasculitis is suspected.

Highlights and recent developments in skin allergy and related diseases in EAACI journals (2018)

“…It is indicated that there is an increased risk of developing acute urticaria and CU, particularly in female patients [48 ]. A comprehensive literature review indicated that chronic hepatitis B and C are not associated with CSU and so routine screening for these viral infections in CSU patients is not necessary [49 ].…”

Case Report: Resolution of chronic urticaria following treatment of odontogenic infection

“…Infection with viral hepatitis has also been associated with CSU 16, 17 and guidelines suggest performing a hepatitis screen if transaminases are abnormal 1 . However, a systematic review on the subject revealed that the prevalence of hepatitis B and hepatitis C was no greater in CSU patients than compared with the general population 18 .…”

“…There are other examples in the literature where chronic infection has been linked with CSU, and one such example is HepC and HepB. However, a comprehensive review of the literature failed to find an obvious associations, and routine screening is not recommended 2 .…”

Urticaria: clinical profile, laboratory evaluation, serum IgE evaluation and its significance

“…22 Also identified is hepatitis, pathogens as strongyloides stercoralis, or helicobacter pylori to mention a few. 24,32 In the laboratory evaluation of urticaria, serum IgE levels, complete blood counts (hypereosinophilia, basophilia), hepatitis screen (HBVand HCV) and stool ova/parasite tests are done. 2 Sr IgE, was raised in almost half the patients in whom it was done.…”

“…13,[21][22][23] In a large proportion of patients triggers are not identifiable. 14 In the few patients where triggers have been identified, these triggers include alcohol, Hepatitis B Virus and Hepatitis C Virus infection, 2,24 drugs (non-steroidal anti-inflammatory drug) and stress. 14 Food has not been found to trigger urticaria despite patients giving a history of food as a trigger.…”