Parasitic Infections in Children with Chronic Spontaneous Urticaria

Abstract

Background: Parasites have been proposed to be an underlying cause of chronic spontaneous urticaria (CSU) in childhood, but a clear causal relationship between them has not been established. This study aimed to investigate the prevalence of parasitic infection-related CSU (PIRCSU) in children and to determine the factors associated with PIRCSU. Method: Data from 211 children with CSU were analyzed. Information on stool examination, antiparasitic medications received, and response to treatment was recorded. The disappearance of urticaria for more than 6 months is defined as remission, and remission of urticaria after antiparasitic treatment is defined as PIRCSU. Results: Parasites were detected in 21 (10%) patients. Blastocystis hominis was the most common parasite. After antiparasitic medication, all samples became normal; urticaria continued in 5, was reduced in 6, and disappeared in 10 patients. The latter 10 patients were considered as cases of PIRCSU (4.7%). The erythrocyte sedimentation rate was significantly higher in patients with PIRCSU than in those without [8.5 mm/h (3.5-14.5) vs. 2 (0-7), p = 0.011]. Gastrointestinal complaints were significantly more frequent in patients with PIRCSU than in those without. The occurrence of abdominal pain was a significant risk factor that increased the probability of PIRCSU [OR = 6.60, 95% CI = 1.35-32.23, p = 0.020]. Conclusion: Parasites may cause CSU even in nontropical countries, and remission may only be possible with the treatment of the parasitic infection. The occurrence of abdominal pain points to parasitic infection in patients with CSU. Therefore, we suggest that parasites should be investigated routinely, especially if the patient has gastrointestinal symptoms of CSU in childhood.

Evaluation of intestinal parasites in patients with chronic spontaneous urticaria in a territory hospital in Turkey

“…In another study from the same country, the incidence of IPI and the distribution of the parasites were similar with the previous study [21]. Besides, in a study of 211 pediatric patients with CSU held in our country, the rate of IPI was 10% and the most prevalent parasites detected were Blastocystis sp., G. duodenalis, D. fragilis and E. vermicularis in row with decreasing order [16]. In another study held in Turkey, parasitic infections had been detected in 38.8% of the CSU patients and 11.1% of control group of which the difference between the groups was statistically significant.…”

“…Autoimmunity, stress, pseudo allergens, inflammation and chronic underlying infections have been found associated with CSU [15]. Particularly parasitic infections are defined as one of the causes of urticaria especially in developing countries [16]. The type and frequency of intestinal parasites varies among different regions of the world.…”

Antalya il merkezinde kronik spontan ürtikeri olan çocukların klinik ve demografik verilerinin değerlendirilmesi.

“…Kronik ürtiker ile paraziter enfeksiyonlar (Giardia lamblia, Strongyloides stercoralis, Toxocara canis, Blastocystis hominis) arasında ilişki bildiren yakın dönem çalışmalar mevcuttur [28][29][30]. Çalışmaların üçte ikisinde KSÜ'de paraziter enfeksiyon sıklığı %10 ve daha az oranda olduğu gösterilmiştir [30].…”

“…Çalışmaların üçte ikisinde KSÜ'de paraziter enfeksiyon sıklığı %10 ve daha az oranda olduğu gösterilmiştir [30]. Yılmaz ve ark.nın [29] kronik ürtikerli çocuklarda %10 oranında paraziter enfeksiyon saptanmışken, bizim çalışmamızda ise 2 (%3) olguda paraziter hastalıklar saptanmıştır (Giardia intestinalis, Blastocystis hominis). Antiparaziter tedavi sonrası hastaların %50'sinden fazlasında tedavi sonrasında KSÜ 'de düzelme olduğu belirtilmiştir [30].…”

Recent Advances in Clinical Allergy and Immunology

“…In India, H. pylori infections, which are mainly asymptomatic, are also frequent in CSU patients; however, the implications for disease course and severity are not clear [66]. Parasites were detected in 10% of children with CSU, of which half responded to an antiparasitic therapy [67]. …”