Urticaria by neurogenic switching of gastroesophageal chemical‐infective inflammation: a phenomenon that should always be evaluated in suspected multiple drug hypersensitivity

Bartolomeis, Fabio De; Savoia, Alfonso; Aitella, Ernesto; Sacerdoti, Carlo; Parlato, Adele; Palmieri, Carmen; Astarita, C.

doi:10.1186/2045-7022-4-s3-p26

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“…Gastrointestinal complaints in these patients were also associated with greater disease burden and higher serum tryptase levels [ 27 ]. Preliminary observations from our group suggest a high prevalence of symptoms and endoscopic signs of gastro-esophageal reflux disease (GERD) among Italian CSU patients with contemporary GICs [ 28 ]. Moreover, GERD is recognised as a syndrome that is prevalent in Southern Italy [ 29 ] and shares features with CSU such as elevated plasma SP levels [ 20 , 30 , 31 ], which may have an important role in pathogenesis and clinical severity of hives [ 20 ].…”

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The overlap syndrome of urticaria and gastroesophageal reflux disease

et al. 2018

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BackgroundOne-quarter of systemic symptoms associated with chronic spontaneous urticaria (CSU) are related to gastrointestinal complaints (GICs).ObjectivesTo investigate the prevalence and features of urticaria-overlapping GICs.MethodsIn this retrospective cross-sectional survey, 1426 consecutive outpatients were observed at our University Department. Only patients suffering from urticaria or GICs with a complete diagnostic work-up including serum total IgE level (Tot-IgE), differential blood count and urticaria activity score (UAS), were evaluated.ResultsAmong different GICs, gastroesophageal reflux disease (GERD) was the most frequent syndrome observed (15.4%; 95%CI: 13.6–17.3). The prevalence of overlap syndrome for urticaria and GERD was 5.9% (95%CI: 4.7–7.2). In urticaria-patients, the prevalence of GERD was four-fold higher than in patients without hives (44% vs. 11%, p<0.001). UAS was significantly higher in urticaria and GERD overlap syndromes vs. isolated urticarias. In patients with GERD or acute/chronic urticaria or overlap syndrome, Tot-IgE and eosinophil blood count (EBC) differed significantly, with a stepwise increase in their values; from the subgroup of patients with GERD only, to that with overlap of CSU to GERD. Prevalence values for urticaria overlapping with GERD were three- and two-fold higher in CSU and in long-duration GERD cases respectively compared to acute urticaria or short-duration GERD cases. Similar to Th2 pathology models, CSU and GERD overlap syndrome was significantly and independently associated with Total-IgE ≥100IU/ml or EBC ≥250/mmc compared to CSU or GERD. Endoscopic/bioptic findings of non-erosive reflux disease (NERD) or Barrett’s esophagus (BE) were more frequent in chronic overlap syndrome than in GERD-patients.ConclusionsGERD was the most frequent GIC in patients with urticaria. Overlap syndrome was more frequent among patients with CSU, where this syndrome was associated with higher values of UAS, Tot-IgE, EBC and frequencies of NERD and BE. These results suggest that overlap syndrome is frequently a chronic syndrome with a Th2-like profile.

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