Association Between Chronic Urticaria and Helicobacter pylori Infection Among Patients Attending Major Hospitals in Sana’a, 2025: A Case-Control Study
DOI:
https://doi.org/10.65693/irss.2026.v7i1.423Keywords:
chronic urticaria; chronic spontaneous urticaria; Helicobacter pylori; stool antigen; case-control study; Sana’a; YemenAbstract
Background: Chronic urticaria (CU) is a persistent inflammatory skin disorder characterized by recurrent wheals, angioedema, or both for more than six weeks. Although many cases are considered spontaneous or idiopathic, accumulating evidence suggests that gastrointestinal inflammation and infection may contribute to disease activity in selected patients. Helicobacter pylori has therefore been investigated as a potentially modifiable associated factor, but findings remain heterogeneous and local evidence from Yemen has been lacking.
Objective: To determine whether H. pylori infection is associated with chronic urticaria among patients attending Al-Jumhuri, Al-Kuwait, and Al-Thawra hospitals in Sana’a City, Yemen.
Methods: A hospital-based case-control study was conducted from May to August 2025 among 132 participants recruited from outpatient settings, including 66 clinically diagnosed CU cases and 66 dermatology controls without urticaria. Demographic, dermatologic, gastrointestinal, and disease-related data were collected using a structured interviewer-administered questionnaire. H. pylori status was assessed using a stool antigen test. Group differences were assessed with chi-square tests and independent-samples comparisons as appropriate. The association between CU and H. pylori positivity was summarized using an odds ratio (OR) with a 95% confidence interval (CI).
Results: Cases and controls were comparable in age, sex, residence type, marital status, and education (all p>0.05), although hospital distribution differed significantly (p=0.028). H. pylori positivity was substantially higher among CU cases than controls (60.6% vs 34.8%, p=0.005), corresponding to nearly threefold higher odds of infection among cases (OR 2.88, 95% CI 1.42–5.83). Gastrointestinal symptoms were common in both groups and tended to be more frequent among cases, but most between-group differences were not statistically significant. Among CU cases, disease burden was considerable, with daily symptoms in 48.5%, sleep disturbance in 53.0%, and mental health impact in 77.3%. Only 25.8% of cases reported receiving eradication therapy; among treated cases, 41.2% reported improvement in urticaria symptoms.
Conclusion: H. pylori infection was significantly associated with chronic urticaria in this Sana’a hospital sample. The findings support considering selective gastrointestinal evaluation and targeted H. pylori testing in CU patients with persistent disease or gastrointestinal complaints, while continuing guideline-based urticaria management. Prospective and interventional studies are needed to clarify temporality and the therapeutic value of confirmed eradication.
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