title: Effectiveness of Helicobacter pylori eradication in chronic urticaria: evidence-based analysis using the Grading of Recommendations Assessment, Development, and Evaluation system.
abstract: OBJECTIVE
  Chronic urticaria is a common and often frustrating condition that physicians encounter in the outpatient setting. Its management continues to be a challenge, and an exogenous cause for chronic urticaria is only found rarely. Helicobacter pylori has been implicated as a factor for many disorders and proposed as an etiologic factor for chronic urticaria. We aim to provide a comprehensive review of the data on H. pylori eradication for treatment of chronic urticaria by utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to analyze and determine the quality of evidence for this proposed therapy.
  
  
  RESULTS
  Although H. pylori eradication has been recommended as part of routine chronic urticaria management by multiple authors, the trials of H. pylori eradication in the treatment of chronic urticaria have yielded conflicting results and suffer from substantial methodological limitations.
  
  
  CONCLUSIONS
  Our critical appraisal of the 10 trials showing the benefit of H. pylori eradication in patients with chronic urticaria leads to an overall very low grade for this intervention. Appraisal of nine studies in which H. pylori eradication showed no benefit in the course of chronic urticaria also leads to an overall very low grade. The evidence that H. pylori eradication leads to improvement of chronic urticaria outcomes is weak and conflicting; this leads to a weak recommendation for routine H. pylori eradication for patients with chronic urticaria. For this reason, a decision to proceed with this management should be considered carefully in the context of relative harms/burdens and benefits, as well as patient values and preferences.
authors.affiliation: Department of Internal Medicine, Las Colinas Medical Center, Irving, Texas, USA. alishakouri@yahoo.com
authors.forename: Ali
authors.initials: A
authors.lastname: Shakouri
authors.forename: Enrico
authors.initials: E
authors.lastname: Compalati
authors.forename: David M
authors.initials: DM
authors.lastname: Lang
authors.forename: David A
authors.initials: DA
authors.lastname: Khan
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine / Q000379:methods*; D006287:Health Planning Guidelines; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014581:Urticaria / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents