Published: 2019-12-25

Can vitamin D, B12, folic acid, inflammatory markers and H. pylori effective in the process of chronic spontaneous urticaria?

Feridun Gurlek, Eyyüp Taşdemir


Background: Etiopathogenesis in Chronic Spontaneous Urticaria (CSU) is not completely clear. Some vitamins, inflammatory markers and even some microorganisms have been held responsible for this process. There are limited number of publications in this field in the literature. The aim of this study is to shed light on the etiology of chronic urticaria.

Methods: This study included a total of 90 patients that 45 with CSU patients and 45 healthy subjects who admitted to Allergy and Clinical Immunology and Internal Medicine outpatient clinics of University of Health Sciences, Bursa Postgraduate Research and Training Hospital between October 2018 and June 2019. They were between the ages of 18-55. Both groups were examined for CRP, Procalcitonin (PCT), Erythrocyte Sedimentation Rate (ESR), Vitamin B12, vitamin D, folic acid and Helicobacter pylori (H. pylori) antibody.

Results: ESR, CRP, PCT, Vitamin B12 and Vitamin D levels were not statistically different according to the groups (p>0.05). Folic acid levels were significantly different between groups (p=0.026; p<0.05); the low folic acid ratio in the healthy group is higher than in the urticaria group. There was no statistically significant difference between the groups according to H. pylori antibody positivity (p>0.05). In urticaria group, sufficient vitamin D ratio was higher in who were H. pylori antibody negative. In healthy group; insufficient and sufficient vitamin D ratio was higher in who were H. pylori antibody positive.

Conclusions: There is no direct correlation between urticaria and Vitamin B12, Vitamin D, folic acid deficiencies and inflammatory biomarkers. CRP, ESR and PCT levels may be generally normal as in patients with urticaria. However, CRP may also increase slightly in patients with severe urticaria. It may be wrong to see H. pylori as a direct cause of urticaria.


Chronic spontaneous urticaria, C-reactive protein, Folic acid, Helicobacter pylori, Procalcitonin, Vitamin B12

Full Text:



Zuberbier T, Aberer W, Asero R, Bindslev‐Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA 2 LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69(7):868-87.

Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative cross‐sectional population survey. Clinical and Experimental Dermatology: Clin Dermatol. 2010;35(8):869-73.

Kasperska‐Zajac A. Acute‐phase response in chronic urticaria. J European Acad Dermatol Venereol. 2012;26(6):665-72.

Kasperska‐Zajac A, Sztylc J, Machura E, Jop G. Plasma IL‐6 concentration correlates with clinical disease activity and serum C‐reactive protein concentration in chronic urticaria patients. Clin Exp Allergy. 2011;41(10):1386-91.

Takahagi S, Mihara S, Iwamoto K, Morioke S, Okabe T, Kameyoshi Y, et al. Coagulation/fibrinolysis and inflammation markers are associated with disease activity in patients with chronic urticaria. Allergy. 2010;65(5):649-56.

Kasperska-Zajac A, Grzanka A, Machura E, Mazur B, Misiolek M, Czecior E, et al. Analysis of procalcitonin and CRP concentrations in serum of patients with chronic spontaneous urticaria. Inflammation Res. 2013;62(3):309-12.

Asero R, Cugno M, Tedeschi A. Activation of blood coagulation in plasma from chronic urticaria patients with negative autologous plasma skin test. J Europ Acad Dermatol Venereol. 2011;25(2):201-5.

Kasperska‐Zając A, Jasinska T. Analysis of plasma d‐dimer concentration in patients with delayed pressure urticaria. J Europ Acad Dermatol Venereol. 2011;25(2):232-4.

Kasperska-Zajac A, Rogala B, Nowakowski M. Assessment of platelet activity as expressed by plasma levels of platelet factor 4 and beta-thromboglobulin in patients with chronic idiopathic urticaria. Exp Dermatol. 2005;14:515-8.

Jasinska T, Kasperska-Zajac A. Soluble CD40 ligand is not elevated in plasma of patients suffering from chronic spontaneous urticaria. Br J Dermatol. 2012;167:450-2.

Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Inf Dis. 2004;39:206-17.

Carrol ED, Thomson AP, Hart CA. Procalcitonin as a marker of sepsis. Int J Antimicrob Agents. 2002;20:1-9.

Nijsten MW, Olinga P, The TH, de Vries EG, Koops HS, Groothuis GM, et al. Procalcitonin behaves as a fast-responding acute phase protein in vivo and in vitro. Crit Care Med. 2000;28:458-61.

Tamaki K, Kogata Y, Sugiyama D, Nakazawa T, Hatachi S, Kageyama G, et al. Diagnostic accuracy of serum procalcitonin concentrations for detecting systemic bacterial infection in patients with systemic autoimmune diseases. J Rheumatol. 2008;35:114-9.

Oussalah A, Laurent V, Bruot O, Guéant JL, Régent D, Bigard MA, et al. Additional benefit of procalcitonin to C-reactive protein to assess disease activity and severity in Crohn’s disease. Aliment Pharmacol Ther. 2010;32:1135-44.

Patel S, Farragher T, Berry J, Bunn D, Silman A, Symmons D. Association between serum vitamin D metantibodyolite levels and disease activity in patients with early inflammatory polyarthritis. Arthritis Rheum. 2007;56:2143-9.

Peterson CA, Heffernan ME. Serum tumor necrosis factor-alpha concentrations are negatively correlated with serum 25(OH)D concentrations in healthy women. J Inflamm. 2008;24:5-10.

Van den Berghe G, Van Roosbroeck D, Vanhove P, Wouters PJ, De Pourcq L, Bouillon R. Bone turnover in prolonged critical illness: effect of vitamin D. J Clin Endocrinol Metab. 2003;88:4623-32.

Kolkhir P, André F, Church MK, Maurer M, Metz M. Potential blood biomarkers in 313 chronic spontaneous urticaria. Clin Exp Allergy. 2017;47:19-36.

Kasperska-Zając A, Grzanka A, Jarzab J, Misiołek M, Wyszyńska-Chłap M, Kasperski J, et al. The association between platelet count and acute phase response in chronic spontaneous urticaria. Biomed Res Int. 2014;2014:650913.

Wu CH, Eren E, Ardern-Jones MR, Venter C. Association between Micronutrient Levels and Chronic Spontaneous Urticaria. Biomed Res Int. 2015;2015:926167.

Thorp WA, Goldner W, Meza J, Poole JA. Reduced vitamin D levels in adult subjects with chronic urticaria. J Allergy Clin Immunol. 2010;126:413-4.

Mete N, Gulbahar O, Aydin A, Sin AZ, Kokuludag A, Sebik F. Low B 12 levels in chronic idiopathic urticaria. J Invest Allergol Clin Immunol. 2004;14:292-9.

AL-Hamdi KI, Khashan LS. Role of Helicobacter pylori in chronic ordinary urticaria: a case-control and therapeutic study. Med J Basrah Uni. 2017;35:39-47.

Tareen A, Butt T, Ali B. Helicobacter pylori infection in patients with chronic urticaria and dyspepsia, experience from a developing country. J Pakistan Assoc Dermatol.2016;26:206-13.

Essrani R, Sullivan M, Shah H. Chronic Urticaria Associated with Helicobacter pylori Cureus. 2019;11:4528.