Journal of Allergy & Therapy

Abstract

Fascinating Giardia Lamblia and Vexing Chronic Spontaneous Urticaria: An Under-appreciated Association

Mujtaba Hasan Siddiqui and Iqbal Akhtar Khan

Background: Chronic Spontaneous Urticaria (CSU) has been found to have a negative impact on all aspects of patients’ lives - physical, mental, social and emotional. The ubiquitous and fascinating Giardia lamblia is primarily a gastrointestinal pathogen but it may present atypically (with or without gastroenterological manifestations). A link between Giardiasis and CSU was identified in the past. However, the possibility of this combination has been under-appreciated in clinical practice, even in developed world, resulting in inordinate delay in reaching correct diagnosis and instituting targeted pharmacotherapy. Such a situation adds to the miseries of the patients, both mental anguish and physical suffering. Objectives: -To determine the role of Giardia lamblia in the causation of CSU -To ratify the effects of eradication of Giardia lamblia on the course of CSU Methods: The present study was conducted on 63 referred cases of CSU (with insignificant improvement from the treatment already instituted). In view of the possibility of concomitant Giardial infection stool microscopy was advised and three fresh stool specimens, taken on alternate days, were collected from every case and examined for parasites. The two validated instruments employed for comparing Patient Related Outcome Measures (PROMs), before and after treatment, were UAS7 (Urticaria Activity Score of 7days) and CU-Q2oL (Chronic Urticaria Quality of Life Questionnaire). Results: Twenty two percent of those tested were found to have sole infection with Giardia lamblia. Secnidazole Sodium, as a single oral dose, resulted in complete parasitological and clinical cure in 93% of the cases. The results of the PROMs were compared and correlated with the clinical picture. Conclusion: The effects of eradication of Giardia lamblia on the course of the urticaria were excellent. Complete resolution of symptoms was seen in 93% of cases (and no recurrence in the follow up period of 16 weeks) with specific anti-giardial therapy alone proving that the causative agent was Giardia lamblia and that there was no role for any concomitant dermatological pathology. There is a dire need for meaningful cooperation between specialists of Dermatology and Tropical Medicine, in the management of otherwise unexplained urticaria.