,6 Macrolides also reduce proinflammatory cytokines such as IL-6, IL-8, and tumor necrosis factor-alpha and are sometimes used as adjunct therapy in managing chronic inflammatory airway diseases like asthma, chronic obstructive pulmonary disease, and chronic rhinosinusitis7,8 While the eradication of H. pylori has in some cases been shown to improve chronic urticaria, suspicion for this infection was low given his lack of gastrointestinal symptoms at rash onset, unconfirmed infection prior to empiric therapy, and recurrence despite an adequate treatment course.9 The gene discussed is TNF; the disease is chronic obstructive pulmonary disease.