Recurrent anaphylaxis caused by parasitizing fish

Anisakis simplex: from Obscure Infectious Worm to Inducer of Immune Hypersensitivity

“…Similar findings have been published by others, and the test discriminated between allergics and controls with a 95 to 100% sensitivity and a 100% specificity (105). (25). IgE was monitored yearly for this patient, and IgE decreased progressively but remained positive for 11 years.…”

“…Hypersensitivity is usually diagnosed by skin prick tests and in vitro confirmation (specific IgE, histamine release, basophil activation test [BAT]). In the case of A. simplex, the skin prick test was first used in 1995 (25), and since then its use has been widespread among allergy clinicians as a valuable screening test in cases of urticaria and anaphylaxis (29,50,69,82). Other Japanese authors have reported preliminary studies using intradermal and scratch tests to investigate allergic manifestations associated with anisakidosis (125,139), but these two techniques are no longer recommended as primary tests for the diagnosis of IgE-mediated allergic diseases or for research purposes by the European and American Academies of Allergy.…”

“…Rheumatic symptoms may appear in the course of anaphylaxis but are extremely rare (68). Alarmingly, some episodes of allergy have been described in association with exposure to even very small doses of A. simplex antigens and without the involvement of living parasites: two episodes of anaphylaxis have been reported in direct association with skin prick testing using an A. simplex extract (25,50). It has also been reported that A. simplex allergy behaves as other severe food allergies in that it can be provoked by skin contact or inhalation of minute quantities of the allergen (258), causing occupational hazards such as conjunctivitis (12) and asthma (17,220,241), protein contact dermatitis, and conjunctivitis (51,61).…”

Anisakis pegreffii-Induced Airway Hyperresponsiveness Is Mediated by Gamma Interferon in the Absence of Interleukin-4 Receptor Alpha Responsiveness

“…Within hours of being ingested, Anisakis L 3 penetrate the mucosal layers of the gastrointestinal tract, causing direct tissue damage that may lead to abdominal pain, nausea, and/or diarrhea. Furthermore, some patients develop an immunoglobulin E (IgE)-mediated "gastroallergic anisakiasis," which presents with clinical manifestations ranging from urticaria to allergic reactions and life-threatening anaphylactic shock (5,13,14). To date, nine allergens from Anisakis simplex, some of which are cross-reactive to other seafood allergens, have been characterized on a molecular level (28).…”

Interleukin-4 production in BALB/c mice immunized with Anisakis simplex

“…These "parasitic characteristics" are comparted by numerous allergens, and may be responsible of the poor adaptation developed against molecules, such as, the proteases of the dust acari, and the phospholipids of the bee venom or the pollen antigens (Finkelman 1995). Such, it could be the case of the Anisakis antigens which have been implicated as cause of allergic disorders (Audícana et al 1995). In a general manner, Th2 responses are protective against Heligmosomoides polygyrus infections, neutral against Nippostrongylus brasiliensis and blokader of the protective responses in Trichinella spiralis infections when Th1 and Th2 responses appeared simultaneously but in different locations (Scott & Kaufmann 1991) and in the Schistosoma mansoni ones (Finkelman et al 1991).…”