Anisakis

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Code: p4
Latin name: Anisakis spp (Type 1)
Source material: Larvae
Family: Anisakidae
Anisakis is a parasitic nematode whose larvae occupy several types of fish and cephalopods such as cod, sardine, tuna, mackerel and squid as intermediate hosts.

Allergen Exposure

Unexpected exposure
Raw or cooked marine fish and cephalopods infected by Anisakis. Widespread in all seas, but the reported infection rate varies considerably.

Potential Cross-Reactivity

The parasite showed surprisingly low cross-reactivity to Ascaris, considering the close biological relation, and no cross-reactivity to Toxocara or Echinococcus (8-9). A study of patients with urticaria and/or seafood hypersensitivity suggests that nematodes might share some IgE binding epitopes with crustaceans and insects (10).

Clinical Experience

Specific IgE-antibodies to Anisakis can contribute to asthma, and it has been shown to cause urticaria, angioodema and anaphylaxis (7-9). In a study of patients thought to have mackerel-induced urticaria, no patient reacted positively to a scratch test with mackerel antigen, but all were positive to Anisakis antigen (1). The authors concluded that Anisakis larva is an antigen in fish-induced allergy. In an earlier case report, these same authors reported gastric anisakiasis in a patient with urticaria covering the entire body after penetration by Anisakis larva, thus indicating that it is a potent antigen. IgE antibodies have been measured to Anisakis using Pharmacia CAP System in patients with bronchial asthma (2), atopic dermatitis (3-4), allergy (5) and in children with inhalant and/or food allergy (6).
 
Review
Anisakis is a parasitic nematode whose larvae occupy several types of fish and cephalopods such as cod, sardine, tuna, mackerel and squid as intermediate hosts.   In a study of patients thought to have mackerel-induced urticaria, no patient reacted positively to a scratch test with mackerel antigen, but all were positive to Anisakis antigen (1). The authors concluded that Anisakis larva is an antigen in fish-induced allergy. In an earlier case report, these same authors reported gastric anisakiasis in a patient with urticaria covering the entire body after penetration by Anisakis larva, thus indicating that it is a potent antigen. IgE antibodies have been measured to Anisakis using Pharmacia CAP System in patients with bronchial asthma (2), atopic dermatitis (3-4), allergy (5) and in children with inhalant and/or food allergy (6). It has been shown that Anisakis can cause urticaria, angioedema and anaphylaxis after consumption of infected fish. Symptoms can also be triggered by carefully cooked fish indicating temperature stability of the allergens. Patients typically have serum IgE antibodies (Pharmacia CAP System) and skin sensitivity to the parasite but not to the fish (7-9). The parasite showed surprisingly low cross-reactivity to Ascaris, considering the close biological relation, and no cross-reactivity to Toxocara or Echinococcus (8-9). A study of patients with urticaria and/or seafood hypersensitivity suggests that nematodes might share some IgE binding epitopes with crustaceans and insects (10). 

References

  1. Kasuya S, Hamano H, Izumi S. Mackerel-induced urticaria and Anisakis. Lancet 1990;335:665.
  2. Kino M, Izumi K. Frequency of positive reaction to Pharmacia CAP System RAST new food and inhalant allergen (26 allergens) specific IgE in patients with atopic bronchial asthma. Japanese Soc Allergol 1992.
  3. Konatsu H, Miyagawa K, Ikezawa Z. Study of clinical efficacy of Pharmacia CAP System new allergens in patients with atopic dermatitis. Japanese Soc Allergol 1992.
  4. Lindqvist A, Ikezawa Z, Tanaka A, Yman L. Seafood specific IgE in atopic dermatitis. Ann Allergy 1993;70:58.
  5. Matsumaru S, Artia M et al. Clinical evaluation of Pharmacia CAP System new allergens for fish, vegetables, fruits and grains. Jap Soc Ped Allergol 1992.
  6. Yamada M, Torii S. Clinical evaluation of Pharmacia CAP System new food and inhalant allergens. Japanese Soc Allergol 1992.
  7. Del Pozo MD, Audicana M, Diez JM, Muños D, Ansotegui IJ, Garcia M et al. Anisakis simplex, a relevant etiologic factor in acute urticaria. Allergy 1997;52:576-9.
  8. Moreno-Ancillo A, Caballero MT, Cabañas R, Contreras J, Martin-Barosso JA, Barranco P et al. Allergic reactions to Anisakis simplex parasitizing seafood. Ann Allergy Asthma Immunol 1997;79:246-50.
  9. Montoro A, Perteguer MJ, Chivato T, Laguna R, Cuéllar C. Recidivous acute urticaria caused by Anisakis simplex. Allergy 1997;52:985-91.
  10. Pascual CY, Crespo JF, San Martin S, Ornia N, Ortega N, Caballero T et al. Cross-reactivity between IgE-binding proteins from Anisakis, German cockroach, and Chironomids. Allergy 1997;52:514-20.

 

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.