Pravettoni V, Primavesi L, Piantanida M.
Anisakis simplex: current knowledge.
Eur Ann Allergy Clin Immunol. 2012 Aug;44(4):150-6.
Anisakiasis, firstly described in 1960s in the Netherlands, is a fish-borne parasitic disease caused by the consumption of raw or undercooked fish or cephalopods contaminated by third stage (13) larvae of the Anisakidae family, in particular Anisakis simplex (As), A. pegreffii and Pseudoterranova decipiens. Every year, approximately 20,000 cases of anisakiasis were reported worldwide, over 90% are from Japan and most others in Spain, the Netherlands and Germany, depending on the habits of fish consuming. Live As larvae can elicit i) a parasitic infection of the digestive tract or, occasionally, other organs, causing erosive and/or haemorrhagic lesions, ascites, perforations until granulomas and masses, if larva is not removed, and ii) allergic reactions, as anaphylaxis, acute/chronic urticaria and angioedema. Like other parasite infestations, As larva induces an immune adaptive response characterised by T-lymphocyte proliferation with polyclonal and monoclonal (responsible for As allergic symptoms) IgE production, eosinophilia and mastocytosis. Several As allergens, many of which thermostable, were described In particular the major allergen Ani s 1 and Ani s 7 could characterized a past or a recent infection. There is a general agreement that an active infection is required to initiate allergic sensitivity to Anisakis. Until now, the only effective treatment for anisakiasis is the endoscopic removal of live larvae and the best protection against anisakiasis is to educate consumers about the dangers of eating raw fish and to recommend avoiding the consumption of raw or inadequately thermally treated marine fish or cephalopods.
Η πρόσβαση στο άρθρο είναι ελεύθερη από το website του εκδότη :
Αν και στην Ελλάδα δεν έχει αναφερθεί περιστατικό παρασίτωσης με anisakis ή αναφυλαξίας μετά από κατανάλωση νωπών ψαριών ή κεφαλοπόδων που έχουν επιμολυνθεί από το παράσιτο, η γνώση των χαρακτηριστικών της νόσου είναι χρήσιμη για τον κλινικό αλλεργιολόγο.
Να σημειωθεί πως σε πρόσφατη μελέτη που διεξήγαγε το Εθνικό Ιδρυμα Αγροτικής Ερευνας σε αλιεύματα από το Αιγαίο ανευρέθει anisakis στο 18.83 % των δειγμάτων :
Chaligiannis I, Lalle M, Pozio E, Sotiraki S.
Anisakidae infection in fish of the Aegean Sea.
Vet Parasitol. 2012 Mar 23;184(2-4):362-6.
Nematode worms of the family Anisakidae are the causative agents of infections in humans when fish is consumed raw and of serious allergies up to the death, when fish is consumed raw or cooked by previously sensitized people. From April until November 2009, 462 fish belonging to 26 species, fished in three areas of the Aegean Sea were tested for Anisakidae larvae. Anisakidae larvae were detected in 87 (18.83%) fish of 13 species. These larvae were identified by morphology as the third-stage larvae of the genera Hysterothylacium sp. or Anisakis. Larvae of the genus Anisakis were identified by PCR-RFLP as belonging to A. simplex s.str., A. pegreffii, or as hybrids between A. simplex s.str and A. pegreffii.
Τέλος οι Ventura και συν. από την Ιατρική Σχολή του Μπάρι της Ιταλίας, επισήμαναν σε πρόσφατη ανακοίνωσή τους πως το 49.7% του πληθυσμού τους με χρόνια κνίδωση (Ν=213) ήταν ευαισθητοποιημένο έναντι του anisakis.
Ventura MT, Napolitano S, Menga R, Cecere R, Asero R.
Anisakis simplex Hypersensitivity Is Associated with Chronic Urticaria in Endemic Areas.
Int Arch Allergy Immunol. 2012 Oct 18;160(3):297-300. [Epub ahead of print]
PubMed PMID: 23095317.
Background: Chronic urticaria (CU) may affect up to 1% of the general population. Anisakis simplex hypersensitivity is frequent in areas where raw fish is consumed and A. simplex allergy represents a relevant cause of acute urticaria. We assessed the possible association between CU and A. simplex sensitization in an area where marinated fish is very frequently eaten.
Methods: A thorough history of CU was sought in 919 adults seen at the Allergy Center, Bari. CU patients and 187 controls underwent skin-prick testing with a commercial extract of A. simplex, and reactors were recommended a 6-month raw-fish-free diet regimen. Responders were followed after a further 3 months.
Results: Of 919 subjects, 213 (23%) met the criteria for CU and 106/213 (49.7%) were sensitized to A. simplex with a significant difference between patients aged >65 or <65 years (56 vs. 41%, respectively; p < 0.05). All patients hypersensitive to A. simplex were regular consumers of marinated fish. In a control population without CU, the prevalence of A. simplex sensitization was 16% (p < 0.001). The 6-month diet regimen led to the disappearance of urticaria in 82/106 cases (77%) versus 1/42 (2%) subjects who did not change their dietary habits (p < 0.001). All nonresponders were sensitized to house-dust mites. Of 75 responders who were followed-up after 3 months, CU relapsed in 88% of those who had reintroduced raw fish versus 14% of those who were still on the diet (p < 0.001).
Conclusion: In areas where raw or marinated fish is frequently eaten, A. simplex hypersensitivity is a frequent cause of CU.