Diagnosis in gastro-allergic anisakiasis (GAA) is straightforward, when clinical history is combined with further allergological evaluation of specific IgE by means of skin prick test and serum specific IgE. In Anisakis simplex sensitisation associated chronic urticaria (CU+), clinical evaluation of possible previous parasitism is difficult, and positive serum specific IgE could be due to cross-reactivity or other unknown factors. In this study, we evaluated the association between IgE seropositivity to the recombinant allergens Ani s 1 and Ani s 7 and several A. simplex-associated allergic disorders. Twenty-eight patients with GAA and 40 patients with CU+ were studied and their IgE responses were compared with a control group composed of patients with chronic urticaria not sensitized to A. simplex (CU-) according to the skin prick test, as well as a group of 15 healthy subjects not referring urticaria or currently A. simplex associated symptoms. 82.1% of GAA patients and 42.5% of CU+ patients were positive for Ani s 1 (P < 0.001), while the Ani s 7 allergen was recognized by 92.9 and 92.5% of sera from patients with GAA and CU+, respectively. The combined positivity obtained for both allergens reached 100% in GAA, and 95% in CU+. IgE determinations to Ani s 1 and Ani s 7 allergens are useful to diagnose the Anisakis infections and to differentiate among several A. simplex-associated allergic disorders. The IgE responses to Ani s 1 are mainly associated with GAA, while this molecule cannot be considered a major allergen in CU+ patients.

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The aim of this study was to assess the expression of CD23 on peripheral blood B-cells, and its in vitro modulation by recombinant human interferon-gamma (IFN-gamma) in phytohaemagglutinin-(PHA) or recombinant human interleukin-4 (IL-4)-stimulated cultures in atopic patients with Dermatophagoides pteronyssinus hypersensitivity and in healthy non-atopic subjects. Atopic patients with asthma not receiving allergen-specific immunotherapy (n = 21) were studied and further compared with a group of atopic subjects with asthma under allergen-specific immunotherapy (n = 21). They were age-(+/- 5 yr) and sex-matched. The results were also compared with those obtained in the non-atopic group (n = 11). CD23 expression on B-lymphocytes and its modulation were analyzed by flow cytometry using conjugated monoclonal antibodies with a double immunofluorescence method. Atopic patients had an increase in the percentage of B-cells expressing CD23 in peripheral blood. Phytohaemagglutinin and IL-4 induced a rise in the percentage of CD23-positive B-cells in both atopic groups and non-atopic subjects. Phytohaemagglutinin provoked an increase in the intensity of CD23 expression on B-cells from stimulated cultures in all groups, while IL-4 only produced a significant increase in atopic patients. The presence of IFN-gamma decreased the CD23 expression on B-cells in PHA-stimulated culture of atopic patients, whereas it caused an increase in CD23 expression in the non-atopic group. Furthermore, the presence of IFN-gamma in IL-4-stimulated cultures induced a decrease in CD23 expression on B-cells in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

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The knowledge on immune mechanisms of chronic urticaria (CU) at the cytokine level is widely scarce. We compared pro- and anti-inflammatory as well as Th1- and Th2-associated serum cytokine levels in two phenotypes of CU: associated with (CU+) and without (CU⁻) sensitization against Anisakis simplex, a ubiquitous fish parasite, that has been associated with acute urticaria in gastro-allergic anisakiasis (GAA) and with CU+. Thirteen CU+ and 19 CU⁻ patients were compared with 13 GAA patients and 15 control subjects for cytokines, measured by cytometric bead array. Urticaria activity score was positively correlated with IL-6 in CU⁻. Serum levels of IL-10 were lower in CU+ and CU⁻ with respect to the control group. Median IFN-γ was lower in all urticaria groups. Patients with previous parasitism by A. simplex displayed higher TGF-β levels than subjects without previous parasitism. The main finding was lower levels of IL-17 in CU+ with respect to GAA or controls, with a further tendency to even lower levels in CU⁻. Different urticaria phenotypes are associated with distinct serum cytokine levels.

Protective as well as enhancing effects of parasite infections on allergic disease have been postulated. Previous studies on this relationship focused frequently on skin test reactivity against aeroallergens, being house dust mites (HDM) the main agents responsible for a positive atopy outcome. We aimed to analyse the possible relationship between human parasite infection induced Anisakis simplex urticaria and respiratory allergy. A total of 86 patients with gastro-allergic Anisakiasis and 203 patients with chronic urticaria sensitized against A. simplex were studied for sensitization against aeroallergens and evaluated for rhinoconjunctivitis or bronchial asthma (RCBA). We compared the results with a control group of 250 consecutive patients referred for evaluation of allergic RCBA and atopy prevalence data of our region. Whereas no effect of A. simplex related disease on the overall allergic respiratory disease could be detected, a highly significant higher prevalence of RCBA associated HDM sensitization, but diminished allergy against other common aeroallergens (pollen, mould or dander) was observed in these groups. The relationship between A. simplex parasitism-associated acute or chronic urticaria on one side and allergic respiratory disease on the other side depends on the definition of atopy. We propose a differential definition of atopy, with a special emphasis on arthropod related sensitization.

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