Anisakiasis, an Underestimated Infection: Effect on Intestinal Permeability of Anisakis simplex–Sensitized Patients

Abstract

Anisakis simplex is a parasite that, if present in uncooked and contaminated saltwater fish, can invade the human gut. Two different clinical situations are recognized: the first, known as a gastrointestinal disease, varying from an asymptomatic episode to vomiting and diarrhea, and the second, classified as an adverse reaction to food, characterized by a wide spectrum of allergic reactions like rhinitis, conjunctivitis, or even anaphylaxis causing hypotension and/or shock. The intestinal epithelium, the major defense system against external molecules, represents an open gate for toxins and allergens if its protective function is compromised. Previous data have demonstrated a strict relationship between an altered intestinal permeability (I.P.) and worsening of the clinical manifestations in patients with adverse reactions to the food. In this article we evaluated the sensitization to A. simplex among patients who referred clinical symptoms of allergy. All subjects underwent commonly used alimentary skin prick test for food allergens, to which Ani s1, an A. simplex allergen, was added. In addition, in A. simplex-sensitized subjects, I.P. was determined upon their enrolment to the study (time 0) and after 6 months of consuming a raw fish-free diet (time 6). Five hundred and forty subjects were screened, and 170 had a positive skin prick test, 87 (51.2%) of whom were positive to Ani s1. Increased I.P. was evidenced in A. simplex-sensitized subjects with worse clinical symptoms, which receded after 6 months' elimination of raw seafood. With our data we demonstrated that the alimentary habit to eat raw fish represents a high risk for the integrity of the intestinal mucosa, and we suggest that this pathological situation may constitute an ideal, under-estimated, open gate for molecules that predispose to other, more important pathologies.

<b><i>Anisakis</i></b> <b><i>simplex</i></b> Hypersensitivity Is Associated with Chronic Urticaria in Endemic Areas

“…This proportion is in line with that found in the same area in a recent Italian multicenter study [13]. The age-old habit of eating raw or marinated fish may well explain this high prevalence confirming data from our center [16]. More than 20% of the subjects studied met the criteria for CU, a proportion that is much higher than that reported in patients attending general allergy departments in other areas of Italy.…”

World Allergy Organization anaphylaxis guidelines: Summary

“…Food triggers differ according to local dietary habits, specific food exposures, and methods of food preparation. [58][59][60][61][62][63][64][65][66][67] In North America and in some countries in Europe and Asia, cow's milk, hen's egg, peanut, tree nuts, shellfish, and fish are common food triggers. In other European countries, fruits such as peach are common triggers; in the Middle East, sesame is a common trigger, and in Asia, foods such as buckwheat, chickpea, rice, and bird's nest soup need to be considered.…”

Helminths and intestinal barrier function

“…In this context, the magnitude of the increase in intestinal permeability in individuals infected with the nematode Anasakis simplex correlated with worse disease. 45 Alternatively, the passage of T. suis E/S products across an epithelial layer driven by the presence of the E/S products themselves could be a component of the anti-inflammatory effect of T. suis, as the E/S products would now be positioned to interact with resident immune cells or those recruited to the gut. 46 Data on the direct effect of trematodes and cestodes on enteric epithelial permeability are limited.…”