Daschner A, Alonso-Gómez A, Caballero T, Suarez-De-Parga J M, López-Serrano M C
Allergy Unit, General University Hospital La Paz, Madrid, Spain.
Clin Exp Allergy. 1999 Sep;29(9):1260-4. doi: 10.1046/j.1365-2222.1999.00569.x.
Sensitization to Anisakis simplex (A. simplex) has been documented to produce severe allergic reactions following ingestion of mainly raw or under-cooked parasitized fish. False positive skin prick tests (SPT) or specific IgE against this nematode and cross-reactivity restricts diagnosis. Gastric anisakiasis and gastro-allergic anisakiasis occur if fish is parasitized by live A. simplex
To investigate if serial serological analysis could be useful in the diagnosis of acute parasitation by this nematode.
We included 41 patients who experienced an allergic reaction and/or abdominal symptoms after ingestion of raw or undercooked fish and displayed specific IgE against A. simplex. Total and specific IgE were determined two times: in the 24-h period after onset of clinical symptoms and after 1 month. SPTs were performed against A. simplex and implicated fish. A fibre optic gastroscopy was performed in 22 patients.
Median total IgE was 80.0 (Interquartile range [IQR] 41.5-186.5) kU/L in the first evaluation and 247.0 (IQR 96.5-649.5) kU/L after 1 month. Median specific IgE against A. simplex was 11.4 (IQR 7.1-33.5) kU/L in the first 24 h and 36.8 (IQR 19.5-79.5) kU/L after 1 month. A rise of total IgE was observed in 35 of 41 patients (P<0.00001) and a rise in specific IgE against A. simplex in 37 of 41 patients (P<0.00001). Mean percentage increment was 392% (215-571%; 95% confidence interval [CI]) for total IgE and 339% (177-502%; 95% CI) for specific IgE. In nine of 22 gastroscopic examinations at least one larva, identified as A. simplex, could be detected by our microbiology service. In this group (n = 9) a rise of total and specific IgE was detected in eight patients (89%) (P = 0.02).
We consider a rise of total and specific IgE in the first month after an allergic reaction as a useful tool in the diagnosis of gastro-allergic anisakiasis (together with patient's history), even if the parasite cannot be seen with fibre optic gastroscopy. The important rise of total and specific IgE against A. simplex can be considered as a reaction induced by the live parasitizing larva in the context of a polyclonal immunological stimulation.
已有文献记载，对简单异尖线虫（A. simplex）致敏后，摄入主要为生的或未煮熟的寄生鱼类会引发严重过敏反应。针对这种线虫的皮肤点刺试验（SPT）或特异性IgE出现假阳性以及交叉反应会限制诊断。如果鱼被活的简单异尖线虫寄生，就会发生胃异尖线虫病和胃过敏性异尖线虫病。
研究连续血清学分析是否有助于诊断这种线虫的急性寄生情况。
我们纳入了41例在摄入生的或未煮熟的鱼后出现过敏反应和/或腹部症状且显示针对简单异尖线虫的特异性IgE的患者。在临床症状出现后的24小时内及1个月后，对总IgE和特异性IgE进行了两次测定。对简单异尖线虫和相关鱼类进行了皮肤点刺试验。对22例患者进行了纤维光学胃镜检查。
首次评估时总IgE中位数为80.0（四分位间距[IQR]41.5 - 186.5）kU/L，1个月后为247.0（IQR 96.5 - 649.5）kU/L。针对简单异尖线虫的特异性IgE中位数在最初24小时为11.4（IQR 7.1 - 33.5）kU/L，1个月后为36.8（IQR 19.5 - 79.5）kU/L。41例患者中有35例观察到总IgE升高（P<0.00001），41例患者中有37例针对简单异尖线虫的特异性IgE升高（P<0.00001）。总IgE的平均百分比增幅为392%（215 - 571%；95%置信区间[CI]），特异性IgE为339%（177 - 502%；95% CI）。在22例胃镜检查中的9例中，我们的微生物学服务检测到至少一条被鉴定为简单异尖线虫的幼虫。在这组（n = 9）中，8例患者（89%）检测到总IgE和特异性IgE升高（P = 0.02）。
我们认为过敏反应后第一个月内总IgE和特异性IgE升高是诊断胃过敏性异尖线虫病的有用工具（结合患者病史），即使通过纤维光学胃镜检查看不到寄生虫。针对简单异尖线虫的总IgE和特异性IgE的显著升高可被视为在多克隆免疫刺激背景下由活的寄生幼虫诱导的反应。
