Minciullo Paola L, Cascio Antonio, Gangemi Sebastiano
From the School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital "G. Martino," Messina, Italy.
Department of Health Promotion Sciences and Mother and Child Care "G. D'Alessandro," University of Palermo, Palermo, Italy.
Allergy Asthma Proc. 2018 Mar 1;39(2):86-95. doi: 10.2500/aap.2018.38.4104.
The association between parasites and urticaria was first suggested in the last century. A wide range, 0-75.4%, of the prevalence of parasitic infection has been reported with chronic urticaria (CU). Moreover, urticaria may be detected in patients with parasitosis. Nematodes are a type of helminth that infect hundreds of millions of people throughout the world.
The aim of this work was to collect and review the published studies and cases of urticaria associated with nematode infections.
A search of scientific literature data bases from January 1960 until May 2017 was carried out.
Numerous nematode infections have been associated with urticaria and/or angioedema: Anisakis simplex, Ascaris species (spp.), Dirofilaria spp., Enterobius vermicularis, Gnathostoma spp., Loa loa, Mansonella streptocerca; Necator americanus, Onchocerca volvulus, Strongyloides stercoralis, Toxocara spp., Trichinella spp., and Wuchereria bancrofti. The pathogenesis of urticaria in these infections generally remains unexplained. In some cases, skin manifestations were caused by the presence of the worm in the skin (Filaria, Gnathostoma); in other cases, such as A. simplex and S. stercoralis infections, there was a clear immunoglobulin E-mediated mechanism that led to allergic reactions, and infection and allergy coexisted; for other nematodes, the association was anecdotal and only a few cases were reported.
It is difficult to detect a certain causal effect, except when urticaria improves or disappears after infection treatment. Cases of isolated urticaria not associated with other symptoms rarely may be caused by helminths. In the current guideline for urticaria, parasitosis is considered to be a rare possible cause of CU in developed industrial countries, Therefore, although a routine screening of parasitic infection in CU is not recommended, in our opinion, testing a patient with urticaria for parasites is a physician's choice based on the characteristics of the patient, such as associated symptoms, dietary habit, provenance country and previous travel.
寄生虫与荨麻疹之间的关联最早在上个世纪被提出。据报道，慢性荨麻疹（CU）患者中寄生虫感染的患病率范围很广，为0 - 75.4%。此外，寄生虫病患者中也可能检测到荨麻疹。线虫是一种蠕虫，全世界数亿人受其感染。
这项工作的目的是收集和综述已发表的与线虫感染相关的荨麻疹研究及病例。
对1960年1月至2017年5月的科学文献数据库进行了检索。
许多线虫感染都与荨麻疹和/或血管性水肿有关：简单异尖线虫、蛔虫属、恶丝虫属、蠕形住肠线虫、颚口线虫属、罗阿丝虫、链尾曼森线虫、美洲板口线虫、盘尾丝虫、粪类圆线虫、弓蛔虫属、旋毛虫属和班氏吴策线虫。这些感染中荨麻疹的发病机制通常仍不清楚。在某些情况下，皮肤表现是由蠕虫在皮肤中的存在引起的（丝虫、颚口线虫）；在其他情况下，如简单异尖线虫和粪类圆线虫感染，存在明确的免疫球蛋白E介导机制导致过敏反应，感染与过敏并存；对于其他线虫，这种关联只是个别情况，仅报道了少数病例。
除感染治疗后荨麻疹改善或消失外，很难确定某种因果关系。与其他症状无关的孤立性荨麻疹病例很少可能由蠕虫引起。在当前的荨麻疹指南中，在发达工业国家，寄生虫病被认为是慢性荨麻疹的一种罕见可能病因。因此，虽然不建议对慢性荨麻疹患者进行寄生虫感染的常规筛查，但在我们看来，根据患者的特征，如相关症状、饮食习惯、来源国和既往旅行史，对荨麻疹患者进行寄生虫检测是医生的选择。
