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.

Anisakis simplex: current knowledge.

Background Nematodes of the genus Anisakis parasitize many commercial fish species and are responsible for a fish-borne zoonosis (anisakiasis) and allergic reactions. Anisakis can also cause consumer distrust in fishery products and economic losses to the fish industry. Scope and approach We review current socioeconomic, legislative, risk management and human health problems caused by the occurrence of Anisakis in fishery products and discuss possible strategies to mitigate them. Key findings and conclusions Visual inspection (and candling) of fishery products as required by EU legislation is not efficient for parasite detection. Consequently, visible (and non-visible) Anisakis reach the market and may be detected (and eaten) by consumers. Marine fish appears to be the only industrial food product that is at high risk of containing parasites when placed on the market. Anisakiasis and allergy to Anisakis are hidden, underestimated emerging zoonoses worldwide. There is a need to better understand the impact of these zoonoses on individual health and particularly exposed human populations, and to assess the risk posed by Anisakis allergens in fishery products. Quantitative risk assessment (QRA) is identified as an appropriate methodology as it estimates the risk from fishing ground to human disease. Improvements in parasite control legislation and procedures (e.g. establishment of research-based and standardized parasite detection methodologies, appropriate sampling strategies, development of non-destructive methods for detection and removal of nematodes from fish products), suitable for use by seafood businesses, are recommended to improve protection of consumers and to protect the industry by minimizing Anisakis-associated economic losses. QRA may help to provide the scientific basis for improved food safety legislation and strategies to reduce the risk of anisakiasis/allergy in humans.

http://digital.csic.es/bitstream/10261/177713/4/Human_health_2019.pdf

Human health, legislative and socioeconomic issues caused by the fish-borne zoonotic parasite Anisakis: Challenges in risk assessment

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 A. simplex were regular consumers of marinated fish. In a control population without CU, the prevalence of A. simplex sensitization was 16% (p Conclusion: In areas where raw or marinated fish is frequently eaten, A. simplex hypersensitivity is a frequent cause of CU.

Anisakis simplex Hypersensitivity Is Associated with Chronic Urticaria in Endemic Areas

This is the first report of anisakiasis in a Croatian patient, evidenced from an archival paraffin-embedded and hematoxylin-eosin stained tissue section. Anisakiasis has been only suspected in the country based on previously detected anti-Anisakis IgE seroprevalence in the healthy coastal population, as well as an acute case where pathohistological and serological findings suggested the diseases, but the migrating larva has not been retrieved. Seventy years-old female, operated in 1998 for pulmonary carcinoma, was admitted to the General hospital Sibenik, Croatia in 2003, because of gastric pain and nausea that lasted for couple of days. She was showing good general condition, full mobility and lucidity, subfebrile status. Abdominal palpation inferred acute pain in paraumbilical and ileocecal region. Exploratory right pararectal laparotomy revealed a hardened, 5 cm-long structure, located intraluminally in the sigmoid colon, not perforating colon serosa. The process has been dissected and sent for patohistological diagnosis. Results showed a 2 mm-long whitish nematode spiralised in muscular layer of colon mucosa surrounded by granulomatous inflammation. After genomic DNA isolation of the nematode from the histological section, and amplification at the mitochondrial cytochrome oxidase 2 locus, etiological agent has been identified as Anisakis pegreffii. Used methodology suggests that screening of archival suspicious sections is feasible in order to study epidemiology of this zoonotic disease poorly recognised in Croatia.

/pdf/a-case-report-of-anisakis-pegreffii-nematoda-anisakidae-5b2sgpy3nu.pdf

A case report of Anisakis pegreffii (Nematoda, Anisakidae) identified from archival paraffin sections of a Croatian patient.

Identification of autoclave-resistant Anisakis simplex allergens.

Background: Anisakis simplex (As), a parasite in fish, is able to sensitize humans via the alimentary tract. The prevalence of hypersensitivity and allergy to As outside the Iberian peninsula has not been investigated so far. We investigated Anisakis hypersensitivity in different areas of Italy. Methods: Consecutive subjects seen at 34 Italian allergy centers from October to December 2010 were investigated both by specific interview and by skin prick test (SPT) with As extract. Results: A total of 10 570 subjects were screened, of which 474 (4.5%) scored positive on Anisakis SPT and 66 of these (14% of those sensitized; 0.6% of the studied population) had a history of As allergy. Marinated anchovies were the most frequent cause of allergic reactions. Thirty-four (52%) patients were monosensitized to Anisakis. Sensitization rate showed marked geographic differences (range: 0.4‐12.7%), being highest along the Adriatic and Tyrrhenian coasts, where homemade marinated anchovies are an age-old tradition. In inland centers in northern Italy, the prevalence was directly related to the number of inhabitants. The analysis of the impact of immigration on the prevalence of Anisakis hypersensitivity showed that about 60% of sensitized subjects in Milano and Torino came from southern Italy or from non-European countries. Conclusions: Anisakis hypersensitivity and allergy are mainly a matter of dietary habits. Areas where marinated anchovies are popular can be considered as ‘endemic’ for this type of food allergy, whereas immigration and, possibly, new or imported trendy food styles, such as eating raw fish carpaccios or sushi, are a major causative factor in big cities of inland zones.

Anisakis hypersensitivity in Italy: prevalence and clinical features: a multicenter study

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Anisakis hypersensitivity in Italy: prevalence and clinical features: a multicenter study