Anisakis simplex induces not only anisakiasis: report on 28 cases of allergy caused by this nematode

Anisakis simplex R., parasitizes several sea-fish and cephalopods. This parasite induces not only anisakiasis but also anaphylactic reactions, as has recently been confirmed. We present 28 patients with immediate hypersensitivity to Anisakis simplex, developed after parasitized fish ingestion. Each case was diagnosed by suggestive anamnesis, skin prick tests with an A. simplex extract, specific IgE detection in serum (CAP System), and histamine release test. The clinical manifestations were urticaria/angioedema in all 28 patients and respiratory arrest in one. Paradoxically, the patients reported tolerance to ingestion of the same kind of fish between and after the allergic episodes. Type 1 hypersensitivity to A. simplex was demonstrated by a positive skin-prick test reaction, specific IgE detection in all cases and positive histamine release in a representative case. Sensitization to the proteins of the fish themselves was ruled out by negative reactions of the same tests in all cases. It was also proven that the allergen/s involved may be resistant to cooking and deep freezing. Hence, anaphylactic reactions may result either from infection or, more frequently, from mere exposure to the allergen. The results confirm that A. simplex can develop IgE-mediated anaphylactic reactions, the clinical severity of which was pronounced in the patients examined. Physicians must take into account that the consumption of parasitized fish may cause severe reactions, even if fish of the same kind is subsequently tolerated. A higher frequency of reactions of this type can be expected in countries where fish is a staple diet.

Relation between flexion angle and intraarticular pressure during active and passive movement of the normal knee

OBJECTIVE

To determine the effect of full active and passive flexion and extension at physiological rates of movement on intraarticular pressure of the normal knee.

METHODS

A 22 gauge Intracath catheter was introduced into 7 clinically normal knees and one abnormal knee in 4 subjects. Pressures were recorded via a pressure transducer and correlated with simultaneous recordings of flexion angle from an electronic goniometer while the subject's knees were traverse through active and passive horizontal flexion at a rate of 1 cycle/2 s.

RESULTS

The technique produced 6 satisfactory records over mean active and passive flexion ranges of 135 degrees and 148 degrees. On passive movement, pressures remained negative through most of the cycle, rising to main maximum pressures of 10 mm Hg after about 110 degrees of flexion. On active movement, the most common result was a U shaped curve rising from negative in midflexion to positive on full flexion and extension. The mean maximum pressures recorded on active movement were 38 mm Hg on flexion and 18 mm Hg on extension.

CONCLUSION

There is no linear correlation between flexion angle and pressure. Under dynamic conditions at zero gravity intraarticular pressure shows a moderate rise on full passive flexion and in most subjects a substantial rise on active flexion and extension. These differences are significant. The factor governing pressure is not the flexion angle but the accompanying soft tissue changes. Failure to use the full movement range could reduce the efficiency of trans-synovial flux.

Laboratory determinations in Anisakis simplex allergy

BACKGROUND

Anaphylactic reactions caused by the fish nematode, Anisakis simplex, after ingestion of parasitized fish, have been described.

OBJECTIVE

This study was undertaken to confirm, by histamine release tests, that A. simplex is able to trigger IgE-mediated reactions and to describe the serologic profiles in this sensitization.

METHODS

Twelve patients who had anaphylactic symptoms after ingestion of cooked fish and positive prick test results and determinations of IgE to A. simplex were studied by indirect IgG ELISA and IgG and IgE immunoblotting. Sera from subjects parasitized with other nematodes, patients with fish allergy, and healthy donors were included as controls. A histamine release test was performed in a representative case.

RESULTS

IgE immunoblotting was a specific test to detect A. simplex allergy. IgE-reacting bands were found in serum samples from 11 of our patients. Specific IgG antibodies were found by ELISA and immunoblotting, but this response was less specific. Histamine release was positive with A. simplex extract and negative with fish.

CONCLUSION

A specific and intense immune response to an A. simplex extract was found in our patients. A. simplex is able to elicit anaphylactic reactions, and A. simplex allergy should be suspected in patients with allergic symptoms after ingestion of fish. A positive prick test response to A. simplex and a negative response to fish is a good indication for a diagnosis of A. simplex allergy.

Immunotherapy with a standardized Dermatophagoides pteronyssinus glutaraldehyde-modified extract against an unmodified extract: a comparative study of efficacy, tolerance and in vivo and in vitro modification of parameters

We comparatively studied clinical efficacy, tolerance and modifications of different in vivo and in vitro parameters induced by two biologically standardized Dermatophagoides pteronyssinus extracts (HEP units), one glutaraldehyde-modified, in patients with allergic rhinitis and/or bronchial asthma after a year of treatment. A decrease in drug consumption was observed in both treatment groups (p < 0.0001). Of all the in vivo parameters studied (cutaneous, conjunctival and bronchial reactivity to the allergen), a decrease in specific bronchial reactivity was only observed in the group treated with the modified extract (p < 0.05). The modifications in total IgE, specific IgE and specific total IgG levels are superimposable on those described in previous papers on immunotherapy. However, IgG4 levels remained stable with respect to time. Tolerance was good and very similar for both treatments; both types of extracts are equally efficacious and safe.

Pickled onion-induced asthma: a model of sulfite-sensitive asthma?

BACKGROUND

Asthma elicited by sulfite ingestion has been mainly described in steroid-dependent and in non-atopic asthmatics. We have studied a group of 18 young extrinsic asthmatics who presented with asthma attacks immediately after eating pickled onions.

OBJECTIVE

The aim of this study is to ascertain if these asthma attacks are elicited by sulfites contained in pickled onions and the influence of the dose and pH of onions.

METHODS

The bronchial hyperreactivity of the patients was assessed by a methacholine challenge test. Oral challenge tests were performed with sodium metabisulfite (MSB) diluted in lemon juice at pH 4.2 and at pH 3.3 (only in patients who did not react with pH 4.2). Two types of pickled onions, Spanish and Dutch pickled onions, were used for oral challenge in seven of the patients. The Monier-Williams method was used to measure the SO2 concentration in pickled onions.

RESULTS

The oral provocation test with MBS, pH 4.2, elicited a positive response in six patients (33.3%) and the test at pH 3.3 was positive in three out of 12. No significant difference in PD20 values was found between these groups. Three of the seven patients challenged with Spanish pickled onions had a positive reaction but had no reaction with Dutch pickled onions. The SO2 concentration in Spanish pickled onions varied between 765 and 1182 ppm while in Dutch pickled onions were 200 ppm; this exceeded the permitted level (100 ppm). SO2 release in Spanish pickled onion samples was nearly 2.5 times higher when the pH of the sample decreased from 4.2 to 3.3.

CONCLUSION

High levels of SO2 in Spanish pickled onions, and their low pH (3.3) would be the responsible factors of the asthmatic outbreaks after ingestion of Spanish pickled onions by these patients.

Allergic reactions to betalactams: studies in a group of patients allergic to penicillin and evaluation of cross-reactivity with cephalosporin

A group of 34 penicillin-allergic patients was studied to determine skin test reactivity to the different penicillins involved in inducing the allergic reaction and the cross-reactivity with side-chain-related and side-chain-unrelated cephalosporins. All the subjects selected for the study had to be skin test positive to at least one of the following determinants: benzyl-penicilloyl-polylysine (BPO-PLL), minor-determinant mixture (MDM), amoxicillin (AX), or ampicillin (AMP), or to possess in vitro IgE to the following conjugates: benzyl-penicilloyl-human-serum albumin (BPO-HSA), ampicilloyl-human-serum albumin (AMP-HSA), and amoxicilloyl-human-serum albumin (AX-HSA). Cephalexin (CE) and ceftazidime (CEF) were used to assess cross-reactivity. If skin tests to any of these compounds were positive, the patient was considered to be allergic; if negative, a challenge test was performed. Sixteen patients (47%) were skin test positive to BPO and/or MDM, and nine (26%) exclusively to AX and/or AMP. In three cases (8%), the RAST was positive although the skin test was negative; one to BPO-HSA and two to AX-HSA and AMP-HSA. Six patients (17%) needed to be challenged with the penicillin involved to establish the diagnosis. In five patients (14%), the skin tests were positive to CE and in none to CEF. In all the others, the skin tests were negative to both cephalosporins, and the patients tolerated the drugs when challenged. These results indicate the relevance of side-chain-specific minor determinants in betalactams allergy and provide support for the role of this chemical structure in the evaluation of cross-reactivity between penicillins and cephalosporins.

Argon laser photocoagulation for chronic clinically significant cystoid macular edema

We report the therapeutic outcome of 14 eyes of 11 patients with chronic clinically significant pseudophakic cystoid macular edema refractory to medical management who underwent argon laser photocoagulation of the perifoveal area. Inclusion criteria included chronic cystoid macular edema of more than six months duration of decreased visual acuity (20/100 or less), positive fluorescein angiogram and contact lens examination, pseudophakos with posterior chamber intraocular lens and intact posterior capsule, normal fasting blood sugar, failed medical treatment and minimal follow up of six months. Fifty per cent of the eyes improved after laser treatment (p = .0345, relative to unchanged plus worsened cases). Further prospective, randomized, clinical trials are recommended to define the effectiveness of this treatment protocol.

Covalent-binding native blot in the determination of specific IgE to latex gloves allergens. Comparison with other methods

Six sera from patients with clinical symptoms of latex hypersensitivity and latex-RAST values ranging from class 1 to 4 were used to characterize latex-glove allergens by immunoblotting. Twelve % acrylamide-SDS-PAGE of the latex glove crude extract revealed a single band with an estimated mol wt lower than 14,000 D. The proteins bound to nitrocellulose after electrical transfer as shown by Ponceau red staining of the membrane. However, standard immunoblotting methods using alkaline-phosphatase anti-IgE did not detect the presence of specific IgE. Different variants of SDS-PAGE immunoblotting were also unsuccessful. On the other hand, the use of IEF and capillary transfer (native blot) to a covalent-binding hydrophilic membrane was found to be the method of choice for the study of this allergen. The authors believe that this procedure can be helpful in the study of other antigen-antibody systems, particularly when standard immunoblotting assays fail.

Sensitization from chestnuts and bananas in patients with urticaria and anaphylaxis from contact with latex

We present eight patients allergic to latex and fruit (chestnut and banana), seven of whom are women, and aged 17 to 42 years (mean 25 years). Four had family and five personal atopic histories. The total IgE varied from 41 to 520 Ku/L (mean 263). The symptoms followed ingestion of fruit (anaphylaxis) in four patients and contact with rubber (contact urticaria and anaphylaxis) in the other four. Skin prick test (SPT) with latex and radioallergosorbent test to latex were positive in all the patients. Histamine release (HR) to latex was carried out on six patients and was positive in three. In the six patients with symptoms after having eaten chestnuts the SPT was positive and specific IgE was detected in five of them. Histamine release to chestnuts was positive in three of the six patients tested and one of them (-SPT and + IgE) tolerated the fruit. Two out of five patients with symptomatic banana allergy had negative SPT with banana while the test was positive in one patient who tolerated this fruit, this being the only case with specific IgE to banana. Histamine release with banana was only positive in one case. The important correlation between SPT, RAST, and HR results to latex and chestnut together with the total inhibition of the chestnut RAST with a serum pool by preincubation with latex suggests cross-reactivity among these allergens.

Utility of the sickness impact profile in Parkinson's disease

The Sickness Impact Profile (SIP) is a questionnaire consisting of 136 items grouped into 12 categories and two dimensions (physical and psychosocial). To characterize its utility in Parkinson's disease (PD), we administered the SIP to 44 consecutive clinic patients with PD. Compared to 44 age- and sex-matched control subjects, PD patients had their greatest dysfunction in the categories of mobility, communication, and home management. The two items that PD patients most commonly endorsed were, "I am having trouble writing or typing" (75%) and, "My sexual activity is decreased" (61%). In general, these treated PD patients had greater dysfunction in the psychosocial than physical dimensions. Two simple PD-specific scales correlated well with the physical dimension score but less so with the psychosocial dimension, suggesting that the SIP assesses more functional domains than the PD-specific scales used. The SIP holds some promise as a broad measure of functional status in PD patients.