Abstract
Anisakis simplex spp. sensitization rates have increased worldwide, with a significant impact on health-care systems. To date, no clear-cut diagnostic criteria and laboratory algorithm have been established, so anisakiasis still represents an under-reported health problem whose clinical manifestations, when present, mimic the much more common allergic and digestive disorders. Aim of the study was to systematically review the available literature on the prevalence of sensitization against Anisakis in the general population and in specific population groups, taking into account the impact of the different available diagnostic techniques on the epidemiological data. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, relevant papers reporting Anisakis sensitization epidemiological data were found covering a period ranging from 1996 to February 2017. Overall, 41 studies comprising 31,701 participants from eleven countries were included in the qualitative synthesis. General asymptomatic population resulted sensitized to Anisakis in 0.4 to 27.4% of cases detected by means of indirect ELISA or ImmunoCAP specific IgE detection, and between 6.6% and 19.6% of the samples by Skin prick test (SPT). Occupationally exposed workers (fishermen, fishmongers and workers of fish-processing industries) documented specific IgE between 11.7% and 50% of cases, whereas SPT positivity ranged between 8% and 46.4%. Symptomatic allergic patients to any kind of allergen were found to be positive to Anisakis specific IgE detection between 0.0% (in children with mastocytosis) to 81.3% (among adults with shellfish allergy). Results highlighted that hypersensitivity prevalence estimates varied widely according to geographical area, characteristics of the population studied, diagnostic criteria and laboratory assays. Further studies are needed to overcome the documented misdiagnosis by improving the diagnostic approach and, consequently, providing more affordable estimates in order to address public health interventions on populations at high risk of exposure to Anisakis and to tailor health services related to specific groups.
Highlights
During the last decades, progress in the food industry and globalization have markedly increased the exposure to new allergenic sources that not always are adequately pointed out [1]
A combination of Medical Subject Headings (MeSH) terms and free text words were arranged in the following research string with OR and AND logical operators: Anisakis AND AND
Higher hypersensitivity rates were obtained from selected samples of symptomatic, allergic subjects usually eating raw or undercooked seafood, coherently with the well-known association between Anisakis sensitization, urticaria/ allergic symptoms and undercooked fish intake [44, 50], while prevalence rates tended to be lower if the study sample size was larger [30,62], and when diagnostic techniques were targeting fewer but more specific Anisakis antigens, or when setting higher positivity threshold for specific antibodies detection
Summary
Progress in the food industry and globalization have markedly increased the exposure to new allergenic sources that not always are adequately pointed out [1]. Within hours after being ingested, Anisakis larvae penetrate the mucosal layers of the gastrointestinal tract, causing direct tissue damage that may lead to the zoonotic disease known as anisakiasis. This acute gastrointestinal form of Anisakis infection is usually transient, with the worm dying within a few weeks. It is manifested by clinical symptoms ranging from nausea, vomiting, diarrhoea, mild to severe abdominal pain and intestinal obstruction [8], mimicking other much more common gastrointestinal disturbances, such as acute appendicitis, gastric ulcer, or tumours, making diagnosis of anisakiasis extremely difficult
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