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Patients suffering anaphylactic reactions after parasitized fish consumption have been reported in Spain in recent years. This reaction is different from the well-known acute or chronic anisakiasis and causes intolerance to parasitized fish ingestion, even after appropriate cooking. High specific IgE values are usually found in these subjects. IgE immunoblotting is now needed to confirm the presence of specific IgE directed to several parasite antigens in order to exclude cross-reactions. Positive specific IgG4 by immunoblotting was found in 60% of the patients, as well as in patients with anisakiasis, and probably reflected recent contact with the parasite proteins. The most specific response of IgE antibodies was directed to low-molecular-mass antigens of the parasite. Therefore, recombinant or purified antigens for in vivo and in vitro use will in future overcome some of the problems found in the diagnosis of sensitized patients.

Background: The fish parasite Anisakis simplex is the etiologic agent of anisakiasis and induces IgE-mediated reactions. Skin prick tests (SPTs) and the measurement of specific IgE to A. simplex were, in our experience, not valid tools with which to discriminate between allergic and nonallergic patients because many control subjects also had positive results. Objective: The study was carried out to assess the usefulness of IgE immunoblotting in the diagnosis of allergy to A. simplex. Methods: We have studied 61 patients with acute symptoms of urticaria, angioedema, or anaphylaxis and positive specific IgE to A. simplex . According to the anamnesis, time interval between ingestion of fish and clinical onset of symptoms, and exclusion of other causes of allergy, three different groups of patients were established: group A (allergic), group NA (nonallergic), and group D (doubtful). Fifty-one healthy donors were included as control subjects (group C). IgE immunoblotting with A. simplex whole-body extract was performed in all patients and control subjects. Results: Four patterns of immunoblotting were observed: type 1, with a group of several bands of medium molecular weight and others of low molecular weight; type 2, two or more bands of medium molecular weight; type 3, only one band of medium molecular weight; type 4, without any band. There was a significant predominance of blotting type 1 in group A and type 4 in group C. Conclusion: These data suggest that IgE immunoblotting is the most useful approach to A. simplex allergy diagnosis. (J Allergy Clin Immunol 1997;99:497-501.)

Although rare, anaphylactic reactions induced by proton pump inhibitors have been reported. The presence of cross-reactivity between different members of the group is not clear. We studied 9 patients with adverse reactions to omeprazole. Clinical symptoms appeared immediately in 8 patients and after 4 hours in 1. Symptoms ranged from urticaria/angioedema in 7 cases to anaphylaxis in 2 cases. Skin prick tests and oral controlled challenge tests with omeprazole, lansoprazole, and pantoprazole were performed. Skin prick or intradermal tests with omeprazole were positive in 8 patients. Four were also positive to pantoprazole. Prick tests with lansoprazole were always negative. Lansoprazole was administered to all 9 patients, with good tolerance in 8. Only 3 patients were challenged with pantoprazole and developed widespread urticaria. We present 9 patients with immunoglobulin E-mediated allergy to omeprazole. In most of our cases, lansoprazole proved to be a good alternative treatment.

Contradictory reports of the sensitivity of skin tests in quinolone allergy have been reported. Our objectives were to describe the outcome of quinolone skin and challenge tests in patients consulting because of a history of adverse reaction to quinolone and to compare the outcome of quinolone skin tests and challenge tests in the subsample of patients who had undergone both tests.We reviewed skin and challenge test results of all patients who consulted at our allergy service over the last 5 years because of a history of quinolone adverse reaction in the form of urticaria or anaphylaxis within 1 hour of drug intake (group 1), urticaria or maculopapular eruption between 1 and 24 hours after intake (group 2) or after 24 hours had passed (group 3), or atypical symptoms (group 4).A total of 71 cases were identified: 27, 8, 24 and 12 in groups 1 through 4, respectively. Skin tests were performed in all patients, with positive results in 31 patients. In group 1, 62.9 % of these patients showed positive skin tests and 22.2% showed positive challenge tests, whereas in the other 3 groups, about 30% of patients had positive skin tests and a variable percentage (from 0% to 4.1% depending on the group) had positive challenge tests. Quinolone challenge tests were performed in 10 patients with positive skin tests (5 of them with positive results) and in 34 patients with negative skin tests (2 of them with positive results).A highly suggestive history of quinolone allergy is more frequently associated with positive skin tests and positive challenge tests. Therefore, skin tests help to predict the result of the challenge test.

In comparison with the extremely frequent use of corticosteroids in different diseases, immediate allergic reactions remain uncommon. In addition to the steroid molecule, the causative agent of these reactions can be an excipient.We report seven cases of immediate reactions induced by different preparations of corticosteroids. Skin tests with the suspected steroid and excipients were carried out. In patients with negative skin tests, oral or parenteral challenges were performed with the drug and the excipients involved. Challenge tests with at least two other corticosteroids belonging to another or even the same group of the Coopman classification were carried out.Of the 7 patients, six had positive skin tests with the suspected preparation of corticoid: three cases with methylprednisolone acetate, two cases with carboxymethylcellulose and one case with the complete triamcinolone preparation. Only in one case did we have to challenge with the suspected steroid preparation to confirm the diagnosis. All challenge tests with other corticosteroids belonging to another or to the same group of the Coopman classification were negative.The reactions were caused by the steroid molecule (Triamcinolone or methylprednisolone succinate) in four patients, by an excipient (carboxymethylcellulose) in another two patients and we could not identify the sensitized molecule in one patient. We did not demonstrate cross-reactivity between different corticosteroids.

The commercial growing of white mushroom (Agaricus bisporus) is a frequent activity in certain Spain regions as La Rioja. We report two cases of white mushroom workers suffering from asthma caused by hypersensitivity to basidiocarp and spores of white mushroom.

Immediate hypersensitivity reactions to quinolones are rare. Moxifloxacin is an quinolone chemically different from other fluoroquinolones. We report 6 patients diagnosed with hypersensitivity to different fluoroquinolones in whom the response to moxifloxacin and cross-reactivity with other quinolones was studied.An allergenic study was made by prick and intradermal test with different fluoroquinolones, in all the patients. Single blind oral challenge tests were performed with moxifloxacin in all the patients, with ciprofloxacin in five patients, with levofloxacin in three patients and with ofloxacin in one patient.The skin test performed with moxifloxacin was positive in five patients, and the oral challenge test was positive in all six patients. All the patients had at least one positive skin test with some of the other fluoroquinolones.The skin test with different quinolones seems to be sensitive at showing group hypersensitivity, but not at predicting specific tolerance of each drug. We found a high degree of cross-reactivity among fluoroquinolones, so we currently recommend to avoid the group. We did not find that moxifloxacin differed from other fluoroquinolones so we cannot recommend it as a valid therapeutic alternative in patients sensitized to other quinolones.

We are discussing two patients, with clinically compatible reactions, who display an immediate hypersensitive mechanism following the administration of oxaliplatin, confirmed by the performance of cutaneous tests.

I. BACKGROUND The consumption of raw or undercooked fish may lead to infection with any of several helminths, the most important being species of the cestode genus Diphyllobothrium, the digenean families Heterophyidae (Heterophyes spp. and Metagonimus yokogawai) and Opisthorchiidae (Clonorchis sinensis and Opisthorchis spp.), and the nematode genera Anisakis and Pseudoterranova of the family Anisakidae (1). As will be reviewed in Sec IV, the anisakid species most commonly involved in human infections are Anisakis simplex and less frequently Pseudoterranova decipiens. Infection with A. physeteris and Contracaecum spp. has only been reported in a very few cases (2-5). At one time, the anisakid species Hysterothylacium aduncum was considered a possible human parasite (6,7), but this hypothesis was later discarded in view of experimental evidence indicating that it is unable to penetrate the gastric mucosa of laboratory animals and it cannot survive at temperatures close to 37°C (8,9). However, it has recently been demonstrated that larvae of some species of this genus are capable of invading the gastrointestinal tract of primates (10), and therefore the possibility of human infection should not be ruled out completely.

Anisakis simplex is a nematode which parasitizes mainly fish and cephalopods and accidentally human beings after ingestion. Apart from the different digestive syndromes, this organism has recently been involved as cause of IgE-mediated allergic reactions of variable degree (urticaria to severe angioedema). In this report three patients with the diagnosis of allergy to Anisakis simplex are reported and a review of the literature is made.

Anaphylactic reactions after parasitized fish consumption are mediated by an IgE response. However, positive skin tests and specific IgE can also be found in many asymptomatic subjects who recognize a single medium-mol.-wt. antigen by IgE immunoblot. The study aimed to find out whether this unspecificity was due to the carbohydrate moieties of parasite antigens. Sixty-two patients with suspected parasite allergy, 51 blood donors, 18 bakers, and 38 atopic patients were studied by blotting. Parasite proteins were treated with periodate. Several selected sera were inhibited with a crude wheat extract and fungal amylase. Twelve patients (19%), eight donors (16%), six bakers (33%), and one atopic patient (3%) recognized a single medium-mol.-wt. band in blotting and should be considered false-positive. This band was periodate-sensitive, but specific IgE to this allergen could not be inhibited by a wheat extract nor by fungal amylase and was clinically irrelevant. Diagnosis of Anisakis simplex hypersensitivity by skin tests and/ or specific IgE values should always be confirmed by specific IgE immunoblotting in order to detect the presence of clinically unrelated antibodies directed to periodate-sensitive allergens. These allergens are probably not a carbohydrate moiety of a parasite glycoprotein.

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.

Del Pozo MD, Audicana M, Diez JM, Munoz D, Ansotegui IJ, Fernandez E, Garcia M, Etxenagusia M, Moneo I, Fernandez de Corres L. Anisakis simplex, a relevant etiologic factor in acute urticaria. Anisakis simplex, a parasite of fish and cephalopods, can induce IgE-mediated reactions. This study aimed to determine the etiologic role of A. simplex in patients affected by urlicaria/angioedema ‘AE’ or anaphylaxis. We studied 100 adult subjects suffering acute episodes of urticaria/AE, by anamnesis, prick tests with A. simplex and fish-mix extracts, and total and specific IgE to both A. simplex and cod. The following criteria of A. simplex allergy were considered: 1’ urticaria/AE within 6 h after fish ingestion; 2’ specific IgE to A. simplex; 3’ positive prick test to A. simplex extract; 4’ exclusion of other suspected causes. Double-blind, placebo-controlled food challenge was not carried out because ethical considerations forbid challenge with a parasite. Specific IgE to A. simplex‘