Anisakiasis

茴香病
  • 文章类型: Journal Article
    背景:人类捕鱼活动对海洋生态系统的环境问题有重大影响,海洋哺乳动物的保护,和人类健康。沿海鲸目动物极易摄入渔具,通过捕捉,或者纠缠,所有这些对这些动物来说都是致命的。特别是,某些沿海海豚和海豚受到渔具如垂钓渔具或渔网等渔具的严重影响,因为它们的食物经常与人类渔业的目标鱼种重叠。
    方法:本研究提供了一个在济州岛海岸搁浅的印度-太平洋江豚(Neopocaenaphocaenoides)的案例,大韩民国,摄入渔具和严重的Anisakis感染。尽管该物种栖息在从波斯湾到台湾的水域中,近年来,济州岛报道了几具搁浅的尸体。验尸计算机断层扫描显示前胃有一束四个钓鱼钩,以及尼龙线和带连接器的钢线,被认为是济州带鱼(Trichiuruslepturus)的垂钓装备。进一步的坏死检查显示,前胃中含有大量的Anisakisspp。(线虫:异象科)。组织学检查显示前胃壁增厚,伴有精确的火山溃疡,一层增厚的复层鳞状上皮,鳞状上皮中的间质浸润。
    结论:这项研究强调迫切需要解决捕捞活动对海洋哺乳动物的影响,海洋垃圾污染,以及韩国海水中的兼捕问题。此外,在将来的地理生态学或兽医病理学研究中,以及在更新其分布时,应提高济州岛周围海水中的N.phocaenoides的发生率。
    BACKGROUND: Human fishing activities have significantly affect environmental concern for marine ecosystems, conservation of marine mammals, and human health. Coastal cetaceans are highly vulnerable to ingestion of fishing gear, bycatching, or entanglement, all of which can be fatal for these animals. In particular, certain coastal dolphins and porpoises are heavily impacted by fishing gear such as angling gear or stownet, as their food often overlap with the target fish species of human fisheries.
    METHODS: This study presents a case of an Indo-Pacific finless porpoise (Neophocaena phocaenoides) beached on the coast of Jeju Island, Republic of Korea, with ingestion of fishing gear and severe Anisakis infection. Although this species inhabits waters ranging from the Persian Gulf to Taiwan, several stranded carcasses have been reported on Jeju Island in recent years. Post-mortem computed tomography revealed a bundle of four fishing hooks in the forestomach, along with nylon lines and steel lines with connectors, which were assumed to be angling gear for Jeju hairtail (Trichiurus lepturus). Further necroscopic investigation revealed that the forestomach contained a large number of Anisakis spp. (Nematoda: Anisakidae). Histological examination revealed a thickened forestomach wall with pinpoint and volcanic ulcerations, a thickened layer of stratified squamous epithelium, and infiltrated stroma in the squamous epithelium.
    CONCLUSIONS: This study emphasizes the urgent need to address the impact of fishing activities on marine mammals, marine litter pollution, and the bycatch problem in Korean seawater. In addition, the occurrence of N. phocaenoides in seawater around Jeju Island should be raised in future geographical ecology or veterinary pathology studies and when its distribution is updated.
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  • 文章类型: English Abstract
    OBJECTIVE: To investigate the prevalence of Anisakis infections in coastal marine fishes and awareness of anisakiasis control knowledge among local residents in Yantai City, Shandong Province in 2021, so as to provide insights into formulation of anisakiasis control interventions.
    METHODS: Marine fishes were purchased from Shunxin Port, Yantai City, Shandong Province in November 2021, and the presence of Anisakis was detected in different species of fishes and different fish sites. The correlations between body length and weight of marine fish and intensity of Anisakis infections were examined using Spearman\'s rank correlation analysis, and the dietary habits and anisakiasis control knowledge were investigated using questionnaire surveys among local residents.
    RESULTS: A total of 201 marine fishes belonging to 20 species were dissected, and Anisakis was detected in 77 marine fishes (38.31%) belonging to 11 species (55.00%), with a mean infection intensity of 45.04 parasites per fish (3 468/77). Spearman\'s rank correlation analysis revealed that the body length (rs = 0.74, P < 0.05) and weight (rs = 0.79, P < 0.01) of the monkfish correlated positively with the intensity of Anisakis infections, and the body length (rs = 0.68, P < 0.05) of the flatfish correlated positively with the intensity of Anisakis infections, while no correlations were examined between the body length or weight of other marine fishes and the intensity of Anisakis infections. Of all respondents, 53.38% men and 56.67% women did not know anisakiasis control knowledge at all, and there was a significant difference in the proportion of respondents using separate chopping boards for raw and cooked food from different villages (χ2 = 17.89, P < 0.01), while there was an age-specific proportion of respondents with habitats of eating raw or semi-raw seafood (χ2 = 28.27, P < 0.01).
    CONCLUSIONS: The prevalence and intensity of Anisakis infections were high in coastal marine fishes in Yantai City in 2021, and the awareness of anisakiasis control knowledge was low among local residents. Intensified health education pertaining to anisakiasis control knowledge is recommended to reduce the risk of Anisakis infections.
    [摘要] 目的 了解2021年山东省烟台市近海海鱼异尖线虫感染率和当地居民异尖线虫病相关知识知晓情况, 为制定 异尖线虫病防控措施提供参考依据。方法 2021年11月, 于山东省烟台市顺鑫港口购买海鱼, 检测海鱼异尖线虫感染 情况, 并分析不同鱼种、不同部位异尖线虫感染率。采用Spearman秩相关分析海鱼体长和体质量与异尖线虫感染度间 的相关性, 对当地居民饮食习惯和异尖线虫病防治知识知晓率进行问卷调查。结果 共解剖海鱼20种201尾, 其中11 种77尾检出异尖线虫, 鱼种异尖线虫感染检出率为55.00% (11/20)、海鱼总感染率为38.31% (77/201); 异尖线虫感染阳 性海鱼中累计检出异尖线虫3 468条, 平均感染度为45.04条/尾。Spearman秩相关结果显示, 鮟鱇鱼体长 (rs = 0.74, P < 0.05) 和体质量 (rs = 0.79, P < 0.01) 与异尖线虫感染度呈正相关, 比目鱼体长与感染度呈正相关 (rs = 0.68, P < 0.05), 其他 种类海鱼体长、体质量与异尖线虫感染度均无相关性。问卷调查结果显示, 53.38%男性和56.57%女性对异尖线虫病防 治知识完全不了解, 不同行政村居民生熟菜板不分比例差异有统计学意义 (χ2 = 17.89, P < 0.01), 不同年龄组居民有生食 或半生食海产品习惯者比例差异有统计学意义 (χ2 = 28.27, P < 0.01)。结论 2021年烟台市近海海域海鱼异尖线虫感染 率、感染度均较高, 当地居民异尖线虫病防治知识知晓率较低; 应加大对居民异尖线虫病健康教育, 降低异尖线虫感染 风险。.
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  • 文章类型: Journal Article
    anisakiasis是一种寄生虫病,通过食用生鱼或未煮熟的鱼和头足类动物而传播,这些鱼和头足类动物感染了单纯性anisakis(sensustricto)或Anisakispegreffii的幼虫。这项研究的目的是调查A.simplex(s.s。)响应驱虫药的影响,例如伊维菌素(IVM)和吡喃酮(PYR)。使用单纯性A.的两个发育阶段的幼虫进行了体外实验(s。s.)(L3和L4)从波罗的海鲱鱼(Clupeaharengusmembras)获得。在厌氧条件(37°C,5%CO2)。ABC转运体的基因表达,抗氧化酶,GABA,和烟碱乙酰胆碱受体,以及氧化状态进行了分析。结果表明,A.单纯形(s.s.)与IVM相比,用PYR培养时,L3阶段的迁移率较低。对相对基因表达的分析显示,用IVM和PYR处理后ABC转运体的mRNA水平存在显着差异,与对照组相比。在响应两种药物的抗氧化酶的基因表达中观察到类似的模式。此外,治疗组的总抗氧化能力(TAC)和谷胱甘肽S-转移酶(GST)活性高于对照组。这些发现表明了所研究基因的表达之间的关系,包括那些与氧化代谢有关的,以及测试药物的有效性。
    Anisakiasis is a parasitic disease transmitted through the consumption of raw or undercooked fish and cephalopods that are infected with larvae of Anisakis simplex (sensu stricto) or Anisakis pegreffii. The purpose of this study was to investigate how A. simplex (s. s.) responds to the influence of anthelmintics such as ivermectin (IVM) and pyrantel (PYR). In vitro experiments were conducted using larvae at two developmental stages of A. simplex (s. s.) (L3 and L4) obtained from Baltic herring (Clupea harengus membras). Larvae were cultured with different concentrations of IVM or PYR (1.56, 3.125, and 6.25 μg/mL) for various durations (3, 6, 9, and 12 h) under anaerobic conditions (37 °C, 5% CO2). The gene expression of actin, ABC transporter, antioxidant enzymes, γ-aminobutyric acid receptors, and nicotinic acetylcholine receptors, as well as the oxidative status were analyzed. The results showed that A. simplex (s. s.) L3 stage had lower mobility when cultured with PYR compared to IVM. The analysis of relative gene expression revealed significant differences in the mRNA level of ABC transporters after treatment with IVM and PYR, compared to the control group. Similar patterns were observed in the gene expression of antioxidant enzymes in response to both drugs. Furthermore, the total antioxidant capacity (TAC) and glutathione S-transferase (GST) activity were higher in the treatment groups than in the control group. These findings suggest a relationship between the expression of the studied genes, including those related to oxidative metabolism, and the effectiveness of the tested drugs.
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  • 文章类型: Journal Article
    Anisakis simplex is a fish-borne zoonotic parasite. Although this parasite has been known since the 19th century, publications on anisakiasis have increased in recent years. Despite this, this subject has yet to be well studied by bibliometric analysis. This study was conducted to show the research points and trends of A. simplex.
    The Web of Science Core Collection (WoSCC) was mined for articles on A. simplex. The VOSviewer software visually evaluated countries, institutions, authors, references, and keywords in this field.
    A total of 1362 publications were included in this bibliometric analysis. The included publications were published between 1970 and 2022 from 79 countries, mainly from Spain (n=456, 33.48%). The most prolific year was 2020 (n=74). The research area that attracted the most publications was parasitology (n=452), while the most productive author in this area was Cuellar C (n=53). \"Anisakis simplex\", \"Anisakis\" and \"anisakiasis\" were the most used three keywords.
    The number of publications on anisakiasis has been increasing over time, suggesting that A. simplex is becoming an increasingly important disease worldwide. Research cooperation should be established between researchers from developed and developing countries to determine effective control strategies for anisakiasis.
    Anisakis simplex, balık kaynaklı zoonotik bir parazittir. Bu parazit 19. yüzyıldan beri bilinmesine rağmen son yıllarda anisakiasis ile ilgili yayınlar artmıştır. Ancak, bu konuyla ilgili herhangi bir bibliyometrik analiz yapılmamıştır. Bu çalışma, A. simplex’in araştırma noktalarını ve eğilimlerini göstermek amacıyla yapılmıştır.
    Web of Science Core Collection (WoSCC) veri tabanında A. simplex ile ilgili makaleler taranmıştır. VOSviewer yazılımı kullanılarak, A. simplex ile ilgili çalışma yapan ülkeler, kurumlar, yazarlar, referanslar ve anahtar kelimeler görsel olarak değerlendirilmiştir.
    Bu bibliyometrik analize toplam 1362 yayın dahil edilmiştir. Dahil edilen yayınlar 1970 ile 2022 yılları arasında, başta İspanya (n=456, %33,48) olmak üzere 79 ülkeden yayınlanmıştır. En fazla yayın yapılan yıl 2020 (n=74) yılı olmuştur. En çok yayın yapılan araştırma alanı parazitoloji (n=452) olurken, bu alandaki en üretken yazar Cuellar C (n=53) olmuştur. “Anisakis simplex”, “Anisakis” ve “anisakiasis” yayınlarda en çok kullanılan üç anahtar kelime olmuştur.Enfestasyonların yaş, mevsim ve cinsiyet ile ilişkisi istatistiki yönden anlamlı bulunmamıştır.
    Anisakiasis ile ilgili yayınların sayısının zaman içinde artması, A. simplex’in dünya genelinde giderek önem kazandığını göstermektedir. Anisakiasis için etkili kontrol stratejilerinin belirlenmesi amacıyla gelişmiş ülkelerdeki araştırmacılar ile gelişmekte olan ülkeler arasında araştırma iş birliği kurulmalıdır.
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  • 文章类型: Journal Article
    与Anisakis相关的过敏性疾病的表型决定了与抗体产生相关的细胞因子的模式。然而,血清IgA的作用以及主动感染L3或被动粘膜接触A.我们通过流式细胞术测量血清细胞因子(IL-2,IL-4,IL-6,IL-10,TNF-α,IFN-γ,IL-17A,TGF-β1)和抗体水平(IgE,IgG4,IgA)通过ELISA针对总和排泄分泌(ES)抗原,来自10例胃过敏性anisakiasis(GAA)患者的血清中的Anis3和主要过敏原Anis1,Anis7和Anis13,11Anisakis致敏相关的慢性荨麻疹(CU)以及17例非Anisakis致敏的慢性荨麻疹(CU-)患者,与荨麻疹对照组(18例)比较。特异性IgE,IgG4和IgA在GAA中很高,但与对照组相比,CU+组的IgA水平明显更高。对于Anis1,Anis7,Anis13和ES,我们观察到CU中的IgA/IgG4比值高于GAA组。此外,慢性荨麻疹(CU)患者的IL-10,IFN-γ和IL-17A水平明显低于无CU患者。抗Anis13IgA/IgG4比值与促炎细胞因子和比值呈正相关(TNF-α,IL-17A,对照组Th17/Th2、Type1/Type2和TNF-α/IL-10)。总的来说,CU患者的抗异尖异语系IgA/G4比值较高。总之,这项研究证明了血清IgA的重要性,因为它与慢性荨麻疹相关,而与Anisakis致敏无关。
    The phenotype of allergic diseases associated with Anisakis determines the pattern of cytokines related to antibody production. However, the role of serum IgA and the immunomodulatory mechanisms exerted by active infection of L3 or passive mucosal contact with A. simplex specific antigens has not been studied before. We measured serum cytokine by flow cytometry (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, IL-17A, TGF-β1) and antibody levels (IgE, IgG4, IgA) by ELISA against total and excretory-secretory (ES) antigens, Ani s 3,and the group of major allergens Ani s 1, Ani s 7, and Ani s 13 in sera from 10 patients with gastro-allergic anisakiasis (GAA), 11 Anisakis sensitization associated chronic urticaria (CU+) as well as 17 non-Anisakis-sensitized patients with chronic urticaria (CU-), compared with the urticaria control group (18 subjects). Specific IgE, IgG4 and IgA were high in the GAA, but IgA levels were significantly higher in the CU+ with respect the CONTROL group. We observed higher levels of the ratio IgA/IgG4 in CU+ than GAA group for Ani s 1, Ani s 7, Ani s 13 and ES. Furthermore, chronic urticaria (CU) patients showed significant lower levels of IL-10, IFN-γ and IL-17A than patients without CU. The anti-Ani s 13 IgA/IgG4 ratio correlated positively with pro-inflammatory cytokines and ratios (TNF-α, IL-17A, Th17/Th2, Type1/Type2 and TNF-α/IL-10) in CONTROL group. In general, Anti-Anisakis IgA/G4 ratio was high in CU patients. In conclusion, this study demonstrates the importance of serum IgA because it is associated with chronic urticaria independently of Anisakis sensitization.
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  • 文章类型: Journal Article
    欧洲an鱼是比斯开湾(ICES分区8)中最重要的商业物种之一,我们的分析集中在时间平均丰度的分析上,患病率,Anisakisspp的强度。2000年、2001年、2014-2016年和2019-2023年,ICES分区8的凤尾鱼幼虫物种。2000年,成年凤尾鱼的患病率仅为1%,但在2014年增加到90%。自2015年以来,患病率有所下降,2023年受影响的人数占17.6%。平均丰度表现出类似的趋势,2014年线虫/凤尾鱼的峰值为3.79,2023年降至0.21。在2019年和2020年,通过PCR/SANGER测序和PCR/RLFP技术鉴定了A.simplexsensustricto和A.pegreffii。异语单纯形(s.s.)是最丰富的物种,根据这两种技术返回的结果,2019年和2020年平均分别占线虫总数的62.4%和52.1%。监测凤尾鱼感染水平的研究结果表明,在研究期间,平均丰度和流行率发生了变化,Anisakis的不同物种的比例也逐年变化。
    The European anchovy Engraulis encrasicolus is one of the most important commercial species in the Bay of Biscay (ICES Subarea 8), and our analysis focused on the analysis of the temporal mean abundance, prevalence, and intensity of Anisakis spp. larvae species in anchovies from ICES Subarea 8 in the years 2000, 2001, 2014-2016, and 2019-2023. Prevalence in adult individuals of anchovy was only 1% in 2000 but increased to 90% in 2014. Since 2015, the prevalence has decreased, and the number of individuals affected in 2023 accounted for 17.6%. The mean abundance showed a similar trend, with a peak of 3.79 nematodes/anchovy in 2014, falling to 0.21 in 2023. The species A. simplex sensu stricto and A. pegreffii were identified by PCR/SANGER sequencing and PCR/RLFP techniques in 2019 and 2020. Anisakis simplex (s.s.) was the most abundant species and, according to the results returned by these two techniques, it accounted for an average of 62.4% and 52.1% of total nematodes in 2019 and 2020, respectively. The results of studies monitoring infection levels in anchovies showed that the mean abundance and prevalence changed over the course of the study period and that the proportion of different species of Anisakis is also subject to variation from year to year.
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  • 文章类型: Case Reports
    异株病是由摄入感染异株幼虫的生的或未煮熟的海鲜引起的寄生虫感染。它通常会影响胃肠道,尤其是胃,但是据报道,肝脏感染导致炎性假瘤形成的病例非常罕见。我们在此报告了一例极为罕见的由肝anisakiasis引起的炎性假瘤,该病例经腹腔镜切除以进行诊断和治疗。一名51岁的妇女接受了超声检查的常规体检,偶然发现肝脏S6表面有一个15毫米的肿块。因为在一些术前影像学研究中不能排除恶性肿瘤,行腹腔镜肝脏部分切除术。组织病理学检查显示炎性假瘤中的异尖幼虫,提示肝茴香病.本报告描述了由肝anisakiasis引起的炎性假瘤的极为罕见的病例。因为术前诊断不能通过几种成像方式获得,具有足够切缘的腹腔镜肝切除术可能适合诊断和治疗该疾病。
    Anisakiasis is a parasitic infection caused by the ingestion of raw or undercooked seafood infected with Anisakis larvae. It generally affects the gastrointestinal tract, particularly the stomach, but very rare cases have been reported in which infection of the liver leads to the formation of inflammatory pseudotumors. We herein report an extremely rare case of an inflammatory pseudotumor induced by hepatic anisakiasis that was laparoscopically resected for the purpose of both diagnosis and treatment. A 51-year-old woman underwent a routine medical checkup by ultrasound examination, which incidentally detected a 15-mm mass on the surface of S6 of the liver. Because a malignant tumor could not be ruled out on several preoperative imaging studies, laparoscopic partial resection of the liver was performed. Histopathological examination revealed Anisakis larva in the inflammatory pseudotumor, suggesting hepatic anisakiasis. This report describes an extremely rare case of an inflammatory pseudotumor induced by hepatic anisakiasis. Because the preoperative diagnosis could not be obtained by several imaging modalities, laparoscopic liver resection with a sufficient margin might be suitable for diagnosis and treatment of this disease.
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  • 文章类型: Journal Article
    在过去的十年里,很明显,各种RNA病毒感染蠕虫,包括Ascariida。然而,仍然没有关于感染Anisakis的病毒的信息。我们在此证明了通过下一代测序分析和RT-PCR检测到的Anisakis幼虫中存在新型弹状病毒。我们确定了由七个开放阅读框组成的病毒基因组的几乎所有核苷酸序列(12,376个核苷酸),我们将该病毒命名为铃鹿弹跳病毒(SkRV)。BLASTx搜索表明,SkRV是一种属于Betanemrhavirus亚科的新型病毒,横纹肌病毒感染蛔虫的寄生线虫。SkRV序列仅在Anisakis的总RNA中检测到,而在Anisakis的基因组DNA中检测不到,排除SkRV是掺入宿主基因组DNA中的内源性病毒元件的可能性。当我们单独测试从日本沿海水域迁移的日本刺槐获得的异语幼虫时,不是所有的,但大约40%的人是SkRV阳性。在Betanemrhavirus和寄主A线虫的系统发育树中,我们观察到病毒的进化距离是,在某种程度上,与寄主线虫平行,这表明病毒的进化可能与宿主的进化有关。尽管SkRV对异尖线虫幼虫的生物学意义仍然未知,有趣的是,如果SkRV与anisakiasis的发病机理有关,因为这是日本和欧洲国家食用生海鱼的重要公共卫生问题。
    In the last decade, it has become evident that various RNA viruses infect helminths including Order Ascaridida. However, there is still no information available for viruses infecting Anisakis. We herewith demonstrate the presence of a novel rhabdovirus from Anisakis larvae detected by next-generation sequencing analysis and following RT-PCR. We determined the nearly all nucleotide sequence (12,376 nucleotides) of the viral genome composed of seven open reading frames, and we designated the virus as Suzukana rhabdo-like virus (SkRV). BLASTx search indicated that SkRV is a novel virus belonging to the subfamily Betanemrhavirus, rhabdovirus infecting parasitic nematodes of the Order Ascaridida. SkRV sequence was detectable only in the total RNA but not in the genomic DNA of Anisakis, ruling out the possibility of SkRV being an endogenous viral element incorporated into the host genomic DNA. When we individually tested Anisakis larvae obtained from Scomber japonicus migrating in the coastal waters of Japan, not all but around 40% were SkRV-positive. In the phylogenetic trees of Betanemrhavirus and of the host Ascaridida nematodes, we observed that evolutional distances of viruses were, to some extent, parallel with that of host nematodes, suggesting that viral evolution could have been correlated with evolution of the host. Although biological significance of SkRV on Anisakis larvae is still remained unknown, it is interesting if SkRV were somehow related to the pathogenesis of anisakiasis, because it is important matter of public health in Japan and European countries consuming raw marine fishes.
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  • 文章类型: Journal Article
    斯洛伐克的鱼类产品已严重感染Anisakisspp。幼虫,导致了人类茴香病。我们在所有冷冻大西洋鲱鱼的测试样本中都发现了幼虫。Anisakid过敏原t-Anis7测试显示人类有2例阳性病例,表明卫生当局需要密切监测人畜共患海洋寄生虫,甚至在内陆地区。
    Fish products in Slovakia have been heavily infected with Anisakis spp. larvae, which causes human anisakiasis. We found larvae in all tested samples of frozen Atlantic herring. Anisakid allergen t-Ani s7 testing revealed 2 positive cases in humans, signaling need for health authorities to closely monitor zoonotic marine parasites, even in inland areas.
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  • 文章类型: Case Reports
    在三名有anisakiasis过敏反应史的患者中检查了anisakis过敏原成分的反应性。案例1,一个38岁的男人,摄入后0.5小时出现过敏症状,成分Anis1和3呈阳性。案例2,一个44岁的女人,摄入后4小时出现过敏症状,成分Ani3和12呈阳性。案例3,一个36岁的女人,在摄入鱼类和贝类7小时后出现过敏症状,Anis1、4和12检测呈阳性。案例3对加热和未加热的Anisakis提取物反应强烈,而案例1和案例2对加热的Anisakis提取物反应较弱。结合10例病例的现有报告进行分析时,最常见的过敏原是Anis12,其次是Anis1。在所有情况下,异尖异株IgE均为3级或更高。13例分析显示2例对Anis4致敏和中度以上过敏反应,而据报道,Ani4致敏患者更有可能发展为严重疾病。对Anis4敏感的患者可能需要注意其过敏症状的严重程度。
    Reactivity to an anisakis allergen component was examined in three patients with a history of an anisakiasis anaphylaxis. Case 1, a 38-year-old man, allergic symptoms appeared 0.5 hours after ingestion, and the component Ani s 1 and 3 were positive. Case 2, a 44-year-old woman, allergic symptoms appeared 4 hours after ingestion, and components Ani s 3 and 12 were positive. Case 3, a 36-year-old woman, developed allergic symptoms 7 hours after ingestion of fish and shellfish, and tested positive for Ani s 1, 4, and 12. Case 3 reacted strongly to both heated and unheated Anisakis extract, while cases 1 and 2 reacted weakly to heated Anisakis extract. The most common allergen was Ani s 12, followed by Ani s 1, when analyzed in conjunction with existing reports on 10 cases. Anisakis IgE was class 3 or higher in all cases. Analysis of 13 cases showed 2 cases sensitized to Ani s 4 and moderate or higher anaphylaxis, while Ani s 4-sensitized patients were reported to be more likely to develop severe disease. It is possible that the patients sensitized to Ani s 4 need to be careful about the severity of their allergic symptoms.
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