A 43-year-old man presented with a 3-h history of itching of the eyelids and dyspnea. He had experienced epigastric pain two days earlier after eating raw bonito. A physical examination revealed wheezing and a facial rash (Picture 1). He immediately received intramuscular epinephrine 0.5 mg with intravenous hydrocortisone 100 mg, and his anaphylaxis symptoms improved. Upper gastrointestinal endoscopy performed the following day showed Anisakis simplex larvae attached to the gastric mucosa (Picture 2). The worms were removed, and his epigastric pain disappeared. Laboratory testing for IgE antibodies specific to A. simplex was positive, and Anisakis-induced anaphylaxis was diagnosed. Approximately 20,000 cases of anisakiasis have been reported worldwide, and over 90% of the cases have occurred in Japan (1). A. simplex is the most common hidden food allergen responsible for acute or chronic urticaria and up to 10% of anaphylactic episodes in adults that had previously been diagnosed as idiopathic (2).
Picture 1.
Picture 2.
The authors state that they have no Conflict of Interest (COI).
References
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