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Vol. 35. Issue 5.
Pages 216-220 (September 2007)
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Vol. 35. Issue 5.
Pages 216-220 (September 2007)
DOI: 10.1157/13110318
Anisakis simplex allergy and nephrotic syndrome
Alergia al Anisakis Simples y síndrome nefrótico
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J. Meseguera, V. Navarrob, I. Sánchez-Guerreroa, B. Bartoloméc, JM. Negro Álvarezd
a Allergy Section. Sta. María del Rosell Hospital. Cartagena. Spain.
b Nephrology Service. General Hospital. Castellón. Spain.
c Bial-Arístegui. Department I + D. Bilbao. Spain.
d Allergy Service. H.U. "Virgen de la Arrixaca". Murcia. Spain.
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Figure 1. --Values of serum total IgE and urine protein. The total IgE was raised three week after the ingestion of raw anchovies and it decreased progressively to the six months. A great and rapid fall of urine proteins levels and total IgE was observed after initiation of cyclosporin A (CsA) treatment 3mg/kg/day. Seven months after CsA suppression, nephrotic syndrome relapsed and treatment with deflazacort was established.
Figure 2. --Anti-A. simplex IgE serum levels were over 100 kU/l during the first months of a diet in absence of fish and seafood. Later it descended gradually during the treatment with cyclosporine A.
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Background: Anisakis simplex is a helmintic parasite of fish and shellfish that can induce in humans, after consumption, an immunoallergic response with multiorganic affectation, especially cutaneous (urticaria and angioedema), gastrointestinal and anaphylactic symptoms. Nephrotic syndrome can be produced by helmintic infection, especially schistosomiasis. Objective: To report the unusual case of nephrotic syndrome associated to an allergic response to A. simplex. Methods: A 60-year-old woman suffered from nephrotic syndrome three weeks after a generalized urticaria, angioedema and nauseas episode, following a raw anchovy's ingestion. Etiological study of nephrotic syndrome and urticaria/angioedema, cutaneous test, serum total and specific IgE determination, IgE-immunoblotting, and HLA typing were performed for diagnostic evaluation. Results: Prick-test with A. simplex extract was positive. It was observed a significance increase of total IgE to the three weeks of anchovy's ingestion and then it diminished progressively. Specific IgE to A. simplex was > 100 UI/ml. Immunoblotting to A. simplex, revealed the existence of IgE-binding proteins with molecular mass ranging from 20 kDa to 99 kDa. Class I HLA expressed by the patient was type HLA-B12. Other secondary causes of nephrotic syndrome were carefully ruled out. Conclusions: These data suggest, for the first time, the association between allergy to A. simplex and nephrotic syndrome.
Keywords:
nephrotic syndrome, allergy, Anisakis simplex, urticaria, angioedema
Antecedentes: el Anisakis simplex es un helmíntico parásito del pescado y marisco que al consumirlo, en los seres humanos puede inducir una respuesta inmunoalérgica con afectación multiorgánica, especialmente cutánea (urticaria y angioedema), gastrointestinal y anafilaxia. El síndrome nefrótico puede producirse por parasitación por helmintos, especialmente esquistosomas. Objetivo: se presenta un inusual caso de síndrome nefrótico asociado a una reacción alérgica por A. Simplex. Paciente y métodos: una mujer de 60 años sufrió un síndrome nefrótico tres semanas después de padecer urticaria generalizada, angioedema y nauseas, después de haber ingerido una anchoa cruda. Para el estudio etiológico del síndrome nefrótico y de la urticaria/angioedema se efectuaron pruebas cutáneas, IgE total e IgE por immunoblotting y la tipificación del HLA para la evaluación diagnóstica. Resultados: el prick-test con extracto de A. Simples fue positivo. Se observó un incremento significativo de IgE total a las tres semanas de la ingesta de anchoas, que fue disminuyendo progresivamente. La IgE específica a A. simplex fue >100 UI/ml. El immunoblotting reveló la existencia de proteínas unidas a IgE con una masa molecular entre 20 y 99 kDa. El HLA de clase I expresado por la paciente fue del tipo HLA-B12. Otras causas secundarias del síndrome nefrótico fueron cuidadosamente descartadas. Conclusiones: estos datos sugieren, por primera vez, la asociación entre alergia a A. simplex y síndrome nefrótico.

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