title: Different fish-eating habits and cytokine production in chronic urticaria with and without sensitization against the fish-parasite Anisakis simplex.
abstract: BACKGROUND
  Anisakis simplex sensitization has been associated with acute, but also with chronic urticaria. The objective of this study is to characterize chronic urticaria with (CU+) and without sensitization (CU-) against the ubiquitous fish parasite A. simplex in a transversal and longitudinal evaluation.
  
  
  METHODS
  16 CU+ and 22 CU- patients were included and assessed for Urticaria activity score (UAS), fish-eating habits by standardized questionnaire and cytokine production (assessed by flow cytometric bead-based array) of peripheral blood mononuclear cells after stimulation with A. simplex extract or Concanavalin A (Con A). Patients were randomly put on a fish-free diet for three months and UAS, as well as cytokine production were again assessed. A difference of ≥1 in UAS was defined as improvement.
  
  
  RESULTS
  There was no difference in UAS in both groups. Anisakis induced IL-2, IL-4 and IFN-γ production was higher in CU+. Con A induced IL-6 and IL-10 production was higher in CU+. CU+ was associated with higher total fish intake, whereas CU- was associated with oily fish intake. The correlation of UAS was positive with oily fish, but negative with total fish intake. There was a better UAS-based prognosis in CU+ without diet. Improvement was associated with higher Con A induced IL-10/IFN-γ as well as IL-10/IL-6 ratios. Further, previous higher oily fish intake was associated with improvement.
  
  
  CONCLUSIONS
  Our data confirm the different clinical and immunological phenotype of CU+. Our results show a complex relationship between fish-eating habits, cytokine production and prognosis, which could have important consequences in dietary advice in patients with CU. When encountering A. simplex sensitization, patients should not be automatically put on a diet without fish in order to reduce contact with A. simplex products.
authors: Servicio de Alergia, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain. alvarodaschner@gmail.com
authors: Alvaro
authors: A
authors: Daschner
authors: Virginia
authors: V
authors: Fernández-Fígares
authors: Ana
authors: A
authors: Valls
authors: Consolación
authors: C
authors: de Frutos
authors: Marta
authors: M
authors: Rodero
authors: Florencio M
authors: FM
authors: Ubeira
authors: Carmen
authors: C
authors: Cuéllar
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D017129:Anisakiasis / Q000150:complications / Q000276:immunology; D017163:Anisakis / Q000145:classification / Q000276:immunology*; D002908:Chronic Disease; D016207:Cytokines / Q000378:metabolism*; D004032:Diet; D005260:Female; D005399:Fishes / Q000469:parasitology; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology* / Q000276:immunology; D007963:Leukocytes, Mononuclear / Q000276:immunology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D014581:Urticaria / Q000150:complications / Q000276:immunology* / Q000469:parasitology; D055815:Young Adult
chemical_list: D016207:Cytokines