[Anaphylactic shock revealing anisakiasis]

The manifestations of anisakiasis are essentially digestive pain, nausea or transit disorders. When it is initially asymptomatic, it is later revealed by a major complication, which is occlusion on an eosinophilic granuloma of the ileum. Over the past 5 years, the international literature has reported allergic manifestations related to this helminthozoonose, such as urticaria, angioedema, bronchospasm and occasionally anaphylactic shock.

A 60 year-old man presented with an anaphylactic shock and diarrhea. One month later, he exhibited persisting asthenia, cough and intermittant pruriginous rashes. Blood hypereosinophilia was borderline and total IgE was clearly increased. The initial event was retrospectively labeled "histaminic shock following ingestion of tuna fish". The discovery of highly positive anisakiasis serology, conducted simultaneously in 2 different laboratories, corrected the diagnosis. The patient was treated with albendazole (10 mg/kg/day for 7 days) with excellent results on the clinical and biological symptomatology.

With the occurrence of an allergic reaction, whether major or minor, a notion of ingestion of fresh fish must be searched for and, if positive, an immunodiagnosis of anisakiasis must be requested. Any seriological positivity should be controled by gastro-duodenal endoscopy. If the search for larvae is negative, we recommend anthelminthic treatment as a precaution.