Thesis etd-09302019-170626 |
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Thesis type
Tesi di specializzazione (3 anni)
Author
BERTI, FRANCESCA
URN
etd-09302019-170626
Thesis title
ANISAKIS: RISCHIO ALLERGOLOGICO NEGLI OPERATORI DEL SETTORE ALIMENTARE
Department
SCIENZE VETERINARIE
Course of study
ISPEZIONE DEGLI ALIMENTI DI ORIGINE ANIMALE
Supervisors
relatore Prof. Armani, Andrea
correlatore Dott. Canova, Alessandro
correlatore Dott. Canova, Alessandro
Keywords
- allergia ad Anisakis nei lavoratori del pesce
- Anisakis allergy in fish handlers
- Anisakis simplex
- ipersensibilità professionale
- malattia professionale
- occupational disease
- occupational hypersensitivity
- sensitivity to Anisakis simplex in fish handlers
Graduation session start date
25/10/2019
Availability
Withheld
Release date
25/10/2089
Summary
L'anisakiasi umana è una zoonosi parassitaria trasmessa dalle larve del genere Anisakis. Oltre a causare forme cliniche gastro-intestinali, acute e croniche, può essere responsabile di forme allergiche che, dagli ultimi anni del 1900 e i primi anni del 2000 fino ad oggi, sono diventate oggetto di studio e ricerche. Sebbene si ritenga che la sensibilizzazione sia legata al contatto con una larva viva, la possibilità che la sensibilizzazione possa avvenire anche in seguito alla sola esposizione all’antigene (necessarie dosi elevate di esposizione antigenica) in assenza di un’infezione con l’ingestione della larva viva, non può essere esclusa. Gli OSA che lavorano giornalmente a contatto con il pesce, sono i soggetti maggiormente esposti a questa problematica e la letteratura riporta diversi casi di probabile allergia da Anisakis sul posto di lavoro. La presente tesi discute 10 casi di malattia professionale allergica presumibilmente indotta dall’inalazione e dal contatto con gli allergeni di Anisakis simplex, dal 1998 (anno dei primi episodi) al 2018. Analizzando i dati si è potuto osservare che il tempo passato nello stesso posto di lavoro, condiziona fortemente la sensibilizzazione ad A. simplex e che i DPI possono avere una certa rilevanza sulla prevenzione della sintomatologia clinica considerando che, sulla base dei dati disponibili, l’utilizzo dei guanti ha portato ad un netto miglioramento dei sintomi cutanei. Le analisi svolte per raggiungere una diagnosi sono state effettuate in tutti i casi mediante il prick test cutaneo, la titolazione delle IgE totali e specifiche per A. simplex, dando risultati quasi sempre positivi ma valori, talvolta, numericamente molto diversi. Questi due metodi, utilizzati per la diagnosi, non sono esenti da possibili falsi positivi a causa delle numerose cross-reattività e quindi è necessario migliorarne l’approccio diagnostico. In tutti i casi analizzati nel presente studio, l’allontanamento dal posto di lavoro (weekend, ferie, cambio di mansione lavorativa) ha portato ad un miglioramento o addirittura ad una scomparsa della sintomatologia, confermando ulteriormente il sospetto diagnostico. Nonostante i dati riportati siano pochi ma molto probabilmente sottostimati, si può dire che il problema delle allergie indotte da A. simplex esiste e merita sicuramente attenzione e ulteriori studi a riguardo. Attualmente, queste forme allergiche non rientrano nell’elenco aggiornato delle malattie di origine professionale riconosciute, ma se in futuro fossero riconosciute come tali, avrebbero sicuramente un impatto sociale molto significativo, dato che ad oggi, sono moltissime le persone che per questioni lavorative sono quotidianamente a contatto con il pesce.
Anisakiasis is a parasitic zoonosis transmitted by larvae of the genus Anisakis. Other than provoking a gastro-intestinal, acute and chronic clinical forms, it can be responsible for allergic forms that, since last years of 1900 to the early of 2000 until today, become the object of study and research on Anisakis as an allergic disease. Although it is believed that sensitization follows contact with a living larva, the possibility that the sensitization may occur even after the exposure to the antigen alone (high antigen exposition are needed) in absence of an infection with the ingestion of the living larva, cannot be excluded. FBO which have daily contact with fish are the working category at highest risk to develop the allergic form and literature reports several cases of probable due to the exposure to Anisakis antigens in the workplace. The present work discusses 10 cases of professional allergic disease, presumably induced by inhalation and contact with Anisakis simplex allergens, from 1998 (year of the first episodes) to 2018. We found Analysing the data, it can be discovered that the time spent in the workplace, strongly affects the sensitization to A. Simplex, and that PPE can have a certain relevance on the prevention of clinical symptomatology, considering that, basing on the available data, the use of gloves has lead to a reduction of skin symptoms. The analyses carried out in order to reach a diagnosis were represented in all cases by through the skin prick test, the titration of total and A. Simplex specific IgE. However two methods are not free from possible false positive due to the numerous cross-reactions. In all the cases analysed in the present study, the removal of the FBO from the workplace (weekends, holidays, change of job function) led to an reduction or even disappearance of the symptomatology, confirming the diagnostic hyphotesis. Although the data available are few, but most probably underestimated, it is possible say that the problem of allergies induced by A. Simplex exists and certainly deserves attention and studies. Currently, these allergic forms are not included in the updated list of recognized occupational disease, but, if in the future they will be recognized as one of them, they will certainly have a strong social impact because there are many people nowadays that, due to work needs, are in daily contact with fish.
Anisakiasis is a parasitic zoonosis transmitted by larvae of the genus Anisakis. Other than provoking a gastro-intestinal, acute and chronic clinical forms, it can be responsible for allergic forms that, since last years of 1900 to the early of 2000 until today, become the object of study and research on Anisakis as an allergic disease. Although it is believed that sensitization follows contact with a living larva, the possibility that the sensitization may occur even after the exposure to the antigen alone (high antigen exposition are needed) in absence of an infection with the ingestion of the living larva, cannot be excluded. FBO which have daily contact with fish are the working category at highest risk to develop the allergic form and literature reports several cases of probable due to the exposure to Anisakis antigens in the workplace. The present work discusses 10 cases of professional allergic disease, presumably induced by inhalation and contact with Anisakis simplex allergens, from 1998 (year of the first episodes) to 2018. We found Analysing the data, it can be discovered that the time spent in the workplace, strongly affects the sensitization to A. Simplex, and that PPE can have a certain relevance on the prevention of clinical symptomatology, considering that, basing on the available data, the use of gloves has lead to a reduction of skin symptoms. The analyses carried out in order to reach a diagnosis were represented in all cases by through the skin prick test, the titration of total and A. Simplex specific IgE. However two methods are not free from possible false positive due to the numerous cross-reactions. In all the cases analysed in the present study, the removal of the FBO from the workplace (weekends, holidays, change of job function) led to an reduction or even disappearance of the symptomatology, confirming the diagnostic hyphotesis. Although the data available are few, but most probably underestimated, it is possible say that the problem of allergies induced by A. Simplex exists and certainly deserves attention and studies. Currently, these allergic forms are not included in the updated list of recognized occupational disease, but, if in the future they will be recognized as one of them, they will certainly have a strong social impact because there are many people nowadays that, due to work needs, are in daily contact with fish.
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