World-wide prevalence of Anisakis larvae in fish and its relationship to human allergic anisakiasis: a systematic review

Parasitol Res. 2020 Nov;119(11):3585-3594. doi: 10.1007/s00436-020-06892-0. Epub 2020 Oct 6.


The infective stage of Anisakidae nematodes responsible for allergic reactions in humans is found in a variety of edible fish and cephalopods. The identification of geographical regions that are high risk for infected seafood may help prevent allergic reactions in humans. Despite an abundance of published literature which has identified anisakid larvae in an array of edible seafood as well as scattered reports of human allergic anisakiasis, the relationship between the two has not been fully explored. Therefore, a systematic spatio-temporal study was conducted to determine the prevalence of Anisakis spp. in fish from January 2000 to August 2020 firstly to explore the relationship between fish infection and cases of allergic anisakiasis and secondly to use fish infection data to map potential allergic anisakiasis 'hot spots'. A systematic literature search for original English text articles was conducted through search engines, Web of Science, Scopus, PubMed, Science Direct and Google Scholar. Out of 3228 articles which describe anisakid infection in fish, 264 were used for data extraction. Of 904 articles describing allergic anisakiasis, 37 were used for data extraction. A qualitative summary of the extracted data was performed using equal interval method (ArcMap software) in order to compare the global distribution of Anisakis-infected fish. Of the 152-identified fish hosts, five families were most commonly infected with Anisakis spp. These included Lophiidae (86.9%), Trichiuridae (77.05%), Zeidae (70.9%), Merlucciidae (67.8%) and Gadidae (56.8%). The hot spot areas for allergic anisakiasis were North and northeast of Atlantic Ocean, southwest of USA, west of Mexico, south of Chile, east of Argentina, Norway, UK and west of Iceland (confidence 99%). The highest rate of allergic anisakiasis was in Portugal and Norway with the prevalence rate of 18.45-22.50%. Allergologists should consider allergic anisakiasis as a public health issue particularly in high-risk countries where high prevalences in fish have been demonstrated.

Keywords: Allergy; Aquatic animal health; Diagnosis; Fish health; Medical parasitology; Seafood safety.

Publication types

  • Systematic Review

MeSH terms

  • Animals
  • Anisakiasis / epidemiology*
  • Anisakiasis / etiology
  • Anisakiasis / veterinary
  • Anisakis
  • Fish Diseases / blood
  • Fish Diseases / epidemiology
  • Fish Diseases / parasitology*
  • Fishes / parasitology
  • Food Hypersensitivity / parasitology*
  • Global Health
  • Humans
  • Larva
  • Prevalence
  • Seafood / parasitology*