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. 2011 Jun;5(6):e1214.
doi: 10.1371/journal.pntd.0001214. Epub 2011 Jun 28.

Synergism between prior Anisakis simplex infections and intake of NSAIDs, on the risk of upper digestive bleeding: a case-control study

Florencio M Ubeira  1 , Ana M Anadón, Angel Salgado, Alfonso Carvajal, Sara Ortega, Carmelo Aguirre, María José López-Goikoetxea, Luisa Ibanez, Adolfo Figueiras
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Synergism between prior Anisakis simplex infections and intake of NSAIDs, on the risk of upper digestive bleeding: a case-control study

Florencio M Ubeira et al. PLoS Negl Trop Dis. 2011 Jun.

Abstract

Background: The aim of this study was to investigate the relationship between prior Anisakis infections and upper gastrointestinal bleeding (UGIB), and its interaction with non-steroidal anti-inflammatory drug (NSAID) intake.

Methods/principal findings: We conducted a hospital-based case-control study covering 215 UGIB cases and 650 controls. Odds ratios (ORs) with their confidence intervals (95% CIs) were calculated, as well as the ratio of the combined effects to the sum of the separate effects of Anisakis allergic sensitization and NSAIDs intake. Prior Anisakis infections were revealed by the presence of anti-Anisakis IgE antibodies specific to the recombinant Ani s 1 and Ani s 7 allergens used as the targets in indirect ELISA. Prior Anisakis infections (OR 1.74 [95% CI: 1.10 to 2.75]) and the intake of NSAIDs (OR 6.63 [95% CI: 4.21 to 10.43]) increased the risk of bleeding. Simultaneous NSAIDs intake and Anisakis allergic sensitization increased the risk of UGIB 14-fold (OR=14.46 [95% CI: 6.08 to 34.40]). This interaction was additive, with a synergistic index of 3.01 (95% CI: 1.18-7.71).

Conclusions: Prior Anisakis infection is an independent risk factor for UGIB, and the joint effect with NSAIDs is 3 times higher than the sum of their individual effects.

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Conflict of interest statement

The authors have declared that no competing interests exist.

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