{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T05:08:55Z","timestamp":1779426535047,"version":"3.53.1"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Marine seafood\u2013derived anisakid nematodes (e.g.,\n                    <jats:italic>Anisakis<\/jats:italic>\n                    spp. and\n                    <jats:italic>Phocanema<\/jats:italic>\n                    spp. [\n                    <jats:italic>formerly Pseudoterranova<\/jats:italic>\n                    spp.]) may cause gastrointestinal and allergic manifestations. Here, we report an unusual case of persistent, asymptomatic peripheral eosinophilia following ingestion of raw or lightly marinated seafood, raising the possibility of subclinical antigenic stimulation. The patient remained entirely asymptomatic with normal total IgE levels, and parasite serology (including Angiostrongylus cantonensis IgG) was negative, yet developed marked eosinophilia. The patient had a childhood history of allergic diseases that fully resolved in adulthood, which may represent an immunologic background relevant to the unusual presentation of marked eosinophilia with persistently normal total IgE. Although the underlying mechanism could not be directly demonstrated, this pattern raises the possibility of a predominantly eosinophil-associated type 2 response without a prominent humoral allergic manifestation. The eosinophil count remained persistently elevated over several months and stayed markedly above the adult upper reference limit before treatment, while comprehensive evaluations for parasitic infection, infectious disease, and autoimmune conditions were negative. Bone marrow findings demonstrated reactive eosinophilic hyperplasia, and imaging studies were unremarkable. Following empiric albendazole therapy, the eosinophil count rapidly returned to normal. This temporal association was supportive of, but not diagnostic for, a parasite-related or antigen-mediated trigger in this otherwise unexplained case. This observation aligns with the latest UK Guideline for the Investigation and Management of Eosinophilia, which recommends considering empiric anthelmintic therapy in asymptomatic patients without an identifiable cause. This case suggests that in patients with otherwise unexplained asymptomatic eosinophilia, even a remote and limited history of consuming raw or lightly marinated seafood should not be overlooked during history taking, and that empiric anthelmintic therapy may offer practical diagnostic and therapeutic value in selected cases.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1804368","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T04:43:38Z","timestamp":1779425018000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent asymptomatic eosinophilia after raw seafood exposure with normal IgE: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Wen","family":"He","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Suzhou Ninth Hospital Affiliated to Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juzhang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Suzhou Ninth Hospital Affiliated to Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianfeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Suzhou Ninth Hospital Affiliated to Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaozhen","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Suzhou Ninth Hospital Affiliated to Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"195","DOI":"10.23822\/eurannaci.1764-1489.339","article-title":"Eosinophil-associated diseases: the allergist's and clinical immunologist's perspective","volume":"56","author":"Marra","year":"2024","journal-title":"Eur Ann Allergy Clin Immunol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2024.106328","article-title":"UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants","volume":"90","author":"Thakker","year":"2025","journal-title":"J Infect"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1159\/000539304","article-title":"A case of nonagenarian gastric anisakiasis with atypical presentation","volume":"18","author":"Arai","year":"2024","journal-title":"Case Rep Gastroenterol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens14030217","article-title":"Anisakidae and anisakidosis: a public health perspective","volume":"14","author":"Nonkovic","year":"2025","journal-title":"Pathogens"},{"key":"B5","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1128\/cmr.00012-07","article-title":"Anisakis simplex: from obscure infectious worm to inducer of immune hypersensitivity","volume":"21","author":"Audicana","year":"2008","journal-title":"Clin Microbiol Rev"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1111\/pim.12349","article-title":"Anisakis - immunology of a foodborne parasitosis","volume":"38","author":"Nieuwenhuizen","year":"2016","journal-title":"Parasite Immunol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1016\/j.pt.2016.05.004","article-title":"Eosinophils in helminth infection: defenders and dupes","volume":"32","author":"Huang","year":"2016","journal-title":"Trends Parasitol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/s41423-025-01261-2","article-title":"Type 2 immunity in allergic diseases","volume":"22","author":"Ogulur","year":"2025","journal-title":"Cell Mol Immunol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-014-0075-3","article-title":"CT findings of gastric and intestinal anisakiasis","volume":"39","author":"Shibata","year":"2014","journal-title":"Abdom Imaging"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1172\/jci39222","article-title":"Low doses of killed parasite in CpG elicit vigorous CD4+ T cell responses against blood-stage malaria in mice","volume":"120","author":"Pinzon-Charry","year":"2010","journal-title":"J Clin Invest"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.12771\/emj.2025.00311","article-title":"Immunogenicity of anisakis larvae molting membrane against human eosinophilia sera","volume":"48","author":"Hong","year":"2025","journal-title":"Ewha Med J"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.alit.2024.08.004","article-title":"Regulation of the IgE response by T follicular regulatory cells","volume":"74","author":"Dent","year":"2025","journal-title":"Allergol Int"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1038\/s41423-023-01036-7","article-title":"Intricacies of TGF-beta signaling in Treg and Th17 cell biology","volume":"20","author":"Wang","year":"2023","journal-title":"Cell Mol Immunol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1804368\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T04:43:59Z","timestamp":1779425039000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1804368\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":13,"alternative-id":["10.3389\/fimmu.2026.1804368"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1804368","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]},"article-number":"1804368"}}