Cited by 0Parasites and Host InteractionsAsthma and respiratory diseasesAllergic Rhinitis and Sensitization

The DOI matches its Crossref record; 187 of the 187 references it cites were found in a registry or an index; none of the 288 sources its claims cite is checked for support yet.

Parasites and allergies: a complex bidirectional relationship from evolutionary origins to modern therapeutics

Open access

Abstract

Parasites and allergic diseases are linked by a complex, bidirectional relationship shaped by long-term host-parasite coevolution. This review discusses how different parasites may either promote or attenuate allergic responses through immunological, epithelial, and microbiome-mediated mechanisms. IgE-mediated immunity, mast cell activation, eosinophilia, and pruritus may have evolved as protective responses against helminths and blood-feeding ectoparasites. In contrast, modern allergies may partly reflect misdirected responses to harmless environmental antigens. The effects of parasites on allergy are not uniform and depend on parasite type, infection site, exposure intensity and chronicity, host immune status, and the degree of host-parasite adaptation. Protozoa such as Giardia intestinalis may contribute to food allergy-related manifestations by disrupting the intestinal barrier, altering gut microbiota composition, and modifying mucosal immune responses, particularly in atopic individuals. In contrast, selected helminths may attenuate allergic inflammation by inducing regulatory T and B cells, anti-inflammatory cytokines, antigen-presenting cell modulation, and IgG4-associated mechanisms that can limit IgE-mediated effector responses. Molecular similarities between parasite-derived antigens and environmental allergens, including conserved protein families and carbohydrate epitopes, may contribute to cross-reactive IgE responses and complicate allergy diagnostics. Therefore, current research is shifting from live helminth therapy toward defined parasite-derived molecules and immunomodulatory pathways that may inspire safer and more controlled therapeutic strategies. A clearer understanding of parasite-allergy interactions may improve diagnostic interpretation and support the development of new approaches to the management of allergic disease.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review synthesizes evidence that parasites and allergic disease interact bidirectionally, with effects depending on parasite type, infection site, intensity, chronicity, host immune status, and host–parasite adaptation. It argues that current research is shifting from live helminth therapy toward defined parasite-derived immunomodulatory molecules for safer, more controlled allergy therapeutics.

Key findings

  • IgE-mediated immunity, mast cell activation, eosinophilia, and pruritus may have evolved as protective responses against helminths and blood-feeding ectoparasites; modern allergies may partly reflect misdirected responses to harmless environmental antigens.
  • Protozoa such as *Giardia intestinalis* may contribute to food allergy-related manifestations by disrupting the intestinal barrier, altering gut microbiota, and modifying mucosal immune responses, particularly in atopic individuals; selected helminths may attenuate allergic inflammation via regulatory T and B cells, anti-inflammatory cytokines, antigen-presenting cell modulation, and IgG4-associated mechanisms.
  • Molecular similarities between parasite-derived antigens and environmental allergens—including conserved protein families such as tropomyosin, paramyosin, HSP70, enolase, glutathione S-transferase, chitinase, cyclophilin, and antigen 5-like proteins, plus carbohydrate epitopes such as CCDs and α-gal—may cause cross-reactive IgE responses and complicate allergy diagnostics.
  • Live helminth therapy has shown mixed results: in an open-label study, 29 patients with active Crohn’s disease ingested 2,500 *Trichuris suis* ova every three weeks for 24 weeks; 79% responded and 72% achieved remission, with no adverse events reported, but later randomized controlled trials yielded mixed results. Helminth treatment groups had significantly higher rates of moderate to severe abdominal pain compared with placebo (RR 7.67, 95% CI 1.87 to 31.57), and higher *Necator americanus* doses (>10 larvae) were associated with more frequent gastrointestinal side effects.

Methods

  • Narrative review; no primary data, systematic search strategy, or meta-analysis is reported. It synthesizes evolutionary, immunological, epithelial, and microbiome-mediated mechanisms from cited literature.
  • Includes comparative tables: Table 1 compares immune pathways in parasitic infections versus allergic hypersensitivity; Table 2 lists representative parasite-derived allergens and cross-reactive molecular families relevant to allergy diagnostics.
  • Discusses protozoa (especially *Giardia intestinalis*), helminths, ectoparasites, molecular cross-reactivity, microbiome effects, and candidate parasite-derived therapeutic molecules such as Hp-ARI, SJMHE1, ES-62, and rAl-CPI.

Limitations

  • Stated: the hygiene hypothesis, “old friends” hypothesis, and common-origin concepts have not been fully confirmed; parasite–allergy effects are context-dependent; cross-reactive IgE may be clinically irrelevant in many cases; live helminth therapy remains limited by safety, ethical, practical, and efficacy concerns; further studies are needed.
  • Stated: it remains unclear whether *G. intestinalis* mechanisms directly promote allergic sensitization or mainly exacerbate symptoms in predisposed individuals.
  • Evident: as a narrative review, it lacks systematic search/inclusion criteria and quantitative synthesis; many claims rely on animal models, observational studies, and selected clinical trials rather than uniform human evidence.

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Integrity signals

Registry

Crossref · 10.1007/s10482-026-02425-4

Cites

187 of 187 references verified0 citation errors · 0 not checkable

Statistics

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Verification

Claims the paper makes

131 Check pending · 50 Own interpretation · 12 No full text of the sources · 11 Not checked yet · 7 Sources not found · 2 No basis given

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Show all 147 claims

  • It may state two separate claims as one. 58
  • Probably not a substantial claim. 10
  • The quote only partly states this claim. 1
66 of 66
  • The authors state this as an assumption.

    Early mammals experienced substantial parasitic pressure from both endoparasites and ectoparasites.

    “While establishing an exact chronology of parasite evolution is challenging due to the scarcity of well-preserved fossils, it is reasonable to assume that early mammals experienced substantial parasitic pressure from both endoparasites and ectoparasites.”
  • The paper relies on this without support.

    The gut microbiome plays a key role in immune health.

    “which plays a key role in immune health”
  • The paper relies on this without support.

    Regulatory T cells are crucial for suppressing excessive immune responses and are a key factor in regulating allergic inflammation.

    “Regulatory T cells are crucial for suppressing excessive immune responses, a key factor in regulating allergic inflammation”
  • The paper relies on this without support.

    Accurate differentiation between fungal and protozoal infection is clinically important in immunocompromised individuals.

    “in whom accurate differentiation between fungal and protozoal infection is clinically important”
4 of 4

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Cited works that were retracted

Works this paper cites that were later retracted, from the retraction notices publishers deposit. Major when the notice came out before this paper was published.

1 of 1

Citations

Cites

1 retracted

Show all 187 references

Research works printed but not linked: 3

  1. Croft AM, Bager P (2012) Kumar S (2012) Helminth therapy (worms) for allergic rhinitis. Cochrane Database Syst Rev 4:CD009238
  2. Hamid F, Amoah AS, van Ree R, Yazdanbakhsh M (2015) Helminth-induced IgE and protection against allergic disorders. Curr Top Microbiol Immunol 388:91–108
  3. Moats CR, Baxter VK, Pate NM, Watson J (2016) Ectoparasite Burden, Clinical Disease, and Immune Responses throughout Fur Mite (Myocoptes musculinus) Infestation in C57BL/6 and Rag1(-/-) Mice. Comp Med 66(3):197–207

Cited by

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Metadata

Authors
Packi, K., Świerczewski, D., Klimczak, S., Ochab, D., Gałęziewska, J., Gromek, P., Kruczkowska, W., Płuciennik, E., Kałuzińska-Kołat, Ż., & Kołat, D.
Affiliations
  • Jan Długosz University (PL)
  • Allergen Research Center (PL)
  • Jan Kochanowski University (PL)
  • Medical University of Lodz (PL)
Corresponding author
Kołat, Damian
Venue
Antonie van Leeuwenhoek
Published
2026-09-10
Volume
119
Issue
10
ISSN
  • 0003-6072 (ISSN-L)
  • 1572-9699
OpenAlex
W7212161188
Cited by
0
References
187
FWCI
0.00
Type
journal article
Language
en
Open access
Locations
  • Antonie van Leeuwenhoek (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
AllerGen Personalized Medicine Center
Topics
  • Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
  • Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
Keywords
helminth therapy, host-parasite coevolution, mast cell activation, eosinophilia, pruritus, Giardia lamblia, food allergy, gut microbiota, intestinal barrier, regulatory T cells, IgG4, environmental allergens, blood-feeding ectoparasites
MeSH terms
Animals, Biological Evolution, Helminths, Host-Parasite Interactions, Humans, Hypersensitivity, Immunoglobulin E, Parasites, Parasitic Diseases

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