The incidence of immune system diseases is increasing globally, particularly in developed countries. The hygiene and old friend hypotheses suggest that the decreased incidence of helminth infections in these countries may underlie the rising prevalence of autoimmune, allergic, and inflammatory diseases. The preventive and therapeutic potential of Trichinella spiralis, a helminthic parasite, has been well demonstrated in animal models of immune dysregulation-mediated diseases. This review comprehensively analyze how T. spiralis modulates immune responses across a spectrum of immune dysregulation. We systematically review the key research findings on the effects of T. spiralis infection on immune-related disease. T. spiralis has shown the ability to regulate host immune responses in autoimmune, allergic, and inflammatory disorders, exerting anti-inflammatory effects and restoring immune homeostasis through various immunological pathways. Given its significant immunomodulatory potential, T. spiralis represents a promising candidate for therapeutic interventions against immune-mediated diseases, warranting further molecular investigations and clinical applications.