Resolution of IgE-mediated fish allergy (original) (raw)
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Fish Allergy Management: From Component-Resolved Diagnosis to Unmet Diagnostic Needs
Current Treatment Options in Allergy, 2019
Purpose of review Fish is a common elicitor of IgE-mediated food allergy. Fish includes a large variety of foods, in terms of species and food processing, with marked distinction in local diets around the globe. Fish-allergic patients present with phenotypic diversity and major differences in levels of clinical cross-reactivity, features that pose an important challenge for the clinical diagnosis and management. Recent findings Parvalbumin is the major fish allergen. However, a single molecule is not sufficient but several homologs, allergens different from parvalbumin and allergen extracts, are needed for IgE-based diagnosis. Summary Parvalbumin-specific IgE are markers for clinical cross-reactions. Added value is provided by IgE typing to parvalbumin homologs from distantly related fish. IgE co-sensitization profiles (parvalbumin, enolase, aldolase) are referred as severity markers. The allergen panel seems to be not yet complete why fish extracts still play a crucial role in seru...
Clinical Reviews in Allergy & Immunology, 2014
Globally, the rising consumption of fish and its derivatives, due to its nutritional value and divergence of international cuisines, has led to an increase in reports of adverse reactions to fish. Reactions to fish are not only mediated by the immune system causing allergies, but are often caused by various toxins and parasites including ciguatera and Anisakis. Allergic reactions to fish can be serious and life threatening and children usually do not outgrow this type of food allergy. The route of exposure is not only restricted to ingestion but include manual handling and inhalation of cooking vapors in the domestic and occupational environment. Prevalence rates of self-reported fish allergy range from 0.2 to 2.29 % in the general population, but can reach up to 8 % among fish processing workers. Fish allergy seems to vary with geographical eating habits, type of fish processing, and fish species exposure. The major fish allergen characterized is parvalbumin in addition to several less well-known allergens. This contemporary review discusses interesting and new findings in the area of fish allergy including demographics, novel allergens identified, immunological mechanisms of sensitization, and innovative approaches in diagnosing and managing this life-long disease.
IgE-Mediated Fish Allergy in Children
Medicina
Fish allergy constitutes a severe problem worldwide. Its prevalence has been calculated as high as 7% in paediatric populations, and in many cases, it persists into adulthood with life-threatening signs and symptoms. The following review focuses on the epidemiology of Immunoglobulin E (IgE)-mediated fish allergy, its pathogenesis, clinical manifestations, and a thorough approach to diagnosis and management in the paediatric population. The traditional approach for managing fish allergy is avoidance and rescue medication for accidental exposures. Food avoidance poses many obstacles and is not easily maintained. In the specific case of fish, food is also not the only source of allergens; aerosolisation of fish proteins when cooking is a common source of highly allergenic parvalbumin, and elimination diets cannot prevent these contacts. Novel management approaches based on immunomodulation are a promising strategy for the future of these patients.
Fish Allergy Around the World—Precise Diagnosis to Facilitate Patient Management
Frontiers in allergy, 2021
Abbreviations: ATP, adenosine triphosphate; BAT, basophil activation test; CK, creatine kinase; DBPCFC, double-blind placebo-controlled food challenge; EAACI, European Academy of Allergy and Clinical Immunology; ELISA, enzymelinked immunosorbent assay; FAO, Food and Agriculture Organization of the United Nations; FPIAP, food protein induced allergic proctocolitis; GAPDH, glyceraldehyde 3-phosphate dehydrogenase; LC/MS, liquid chromatography coupled with mass spectrometry; LDH, lactate dehydrogenase; OFC, oral food challenge; PCR, polymerase chain reaction; PK, pyruvate kinase; SPT, skin prick test; TIM, triosephosphate isomerase. and mackerel, and tolerance of at least one of the species was detected in 10 participants. However, current clinical practice usually advises patients to generally avoid all fish. This review focuses on the complexity of IgE-mediated fish allergy and discusses different aspects that need to be considered for the improvement of diagnosis and patient management.
Monosensitivity to pangasius and tilapia caused by allergens other than parvalbumin
Journal of investigational allergology & clinical immunology, 2010
Fish allergy is one of the most common food allergies in populations where fish is a major part of the diet. Most fish-allergic patients react to the panallergen parvalbumin present in multiple fish species. Our aim was to investigate the clinical case of a patient with oral allergy syndrome to pangasius and Nile tilapia but tolerance of other fish and seafood. The temporal relationship between fish consumption and allergic symptoms, the positive skin prick tests, and the basophil activation test results for both fish species strongly supported the diagnosis of an immunoglobulin (Ig) E-mediated allergy. This was confirmed by the detection of specific IgE to 18-kDa and 45-kDa proteins in immunoblot analysis. Notably, the patient was not sensitized to parvalbumin, as shown by enzyme-linked immunosorbent assay using purified allergens. Cross-reactivity between fish species can result from sensitization to allergens other than parvalbumin. This case report emphasizes the applications of...
Clinical and Translational Allergy, 2014
Background: Fish is an important cause of food allergy. Studies on fish allergy are scarce and in most cases limited to serological evaluation. Our objective was to study patterns of self-reported allergy and tolerance to different commonly consumed fish species and its correlation to IgE sensitization to the same species. Methods: Thirty-eight adult fish allergic patients completed a questionnaire regarding atopy, age of onset and symptoms to 13 commonly consumed fish species in the Netherlands (pangasius, cod, herring, eel, hake, pollock, mackerel, tilapia, salmon, sardine, tuna, plaice and swordfish). Specific IgE to these fish extracts were analyzed by ImmunoCAP.
Fish-allergic patients tolerate ray based on the low allergenicity of its parvalbumin
The Journal of Allergy and Clinical Immunology: In Practice
What is already known about this topic? Patients allergic to fish are generally advised to avoid all types of fish. Most of these patients are sensitized to bony fish and their major allergen parvalbumin. The allergenicity of cartilaginous fish, a potential dietary alternative, is not well understood. What does this article add to our knowledge? We demonstrated tolerance of ray, a cartilaginous fish, by patients with allergy to bony fish. Furthermore, ray parvalbumin showed lower allergenicity than did the parvalbumins from bony fish. How does this study impact current management guidelines? Current diagnosis of fish allergy focuses on bony fish. Inclusion of cartilaginous fish and their parvalbumins in routine diagnosis of fish allergy may prevent unnecessary food restrictions. BACKGROUND: Clinical reactions to bony fish species are common in patients with allergy to fish and are caused by parvalbumins of the b-lineage. Cartilaginous fish such as rays and sharks contain mainly a-parvalbumins and their allergenicity is not well understood. OBJECTIVE: To investigate the allergenicity of cartilaginous fish and their a-parvalbumins in individuals allergic to bony fish. METHODS: Sensitization to cod, salmon, and ray among patients allergic to cod, salmon, or both (n [ 18) was explored by prick-to-prick testing. Clinical reactivity to ray was assessed in 11 patients by food challenges or clinical workup. IgEbinding to b-parvalbumins (cod, carp, salmon, barramundi, tilapia) and a-parvalbumins (ray, shark) was determined by IgE-ELISA. Basophil activation tests and skin prick tests were performed with b-parvalbumins from cod, carp, and salmon and a-parvalbumins from ray and shark. RESULTS: Tolerance of ray was observed in 10 of 11 patients. Prick-to-prick test reactions to ray were markedly lower than to bony fish (median wheal diameter 2 mm with ray vs 11 mm with cod and salmon). IgE to a-parvalbumins was lower (median, 0.1 kU/L for ray and shark) than to b-parvalbumins (median, ‡1.65 kU/L). Furthermore, a-parvalbumins demonstrated a significantly reduced basophil activation capacity compared with bparvalbumins (eg, ray vs cod, P < .001; n [ 18). Skin prick test further demonstrated lower reactivity to a-parvalbumins compared with b-parvalbumins. CONCLUSIONS: Most patients allergic to bony fish tolerated ray, a cartilaginous fish, because of low allergenicity of its a-parvalbumin. A careful clinical workup and in vitro
Diagnosis of fish and shellfish allergies
Journal of Asthma and Allergy
Seafood allergy is a hypersensitive disorder with increasing prevalence worldwide. Effective and accurate diagnostic workup for seafood allergy is essential for clinicians and patients. Parvalbumin and tropomyosin are the most common fish and shellfish allergens, respectively. The diagnosis of seafood allergies is complicated by cross-reactivity among fish allergens and between shellfish allergens and other arthropods. Current clinical diagnosis of seafood allergy is a complex algorithm that includes clinical assessment, skin prick test, specific IgE measurement, and oral food challenges. Emerging diagnostic strategies, such as component-resolved diagnosis (CRD), which uses single allergenic components for assessment of epitope specific IgE, can provide critical information in predicting individualized sensitization patterns and risk of severe allergic reactions. Further understanding of the molecular identities and characteristics of seafood allergens can advance the development of CRD and lead to more precise diagnosis and improved clinical management of seafood allergies.
Patients Allergic to Fish Tolerate Ray Based on the Low Allergenicity of Its Parvalbumin
The Journal of Allergy and Clinical Immunology: In Practice, 2018
What is already known about this topic? Patients allergic to fish are generally advised to avoid all types of fish. Most of these patients are sensitized to bony fish and their major allergen parvalbumin. The allergenicity of cartilaginous fish, a potential dietary alternative, is not well understood. What does this article add to our knowledge? We demonstrated tolerance of ray, a cartilaginous fish, by patients with allergy to bony fish. Furthermore, ray parvalbumin showed lower allergenicity than did the parvalbumins from bony fish. How does this study impact current management guidelines? Current diagnosis of fish allergy focuses on bony fish. Inclusion of cartilaginous fish and their parvalbumins in routine diagnosis of fish allergy may prevent unnecessary food restrictions. BACKGROUND: Clinical reactions to bony fish species are common in patients with allergy to fish and are caused by parvalbumins of the b-lineage. Cartilaginous fish such as rays and sharks contain mainly a-parvalbumins and their allergenicity is not well understood. OBJECTIVE: To investigate the allergenicity of cartilaginous fish and their a-parvalbumins in individuals allergic to bony fish. METHODS: Sensitization to cod, salmon, and ray among patients allergic to cod, salmon, or both (n [ 18) was explored by prick-to-prick testing. Clinical reactivity to ray was assessed in 11 patients by food challenges or clinical workup. IgEbinding to b-parvalbumins (cod, carp, salmon, barramundi, tilapia) and a-parvalbumins (ray, shark) was determined by IgE-ELISA. Basophil activation tests and skin prick tests were performed with b-parvalbumins from cod, carp, and salmon and a-parvalbumins from ray and shark. RESULTS: Tolerance of ray was observed in 10 of 11 patients. Prick-to-prick test reactions to ray were markedly lower than to bony fish (median wheal diameter 2 mm with ray vs 11 mm with cod and salmon). IgE to a-parvalbumins was lower (median, 0.1 kU/L for ray and shark) than to b-parvalbumins (median, ‡1.65 kU/L). Furthermore, a-parvalbumins demonstrated a significantly reduced basophil activation capacity compared with bparvalbumins (eg, ray vs cod, P < .001; n [ 18). Skin prick test further demonstrated lower reactivity to a-parvalbumins compared with b-parvalbumins. CONCLUSIONS: Most patients allergic to bony fish tolerated ray, a cartilaginous fish, because of low allergenicity of its a-parvalbumin. A careful clinical workup and in vitro