Fish, Shellfish & Mollusks

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Lars Yman, Pharmacia & Upjohn Diagnostics AB, Uppsala, Sweden
 
World of Fish
 

Fig. 1. The world of fish is divided in 50 orders containing 445 families representing >4000 genera or >20000 species. Their degree of relation can be judged from the distance indicated by the numbers of orders and families. (Nelson JS: Fishes of the world, John Wiley & Sons, New York 1984).
 
The first demonstration of the presence of reagins in an allergic person's serum specifically directed towards allergens and capable of eliciting reactions was carried out with serum from Küstner. This serum from Küstner, who was allergic to fish, was injected into Prausnitz, who was not. This was also the advent of the Prausnitz-Küstner reaction as a diagnostic measure used in earlier clinical studies.
 
Much attention has been focused on cod as a catch-all allergen for both fresh and salt-water fish. The other 20,000 species have been somewhat ignored. Fig. 1 indicates the degree of relation between commonly consumed fish. Often patients are advised to stay away from all sorts of fish. Modern methods, however, have led to an increasing differentiation of which allergens appear where and which patients may tolerate different species.
 
As an example, a study of fish allergy in Japanese atopic dermatitis patients clearly showed species-specificity of IgE antibodies against fish (1). Fig. 2 shows the IgE antibody concentrations measured with Plaice and Chub mackerel. The pattern indicates fully specific sensitization to either Plaice or Mackerel or both, but probably occurring independently.
 
Specificity of fish allergens
Pharmacia CAP System
 
 
Fig. 2. Specific IgE antibodies against two unrelated fish species in 183 Japanese atopic dermatitis patients (1).
 
This is in full agreement with results of an isoelectric focusing analysis of the protein composition of the meat of some species. Fig. 3 shows repro-ducible species-specific patterns which can be used for identity testing.
 
Currently available data indicate that from an allergy point of view, fish may be divided into at least 4 types: shark represented by e.g. dogfish, the order Gadiformes like codfish and hake, the Scombroid fishes including e.g. tuna and mackerels, and the order Pleuronectiformes (flatfishes) like megrim and sole. The overlap of allergen specificity between the types seems to be moderate or even small (2, 3, 4, 5, 6). Furthermore, the order Clupeiformes, e.g. herrings and sardines (7), and the family Xiphiidae (8) may constitute allergenically distinct groups.
 



Fig. 3. Species-specific fish protein patterns (Coomassie blue staining). Isoelectrofocusing pH 3.5-9.5 (1).

Also, recent studies have indicated that several species appear to lose allergenicity during commercial processing. This tempers the belief that all fish allergens are strongly stable, remaining unaltered during food preparation processes (9).

Shellfish have been recognized as potent allergens both in food allergy and occupational allergy. Of these, shrimp has received the most attention, but studies on cross-reactivity have pointed to similar antigenic structures in other shellfish.

Fish muscle fiber is almost identical to the counterpart in red meat. Fish has a lower collagen content than meat, making it softer. Many techniques used for processing meat are applied to fish, producing such products as fish-burgers, fishfingers, sausages and nuggets. The switch from canning salmon, mackerel and sardines in oil to an aqueous solution has meant the inclusion of milk protein hydrolysates as stabilizers. This process adds new allergens which may be responsible for food allergic reactions when eating processed fish (10, 11). In addition, the use of surimi (processed fish meat) from Walleye pollock, Theragra chalcogramma and other species as a beef or pork substitute is increasing, and skin sensitivity and IgE antibodies to this substitute have been measured in fish-sensitive persons (12, 13, 14).

Steam or aerosol formed by cooking or handling fish may be an occu-pational hazard as well as a risk for patients with IgE-mediated food allergy to fish (15, 16). Immediate local as well as systemic reactions in food - allergic patients were also observed after skin contact with fish (17).

Prevalence of allergy to fish
The frequency of fish allergy varies according to geography and exposure.

In Norway, fish allergy was found in 1/1000 of the general population; in Sweden, about 39% of a pediatric group with food allergy was affected; and in Spain the figure ranges between 18-30% (See review in 4).

Moneret-Vautrin (18) found the frequency in 188 food allergic adults to be 15.4% and 12.7% for fish and shellfish, respectively. Whereas egg allergy prevails in infancy, fish allergy moves up in the roster of important allergies as children grow older.

While many children may outgrow allergy to cow's milk (19), they may continue to be hypersensitive to fish and shellfish in later life (20).

Diagnostic tests
In general, skin test and serum specific IgE antibody measurements show good agreement in allergy to seafood. However, important exceptions have been observed, especially for Scombroid fish and other species where histamine is rapidly formed upon storage and false positive skin test results are frequent (6,21). The concordance between testing and clinical history is influenced by the same phenomena and by the difficulties to correctly identify the seafood species eaten.

ImmunoCAP Allergens

Fish

  • Anchovy f313
    Engraulis encrasicolus
     
  • Cod f3
    Gadus morhua
     
  • Eel f264
    Anguilla anguilla
     
  • Hake f307
    Merluccius merluccius
     
  • Halibut f303
    Hippoglossus hippoglossus
     
  • Herring f205
    Clupea harengus
     
  • Jack mackerel/Scad f60
    Trachurus japonicus
     
  • Mackerel f206
    Scomber scombrus
     
  • Chub mackerel f50
    Scomber japonicus
     
  • Megrim/whiff f311
    Lepidorhombus whiffiagonis
     
  • Plaice f254
    Pleuronectes platessa
     
  • Rainbow trout f204
    Oncorhynchus mykiss
     
  • Salmon f41
    Salmo salar
     
  • Sardine/Japanese pilchard f61
    Sardinops melanosticta
     
  • Sardine/Pilchard f308
    Sardina pilchardus
     
  • Sole f337
    Solea solea
     
  • Swordfish f312
    Xiphias gladius
     
  • Tuna (yellow fin) f40
    Thunnus albacares
     
  • Anisakis p4

Shellfish

  • Crab f23
    Cancer pagurus
     
  • Crayfish f320
    Astacus astacus
     
  • Lobster f80
    Homarus gammarus
     
  • Pink Shrimp/Prawn f24
    Pandalus borealis
     
  • Langust/Spiny lobster f304
    Palinurus spp.


Mollusks

  • Blue mussel f37
    Mytilus edulis
     
  • Clam f207
    Ruditapes spp.
     
  • Octopus f59
    Octopus vulgaris
     
  • Oyster f290
    Ostrea edulis
     
  • Scallop f338
    Pecten spp.
     
  • Snail, escargot f314
    Helix aspersa
     
  • Squid f258
    Loglio spp.
     
  • Squid/Flying squid f58
    Todarodes pacificus

References:

    1. Lindqvist, A; Ikezawa, Z.; Tanaka, A; Yman, L. Seafood specific IgE in atopic dermatitis. Ann Allergy; 1993; 70:58.
    2. Bernhisel-Broadbent, J; Scanlon, SM; Sampson, HA. Fish hypersensitivity. J Allergy Clin Immunol; 1992; 89: 730-737.
    3. de Martino, M; Novembre, E; Galli, L; de Marco, A; Botarelli, P; Marano, E; Vierucci, A. Allergy to different fish species in cod-allergic children: In vivo and in vitro studies. J Allergy Clin Immunol; 1990; 86: 909-914.
    4. Pascual, C; Martín Esteban, M; Fernández Crespo, J. Fish allergy: Evaluation of the importance of cross-reactivity. J Pediatr; 1992; 121: S29-34.
    5. Pascual, CY; Larramendi, CH; Martín Esteban, M; Fiandor, A; Ojeda, JA. Fish allergy and fish allergens. J Allergy Clin Immunol; 1988; 81: 264.
    6. Helbling, A; McCants, ML; Musmand, JJ; Schwartz, HJ; Lehrer, SB. Immunopatho-genesis of fish allergy: identification of fish-allergic adults by skin test and radio-allergosorbent test. Ann Allergy, Asthma Immunol; 1996; 77: 48-54.
    7. Alonso, MD; Dávila, I; Conde Salazar; L; Cuevas, M; Martin, JA; Guimaraens, MD; Losada, JA. Occupational protein contact dermatitis from herring. Allergy; 1993; 48: 349-352.
    8. Kelso, JM; Jones, RT; Yunginger, JW. Monospecific allergy to swordfish. Ann Allergy Asthma Immunol; 1996; 77: 227-228.
    9. Bernhisel-Broadbent, J; Strause, D; Sampson, HA. Fish hypersensitivity. II: Clinical relevance of altered fish allergenicity caused by various preparation methods. J Allergy Clin Immunol; 1992; 90: 622-629.
    10. Gern, JE; Yang, E; Evrard, HM; Sampson, HA. Allergic reactions to milk-contaminated "nondairy" products. New Eng J Med; 1991; 324: 976-979.
    11. Hill, YJ. Encyclopedia of food science and technology. NY, NY: John Wiley & Sons; 1992; ISBN: p. 545.
    12. Lehrer, SB; McCants, ML; Helbling, A; Wolfe, M; Lopez, M. Hidden fish allergy: Reactivity to a surimi based product. J Allergy Clin Immunol; 1992; 89: 194.
    13. Mata, E; Favier, C; Moneret-Vautrin, DA; Nicolas, JP; Han Ching, L. Surimi and native codfish contain a common allergen identified as a 63-kDa protein. Allergy; 1994; 49: 442-447.
    14. Musmand, JJ; Helbling, A; Lehrer, SB. Surimi: Something fishy. J Allergy Clin Immunol; 1996; 98: 697-699.
    15. Pascual, CY; Crespo, JF; Dominguez Noche, C; Ojeda, I; Ortega, N; Martin Esteban, M. IgE-binding proteins in fish and fish steam. Monogr Allergy; 1996; 32: 174-180.
    16. Rodríguez, J; Reaño, M; Vives, R; Canto, G; Daroca, P; Crespo, JF; Vila, C; Villareal, O; Bensabat, Z. Occupational asthma caused by fish inhalation. Allergy; 1997; 52: 866-869.
    17. Dominguez, C; Ojeda, I; Crespo, JF; Pascual, C; Ojeda, A Martín; Esteban, M. Allergic reactions following skin contact with fish. Allergy and Asthma Proc; 1996; 17: 83-87.
    18. Moneret-Vautrin, DA. Food antigens and additives. J Allergy Clin Immunol; 1986; 78: 1039-1046.
    19. Bock, SA. Natural history of severe reactions to foods in young children. J Pediatrics; 1985; 107: 676-680.
    20. James, JM; Helm, RM; Burks, AW; Lehrer, SB. Comparison of pediatric and adult IgE antibody binding to fish proteins. Ann Allergy Asthma Immunol; 1997; 79: 131-137.
    21. Williams, PB; Nolte, H; Dolen, WK; et al. The histamine content of allergen extracts. J Allergy Clin Immunol; 1992; 89: 738-45.
1999