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Jan Hed, Clin Immunologist, MD, PhD
Karolinska Institutet, IMPI, Div of Clin Immunology
Huddinge University Hospital, Sweden
 
The statements below are based on conclusions from selected publications. Their intention is to highlight recent research and information that could be beneficial in allergy in vitro testing. They can include seemingly contradictory statements due to differences in selecting patient populations as well as in the study design.
  • Several studies show a high cross-reactivity to the parvalbumin in many different fish species; cod, tuna, salmon, perch, carp, and eel in one study (1); cod, mackerel, herring and plaicein a second study (2); and in a third study, high cross-reactivity was shown between 17 fish species, indicating that cod sensitization is a reliable index of fish allergy (3).
     
  • Allergic reactions to fish through ingestion begin in most patients (79-86%) within the first 24 months of life (4, 5).
     
  • Atopic dermatitis is a common clinical manifestation of fish sensitization (6).
     
  • The onset and frequency of asthma was significantly earlier in fish-allergic children (7).
     
  • A level of specific IgE to fish above 20 kU/L predicted with greater than 95% certainty a positive double-blind, placebo-controlled food challenge test (DBPCFC) in one study (8).
     
  • The prevalence of cod allergy in children was calculated to be 4-5 per 1000 in one area of Italy (7).
     
  • IgE from pediatric and adult fish-allergic patients have similar in vitro binding to fish extracts (9).
     
  • In adult patients with food allergy based on suggestive history (0.98% of the population), fish was implicated in 4.2% of the cases (10), indicating a very low prevalence in relation to children.
     
  • Occupational asthma has been shown in fish industries where employees have been sensitized to fish by inhalation (11).
     
  • Fish-allergic patients usually experience different reactions when eating different fish species (12) and the allergenicity differs between species (13).
     
  • In 11 fish allergic patients, eight patients were sensitized to all 10 tested fish species, but in 7 patients, only one species gave a positive food challenge (14).
     
  • The level of fish-specific IgE remained unchanged or increased during an allergen avoidance period of 24-113 months in children, perhaps due to minimal or hidden contact with the allergen (15).
     
  • A few cases of species-specific fish sensitization have been described, such as for tuna (9) and swordfish (16).
     
  • Canned fish extracts from tuna and salmon were shown to have minimal IgE binding, indicating alteration of the antigen during food processing (17).
     
  • Anisakis simplex sensitization is one possible cause of allergic reactions, most often seen as urticaria/angioedema, after eating fish as the fish may still carry the parasite even if it has been cooked safely (18, 19, 20).
     
  • The parasite Anisakis simplex shows cross-reaction to Ascaris, Daphnia, shrimp and cockroach (20).
     
  • Scromboid fish poisoning is a food-borne chemical intoxication caused by certain spoiled fish of the dark meat varieties that contain a large amount of histamine and some biogenic diamines. The symptoms may incorrectly be interpreted as a fish-allergic reaction (21, 22, 23).

References:

    1. Bugajska-Schretter A, Elfman L, Fuchs T, Kapiotis S, Rumpold S, Valenta R, Spitzauer S. Parvalbumin, a cross-reactive fish allergen, contains IgE-binding epitopes sensitive to periodate treatment and Ca2+ depletion. J Allergy Clin Immunol 1998;101:67-74.
    2. Hansen TK, Bindslev-Jensen C, Skov PS, Poulsen LK. Codfish allergy in adults: IgE cross-reactivity among fish species. Ann Allergy Asthma Immunol 1997;78:187-94.
    3. de Martino M, Novembre E, Galli L, de Marco A, Botarelli, Marano E, Vierucci A. Allergy to different fish species in cod-allergic children: in vivo and in vitro studies. J Allergy Clin Immunol 1990;86:909-14.
    4. Dominguez C, Ojeda I, Crespo JF, Pascual C, Ojeda A, Martin-Estaban M. Allergic reactions following skin contact with fish. Allergy Asthma Proc 1996;17:83-7.
    5. Crespo JF, Pascual C, Dominguez C, Ojeda I, Munoz FM, Esteban MM. Allergic reactions associated with airborne fish particles in IgE-mediated fish hypersensitive patients. Allergy 1995;50:257-61.
    6. Oehling A, Fernandez M, Cordoba H, Sanz ML. Skin manifestation and immunological parameters in childhood food allergy. J Investig Allergol Clin Immunol 1997;7:155-9.
    7. de Martino M, Peruzzi M, de Luca M, Amato AG, Galli L, Lega L, et al. Fish allergy in children. Ann Allergy 1993;71:159-65.
    8. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenge in children and adolescents. J Allergy Clin Immunol 1997;100:444-51.
    9. James JM, Helm RM, Burks AW, Lehrer SB. Comparision of pediatric and adult IgE antibody binding to fish proteins. Ann Allergy Asthma Immunol 1997;79:131-7.
    10. Joral A, Villas F, Garmendia J, Villareal O. Adverse reactions to food in adults. J Investig Allergol Clin Immunol 1995;5:47-9.
    11. Douglas JD, McSharry C, Blaikie L, Morrow T, Miles S, Franklin D. Occupational asthma caused by automated salmon processing. Lancet 1995;346:737-40.
    12. Lindstrom CD, van Do T, Hordvik I, Endresen C, Elsayed S. Cloning of two distinct cDNAs encoding parvalbumin, the major allergen of Atlantic salmon (Salmon salar). Scand J Immunol 1996;44:335-44.
    13. Pascual C, Martin Esteban M, Crespo JF. Fish allergy: evaluation of the importance of cross-reactivity. J Pediatr 1992:121:S29-43.
    14. Bernhisel-Broadbent J, Scanlon SM, Sampson HA. Fish hypersensitivity. I. In vitro and oral challenge results in fish allergic patients. J Allergy Clin Immunol 1992;89:730-7.
    15. Lerramendi CH, Martin Esteban M, Pascal Marcos C, Fiandor A, Dias Pena JM. Possible consequences of elimination diets in asymptomatic immediate hypersensitivity to fish. Allergy 1992;47:490-4.
    16. Kelso JM, Jones RT, Yunginger JW. Monospecific allergy to swordfish. Ann Allergy Asthma Immunol 1996;77:227-8.
    17. 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;90:622-9.
    18. Moreno-Ancillo A, Caballero MT, Cabanas R, Contreras J, Martin-Barroso JA, Barranco P, Lopez-Serrano MC. Allergic reactions to Anisakis simplex parasitizing seafood. Ann Allergy Asthma Immunol 1997;79:246-50.
    19. Del Pozo MD, Audicana M, Diez JM, Munoz D, Ansotegui IJ, Fernandez E, et al. Anisakis simplex, a relevant etiologic factor in acute urticaria. Allergy 1997;52:576-9.
    20. Pascual CY, Crespo JF, San Martin S, Ornia N, Ortega N, Caballero T, et al. Cross-reactivity between IgE-binding proteins from Anisakis, German cockroach, and chironomids. Allergy 1997;52:514-20.
    21. Wu ML, Yang CC, Yang GY, Ger J, Deng JF. Scromboid fish poisoning: an overlooked marine food poisoning. Vet Hum Toxicol 1997;39:236-41.
    22. Smart DR. Scromboid poisoning. A report of seven cases involving the Western Australian salmon, Arripis truttaceus. Med J Aust 1992;157:748-51.
    23. Muller GJ, Lamprecht JH, Barnes JM, De Villiers RV, Honeth BR, Hoffman BA. Scromboid poisoning. Case series of 10 incidents involving 22 patients. S Afr Med J 1992;81:427-30.