Abstract
Fish is a common trigger of severe, food-allergic reactions. Only a limited number of proteins induce specific IgE-mediated immune reactions. The major fish allergens are the parvalbumins. They are members of the calcium-binding EF-hand protein family characterized by a conserved protein structure. They represent highly cross-reactive allergens for patients with specific IgE to conserved epitopes. These patients might experience clinical reactions with various fish species. On the other hand, some individuals have IgE antibodies directed against unique, species-specific parvalbumin epitopes, and these patients show clinical symptoms only with certain fish species. Furthermore, different parvalbumin isoforms and isoallergens are present in the same fish and might display variable allergenicity. This was shown for salmon homologs, where only a single parvalbumin (beta-1) isoform was identified as allergen in specific patients. In addition to the parvalbumins, several other fish proteins, enolases, aldolases, and fish gelatin, seem to be important allergens. New clinical and molecular insights advanced the knowledge and understanding of fish allergy in the last years. These findings were useful for the advancement of the IgE-based diagnosis and also for the management of fish allergies consisting of advice and treatment of fish-allergic patients.
Highlights
PREVALENCE In human diet, fish is a valuable source of essential amino acids, polyunsaturated fatty acids, and lipid-soluble vitamins
Variable allergenicity of fish parvalbumins established, but a high titer of specific IgE (20 kUA/L) was reported to predict an allergy to cod with a likelihood of 95% [29]
Parvalbumin has been defined as the major fish allergen as a majority of fish-allergic patients have IgE antibodies reacting to this muscle protein [63,64,65]
Summary
PREVALENCE In human diet, fish is a valuable source of essential amino acids, polyunsaturated fatty acids, and lipid-soluble vitamins. No cross-reactivity has been shown for fish and other seafood allergens while in some cases, a co-sensitization to both allergen sources might occur [27]. DIAGNOSIS AND PATIENT CARE The diagnostic procedure is based on four main pillars: the patient’s clinical history, in vivo analysis of skin reactivity, in vitro quantification of specific serum IgE and, in selected cases, oral provocation challenges. Variable allergenicity of fish parvalbumins established, but a high titer of specific IgE (20 kUA/L) was reported to predict an allergy to cod with a likelihood of 95% [29]. Consumption of fish contaminated with the parasite Anisakis simplex (herring worm) provokes acute allergic manifestations caused by IgE-mediated sensitization to Anisakis allergens [27, 32]. The current recommendations of the American Academy of Allergy, Asthma & Immunology do not suggest a general, delayed introduction of fish in the diet of children [38]
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