Abstract
Fish allergy is one of the most common food allergies. The currently recommended treatment commonly consists of avoiding all fish species. Recent literature suggests that these recommendations are overprotective for the majority of fish-allergic patients. This review summarizes recent findings and provides practical information regarding management of fish allergy in the individual patient. After precise history taking supported by additional specific IgE measurements and/or skin prick tests, fish-allergic patients can generally be categorized into the following clinical clusters: (A) poly-sensitized patients reacting to all fish species due to their sensitization to the panallergen β-parvalbumin, (B) mono-sensitized patients with selective reactions to individual fish species only, and (C) oligo-sensitized patients reacting to several specific fish. A number of allergens including parvalbumin, enolase, and aldolase can be involved. Depending on the specific cluster the patient belongs to, oral food challenges for one or more fish species can be performed with the aim to provide safe alternatives for consumption. This way, several alternative fish species can be identified for mono- and oligo-sensitized patients that can safely be consumed. Notably, even poly-sensitized patients generally tolerate fish species low in β-parvalbumin such as tuna and mackerel, particularly when processed. Taken together, allergological evaluation of patients with a documented fish allergy should be strongly considered, as it will allow the majority of patients to safely reintroduce one or more fish species.
Highlights
There is a large biodiversity of fish, and there are considerable differences in fish consumption worldwide
Most people who are allergic to fish have allergic reactions to multiple fish species [5]. This is explained by the high crossreactivity of β-parvalbumin, the most important fish allergen present in various fish species (Table 1) [16–18]
Enolase Aldolase Enolase Aldolase Tropomyosin Vitellogenin Enolase Aldolase tropomyosin from crustaceans and shellfish does not crossreact with that of fish, a tropomyosin allergen may seem to play a role in allergic reactions to cod, albacore tuna [36], swordfish, monkfish, flatfish, and hake [37]
Summary
Fish is a valuable source of healthy nutrients such as omega-3 fatty acids and fat-soluble vitamins, and its consumption is increasing [1]. It is estimated that 0.1–0.4% of the world’s population has an allergy to fish [2, 3] For this reason, fish has been included in the European mandatory labeling legislation together with 13 other allergens [4]. Sensitization can be caused by fish consumption and by skin contact or by inhalation of fish steam during processing of fish [4]. In only 3% of people with a known fish allergy or sensitization to tuna, IgE was found for fish gelatin made from tuna skin [9]. Clinic Rev Allerg Immunol sensitization to cod, only three patients had a positive skin test for fish gelatin made from cod. None of the 30 patients had an allergic reaction to fish gelatin made from cod skin during a food challenge test [10]. Fish blood seems to be a relevant allergen for employees of fish processing companies, as its inhalation may cause occupational asthma
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