Diagnosis Of Food Hypersensitivity Research Articles

Management of Adult Patients with Gastrointestinal Symptoms from Food Hypersensitivity-Narrative Review.

The incidence of food hypersensitivity has increased dramatically over the years not only among children but also in adults. Adult patients are usually less suspected of food hypersensitivity symptoms since food allergies are more typical for small children, with a tendency to outgrow the condition. The aim of this article is to increase awareness of hypersensitivity to food symptoms and their diagnosis and treatment possibilities among gastroenterologists and other health care professionals dealing with this type of patient. Symptoms of many gastrointestinal disorders, especially functional, may be driven by different types of mechanisms, and food intolerance or allergy should be considered as a potential cause. This article presents the current understanding of the epidemiology, diagnosis and treatment of immune- and non-immune-mediated food-induced diseases. Diagnosis of food hypersensitivity is based mainly on medical history, different types of sensitivity tests, e.g., hydrogen breath test, specific IgE (sIgE) serum concentration, tissue eosinophil count, skin tests and oral food challenges considered as a "gold standard" for food allergy. Elimination diet and pharmacologic treatment for allergy symptoms are first-line therapies. Eosinophilic gastrointestinal diseases are often caused by non-IgE-mediated food allergies, require endoscopic biopsy samples to confirm diagnosis and proper elimination diet often combined with steroids or proton pump inhibitor agents for treatment. Mast cell activation syndrome (MCAS) derives from pathologic reaction of mast cells with increased tryptase serum level as a marker. Symptoms may occur in the digestive, respiratory, skin, neurologic and cardiovascular system. Treatment is based on histamine type 1, type 2 (H1, H2) receptor antagonists and other mast cell stabilizing agents. Carbohydrate intolerances are the most common type of food hypersensitivity in adult patients, and an elimination diet is effective for reducing symptoms. Food additives hypersensitivity remains difficult to diagnose, but use of a diet low in chemical substances alleviates symptoms and helps to diagnose the triggering factors.

Diagnosis of Food Hypersensitivity and Food Intolerance in Patients with a Functional Gastrointestinal Disorder

Patients with a functional gastrointestinal disorder (FGID) frequently report abdominal discomfort and bloating after ingesting specific foods. However, evidence on the relationship between foods and symptoms is lacking. In addition, the diagnosis of food hypersensitivity and food intolerance does not seem to be established yet. Food hypersensitivity can be divided into immunologically mediated and non-immunologically mediated forms. The immunologically mediated forms are specifically termed food allergies, whereas the non-immunologically mediated forms are referred to as food intolerances. Various diagnostic tools are required to make an accurate diagnosis of a food allergy or a food intolerance. First, a thorough examination of the history and basic tests to rule out other organic diseases are needed. Next, diagnostic tests for immunoglobulin E-mediated food allergies are required and diseases, such as celiac disease and lactose intolerance, should be differentiated. A diagnosis for non-celiac gluten sensitivity (NCGS) is also required. A double blind, randomized, placebo-controlled, dietary challenge test can be used for diagnosing NCGS and food intolerance. Diagnostic tests for food intolerance, in which scientific evidence is lacking, may result in a misdiagnosis of food hypersensitivity or food intolerance in patients with a FGID. Therefore, an accurate diagnosis of food hypersensitivity or food intolerance based on reliable tests is required. Keywords: Food intolerance; Food hypersensitivity; Gastrointestinal diseases 중심 단어: 음식 과민증; 음식 불내증; 기능성 위장관 질환

Bebeklik Çağı Atopik Dermatitinde Besin Duyarlılığı; Hangi Hastalara Deri Testi Yapmalı?

Objective: Atopic dermatitis (AD) is a common disease during infancy. The data on food hypersensitivity (FH) in the first six months and especially in the first three months of life is limited in children with AD. The aim of this study was to find out the frequency of FH and related factors in infants with AD in regard to their referral age. Materials and Methods: Infants younger than 1 years of age who were diagnosed as AD at the Ankara Training and Research Hospital’s Department of Pediatrics were included in our study. The demographic features, nutritional status, disease severity and skin test results were recorded. A diagnosis of FH was made in the presence of a positive skin test with the related allergen. All the patients with FH had resolution of the symptoms with the elimination of the relevant food from the diet. Results: One-hundred and ten patients (70% male) were included. In patients younger than 3 months of age, the SCORAD-index and total IgE levels were higher in the patients with FH compared to patients without FH [(25.2(20.9-34.9) vs. 19.2(13.1-24.2), (p=0.034) and 22.2(11.6-52.6)kU/L vs. 4(4-10)kU/L, (p=0.04), respectively]. In patients aged between 3 and 6 months of age, the SCORAD index, total IgE and eosinophil levels were higher in patients with FH compared to patients without FH [36.2(29.3-44.7) vs. 18.8(13.3- 26.7), (p<0.001)], [42.1(6.3-283)kU/L vs. 8.3(4.8-8.3)kU/L, (p=0.033)], [7.5%(3.9-9.7) vs. 3.5%(1.8-5.8), (p=0.01)]. In patients older than 6 months of age, the SCORAD index, eosinophil and IgE levels were similar between patients with and without FH. Conclusion: In infants with AD, the prevalence of food allergy in early life (≤3 months) might be higher in patients with a higher SCORAD index and IgE levels. These laboratory features are useful tools in order to predict food hypersensitivity and in relevant clinical conditions food allergy, and might avoid unnecessary testing.

Incidence and risk factors for food hypersensitivity in UK infants: results from a birth cohort study.

BackgroundThe prevalence of food hypersensitivity in the UK is still largely open to debate. Additionally its pathogenesis is also unclear although it is known that there are differing phenotypes. Determining its prevalence, along with identifying those factors associated with its development will help to assess its clinical importance within the national setting and also add to the debate on appropriate prevention strategies.MethodsA population based birth cohort study conducted in Hampshire, UK as part of the EuroPrevall birth cohort study. 1140 infants were recruited with 823 being followed up until 2 years of age. Infants with suspected food reactions were assessed including specific IgE measurement and skin prick testing. Diagnosis of food hypersensitivity was by positive double-blind, placebo-controlled food challenge (DBPCFC) where symptoms up to 48 h after the end of the food challenge were considered indicative of a food hypersensitivity. Factors associated with food hypersensitivity and its two phenotypes of IgE-mediated and non-IgE-mediated disease were modelled in a multivariable logistic regression analysis.ResultsCumulative incidence of food hypersensitivity by 2 years of age was 5.0 %. The cumulative incidence for individual food allergens were hens’ egg 2.7 % (1.6–3.8); cows’ milk 2.4 % (1.4–3.5); peanut 0.7 % (0.1–1.3); soy 0.4 % (0.0–0.8); wheat 0.2 % (0.0–0.5) and 0.1 % (0.0–0.32) for fish. The cumulative incidence of IgE-mediated food allergy was 2.6 % with 2.1 % reacting to hens’ egg. For non-IgE-mediated food allergy the cumulative incidence was 2.4 % (cows’ milk 1.7 %). Predictors for any food hypersensitivity were wheeze, maternal atopy, increasing gestational age, age at first solid food introduction and mean healthy dietary pattern score. Predictors for IgE mediated allergy were eczema, rhinitis and healthy dietary pattern score whereas for non-IgE-mediated food allergy the predictors were dog in the home, healthy dietary pattern score, maternal consumption of probiotics during breastfeeding and age at first solid food introduction.ConclusionsJust under half the infants with confirmed food hypersensitivity had no demonstrable IgE. In an exploratory analysis, risk factors for this phenotype of food hypersensitivity differed from those for IgE-mediated food allergy except for a healthy infant diet which was associated with less risk for both phenotypes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13601-016-0089-8) contains supplementary material, which is available to authorized users.

Food Protein-Induced Protocolitis: A Case Report of a Two-Day-Old Boy

Bloody stools from rectal bleeding in healthy newborns are rare, and swallowing of maternal blood is a more common cause. Here, we present a two-day-old newborn who swallowed maternal blood and presented with a bloody stool who was later diagnosed with food protein-induced protocolitis. A diagnosis of food hypersensitivity in a newborn is obtained by examining the responses to food elimination and performing sigmoidoscopy, rectal mucosal biopsy or even an oral challenge test. Extensively-hydrolyzed formula, rather than partiallyhydrolyzed formula, should be the first choice for the treatment of rectal bleeding caused by food hypersensitivity in a newborn.

A comparison between two different in vitro basophil activation tests for gluten- and cow’s milk protein sensitivity in irritable bowel syndrome (IBS)-like patients

The diagnosis of food hypersensitivity (FH) in adult patients with gastrointestinal symptoms, beyond the immediate IgE-mediated clinical manifestations, is very often difficult. The aims of our study were to: 1) evaluate the frequency of FH in patients with irritable bowel syndrome (IBS)-like clinical presentation; and 2) compare the diagnostic accuracy of two different methods of in vitro basophil activation tests. Three hundred and five patients (235 females, age range 18-66 years) were included and underwent a diagnostic elimination diet and successive double-blind placebo-controlled (DBPC) challenges. Two different methods of in vitro basophil activation tests (BAT) (CD63 expression after in vitro wheat or cow's milk proteins stimulation) were evaluated: one was performed on separated leukocytes, and the other on whole blood. Ninety patients of the 305 studied (29.5%) were positive to the challenges and were diagnosed as suffering from FH. BAT on separate leukocytes showed a sensitivity of 86% and a specificity of 91% in FH diagnosis. BAT on whole blood showed a sensitivity of 15%-20% and a specificity of 73% in FH diagnosis (p<0.0001 compared to the other method). About one third of the IBS patients included in the study were suffering from FH and were cured on the elimination diet. The BAT based on CD63 detection on whole blood samples did not work in FH diagnosis and showed a significantly lower sensitivity, specificity and diagnostic accuracy than the assay based on separated leukocytes.

Outcomes of office-based, open food challenges in the management of food allergy

This letter reports the largest series of open oral food challenges in the literature to date. It describes the feasibility and utility of oral food challenge, further justifying its use in the everyday practice of allergy.

Article Commentary: A Cytological Assay for Diagnosis of Food Hypersensitivity in Patients With Irritable Bowel Syndrome

Article Commentary: A Cytological Assay for Diagnosis of Food Hypersensitivity in Patients With Irritable Bowel Syndrome

Hipersensibilidade alimentar em cães

Realizou-se um estudo retro e prospectivo em 117 cães com prontuários suspeitos de apresentarem hipersensibilidade alimentar. Os animais foram distribuídos em dois grupos: os do grupo I (n=86) foram atendidos em 1993 e 1994 e os do grupo II (n=31) em 1995. Os cães de ambos os grupos foram caracterizados quanto aos aspectos epidemiológicos e clínicos. Os do grupo II foram submetidos a exames complementares para a diferenciação diagnóstica do prurido, incluindo: hemograma, micológico e parasitológico cutâneo, coproparasitológico, histológico de pele e sorológicos - RAST (radioimunoensaio) e ELISA (ensaio imunoenzimático) - ambos para determinação de IgE contra antígenos alimentares -, e ao exame da dieta de eliminação seguida pela exposição provocativa. Este último exame foi o mais confiável para o estabelecimento do diagnóstico, ao determinar que 20 cães, provenientes de ambos os grupos, eram alérgicos a alimentos. Pelos RAST e ELISA, não foi possível demonstrar resultados confiáveis quando comparados aos resultados com a dieta de eliminação. Os animais acometidos foram principalmente machos, com raça definida e na faixa etária de um a seis anos. Os principais alimentos incriminados foram a carne bovina, o arroz e a carne de frango.

Patterns of quantitative food‐specific IgE‐antibodies and reported food hypersensitivity in 4‐year‐old children

Diagnosis of food hypersensitivity (FHS) is difficult and interpretation of food allergy tests is complicated. To investigate the probability of reported FHS in relation to levels of food-specific IgE-antibodies (AB) in a population-based setting of 4-year-old children (n = 2336). Information on FHS was obtained from a questionnaire and specific IgE-AB to milk, egg, fish, peanut, soy and wheat were analysed. Thirty-one per cent of the children with reported FHS (n = 284) were sensitized (> or =0.35 kU(A)/l) to at least one of the tested foods compared with 11% of children without FHS (n = 2052). Furthermore, the probability of reported symptoms to milk, egg and fish increased with increasing levels of food-specific IgE-AB to the same food allergens. A similar trend was seen for peanut and wheat, but not for soy. Increasing levels of specific IgE-AB to milk or egg were also associated with an increasing risk of reported symptoms caused by other foods. Quantitative measurements of IgE-AB to milk, egg and fish are useful to evaluate IgE-associated FHS in preschool children also in a population based sample. Such measurements appear to be of limited value for soy bean and wheat, in particular as a screening method.

Comparison of open and double‐blind placebo‐controlled food challenges in diagnosis of food hypersensitivity amongst children

Correct diagnosis of food hypersensitivity (FHS) is important to ensure appropriate patient care and to accurately establish the population prevalence and incidence. Food challenges play a very important role in the diagnosis of FHS, but it is unclear when open food challenges (OFCs) opposed to double-blind placebo-controlled food challenges (DBPCFCs) should be used. This study investigated the use of OFCs and DBPCFCs when diagnosing FHS. Children with a reported history of FHS or with sensitization to a food without known previous consumption were invited to undergo food challenges. Children of consenting parents underwent an OFC and those with a positive OFC were approached to undergo a DBPCFC. Food challenges were either performed as 1-day or 1-week challenges depending on sensitization status and clinical history. Forty-one children underwent both OFCs and DBPCFCs. The positive predictive values for 1-day and 1-week OFCs were 73% (8/11; 95% CI: 39-94%) and 57% (20/35; 95% CI: 39-74%) respectively. There was no evidence to indicate that the younger children were more likely to have a positive OFC confirmed by a DBPCFC compared to older children (Fisher's exact P = 0.53). In the 1-day challenges parents indicated a preference for OFC rather than DBPCFC. By contrast, in the 1-week challenge parents indicated a preference for DBPCFC (P = 0.0192). Open food challenge may be suitable for diagnosing immediate objective symptoms, whereas DBPCFC may be needed for the diagnosis of delayed and mainly subjective symptoms, irrespective of the child's age.

Measurements of Eosinophil Activation before and after Food Challenges in Adults with Food Hypersensitivity

Background: Objective assessment of inflammatory reactions in the gastrointestinal tract could be useful in the diagnosis of food hypersensitivity. The aim of the present study was to investigate the involvement of eosinophils and mast cells in the inflammatory response of patients with food hypersensitivity before and after food challenges. Methods: Eleven patients (4 with IgE-mediated allergy and 7 without) with food hypersensitivity and positive double-blind, placebo-controlled food challenge were subjected to food challenge in a single-blinded fashion. Four subjects with no known food hypersensitivity were recruited as controls. Placebo was given after a 1-week washout period followed by an active dose. Stool, urinary and serum samples were collected and symptoms were recorded in a diary. Fecal samples were analyzed for eosinophil protein X (F-EPX) and tryptase; urinary samples for EPX (U-EPX) and leukotriene E₄ (U-LTE₄) and serum samples were analyzed for eotaxin and food-specific IgE antibodies. Results: Patients with IgE-mediated food allergy had increased levels of F-EPX compared to controls and tended to have lower serum levels of eotaxin compared to non-allergic patients and controls. U-LTE₄ was significantly higher in allergic patients compared to non-allergic patients after challenge. Moreover, F-EPX correlated to U-LTE₄ (p = 0.011). Reported symptoms, abdominal pain, distension, flatulence and nausea were similar in the allergic and non-allergic patients. Conclusion: The results strongly indicate that eosinophils are activated in the gastrointestinal tract of food-allergic patients but not in patients with non-allergic food hypersensitivity. Due to the inconsistent pattern of symptoms after placebo and active food challenge, it was not possible to relate the levels of inflammation markers to the recorded symptoms.

Response to intestinal provocation monitored by transabdominal ultrasound in patients with food hypersensitivity

ObjectiveOwing to lack of objective measures, the diagnosis of food hypersensitivity may be difficult. The aim of this study was to investigate whether the intestinal response to direct provocation in patients with food hypersensitivity could be recognized by ultrasound. Material and methodsThirty-two patients with chronic abdominal complaints, self-attributed to food hypersensitivity/allergy were included in the study. Via a nasoduodenal tube, the duodenal mucosa was challenged with the suspected food item dissolved in 10 ml water or saline. Using external ultrasound, the sonographic features (wall thickness and diameter of the duodenal bulb and jejunum, peristalsis activity and luminal fluid) were recorded before and during one hour after challenge. ResultsSonographic changes were observed after challenge in 14 (44%) of the 32 patients. A positive sonographic response (increased wall thickness, diameter, peristalsis and/or luminal fluid) was significantly related to a positive skin prick test (p=0.008) and a positive double-blind placebo-controlled food challenge (p=0.03). A significant correlation was found between provocation-induced symptoms and wall thickness of the duodenal bulb (r=0.50, p=0.004) or the jejunum (r=0.42, p=0.02). Intra- and interobserver variation of the tracing procedure showed low values. ConclusionsResponses of the proximal small intestines to direct provocation (swelling of the wall and exudation of fluid into the lumen) could be visualized by transabdominal ultrasound. This new provocation test could be helpful in the evaluation of patients with food hypersensitivity.

P0483 SKIN PRICK TESTS AND RASTS IN THE DIAGNOSIS OF COW MILK ALLERGY WITH EXCLUSIVE GASTROINTESTINAL SYMPTOMS

Introduction: The provocative challenge test is still considered gold standard in the diagnosis of food hypersensitivity. However this test requires many cautions and can espose the patients (pts) to sometimes severe allergic symptoms. Therefore the diagnostic approach to food hypersensitivity could be made safe and fast by laboratory tests gifted of good predictive value in comparison with the gold standard. Aim of this retrospective study was to evaluate predictive value of skin prick tests (SPTs) and RASTs in comparison with the open challenge in the diagnosis of cow milk allergy with exclusive gastrointestinal symptoms. Methods: Ninety-six consecutive patients (pts), 41 females and 55 males, mean age 7.2 ± 2.6 years were enrolled. Inclusive criteria was: exclusive gastrointestinal symptoms (vomiting, diarrhea and abdominal pain); medical history suggestive of cow milk hypersensitivity and age more than 4 years. SPTs and RASTs for the main cow milk protein (casein, β-lactoglobulin and lattoalbumin) were performed in all pts; these pts affected by diarrhea and abdominal pain also underwent lactose breath test. All pts started a cow milk free diet and after 20 days from the beginning of the elimination diet underwent an open challenge test. A provocative test with lactose free milk was performed in all pts positive to lactose breath test. According to open challenge the pts were divided in two groups: group A (pts with positive open challenge) and group B (pts with negative open challenge). Results: GroupA (79 pts): 19 % were positive and 71 % negative to SPTs; 70% positive and 30% negative to RASTs; 4% were positive to SPTs and negative to RASTs; 58% were negative to SPTs and positive to RASTs. The number of the positive RASTs pts was significantly higher (p 0.00001) than of the positive SPTs pts. The 10 % resulted positive to lactose breath test. Group B: 6% were positive and 94 % negative to SPTs and to RASTs; 6% were positive to SPTs and negative to RASTs; 6% were negative to SPTs and positive to RASTs. The 53 % were positive to lactose breath test. Therefore the SPTs and RSTs sensitivity and specificity reached respectively 21%, 73%, 94% and 94%; the SPTs and RSTs positive and negative predictive values were respectively 28%, 57%, 91% and 97%. Conclusion: Our study shows that the RASTs are more reliable than the SPTs in the diagnosis of cow milk allergy with exclusive gastrointestinal symptoms and suggestive medical history.

Evaluation of the usefulness of lymphocyte proliferation assays in the diagnosis of allergy to cow's milk

Background: The significance of cell-mediated mechanisms in IgE-mediated milk allergy (IgE-MA) and in milk-induced enterocolitis syndrome (ME) is controversial. Some investigators have claimed that lymphocyte proliferation assays are useful in the diagnosis of food hypersensitivity, despite the great variability in study designs and results reported. This study was undertaken to address many of these variables and to determine whether lymphocyte proliferation assays correlate with clinical diagnoses. Methods: Lymphocyte proliferative responses to milk antigen were evaluated in two groups of children, 27 with IgE-MA, and nine with ME and in 21 pediatric control subjects. IgE-mediated food allergy was documented by positive double-blind, placebo-controlled food challenges and positive skin prick test results. ME was diagnosed by oral challenge or by a history of repeated episodes of delayed vomiting (>2 hours) after ingestion of milk and by negative skin prick test responses. Peripheral blood mononuclear cells were isolated and cultured. Cultures stimulated with milk (the food antigen of interest), soy antigen (a nonrelevant food antigen), or tetanus antigen (a positive control antigen) and unstimulated controls were performed in quadruplicate. On days 5, 7, and 9, cells were pulsed with tritium-labeled thymidine and incubated for 4 hours. Results were compared as counts per minute (cpm) and as stimulation indices (SIs). Results: Maximal proliferation was generally seen on day 7. The median cpm (20,941) and the median SI (19.2) in response to milk antigen in the 27 children with IgE-MA were significantly greater than those in the control patients (6969 cpm; SI = 14.2; p = 0.001 and p < 0.05, respectively). However, the ranges were large and overlapped extensively (IgE-MA, 5616 to 52,053 cpm; controls, 469 to 39,260 cpm). The non–soy-allergic patients with IgE-MA also had a significantly greater response to soy antigen than did the control subjects when cpm were compared (0.01 < p < 0.05). There were no differences in background or in response to tetanus antigen. The median response to milk in the patients with ME (11,975 cpm) was significantly greater than that in control subjects (6969 cpm; 0.01 < p < 0.05), when cpm were compared but not when SIs were compared. There were no significant differences between the patients with IgE-MA and those with ME. Conclusion: Overall, these results indicate that lymphocyte proliferation assays are neither diagnostic nor predictive of clinical reactivity in individual patients with milk allergy. Lymphocytes of many control patients are highly responsive to milk antigens, and lymphocytes of many patients with milk allergy are not. Statistically significant differences are only evident when the patients are compared as groups. (J Allergy Clin Immunol 1997;99:360-6.)

Serumanti-Gliadin IgA Antibody (AAG-IgA) and D-Xylose Absorption Test for Differential Diagnosis of Celiac Disease (CD) and Food Hypersensitivity (FH)

Clinical features of CD may overlay the presentation of other diseases responsible for small intestinal anatomical and/or functional changes. Among these, FH is an important cause of chronic diarrhea in children with identical age-range of common CD presentation. The aim of this study was to evaluate the AAG-IgA and D-xylose absorption tests for differential diagnosis of CD and FH. We studied 10 patients, mean age 2.7 ± 1.6 years with CD (jejunal biopsy: total villous atrophy with hyperplasia of the crypts) and 14 patients, mean age 2.1 ± 0.9 years, with FH(jejunal biopsy: mild/moderate villous atrophy). IgA deficiency was ruled out. Serum AAG-IgA was measured by enzyme immunoassay (ELISA) (Gluten-IgA EIA, Pharmacia Diagnostics AB), abnormal levels: >30.3, expressed in Arbitrary Units, AU. D-xylose absorption test was performed using 0.5g/Kg followed by a 1 h and 2 h blood level determinations, normal values: >=30 mg/%. AAG-IgA values were higher in DC(240.4±136.2 AU) than in FH (19.3±8.5 AU) (p<0.001, Mann-Whitney test). On the contrary, D-xylose values were lower in CD(13.2±8.0 mg/%) than in FH (41.3±11.8 MG/%) (p<0.001). The combined use of both tests, AAG-IgA determination and D-xylose absorption test, showed sensitivity of 100% and specificity of 86% in diagnosis CD. Jejunasl biospsy was performed only in 2 out of 14 children with FH because AAG-IgA or D-xylose test was found abnormal. We concluded: 1) The determination of serum AAG-IgA and D-xylose absorption test are important methods for differencial diagnosis in patients with chronic diarrhea; 2) The combined use of the above two tests is reliable for screening patients for small intestinal biopsy.

Fish allergy: Evaluation of the importance of cross-reactivity

Fish constitute one of the most important groups of allergens in the induction of immediate (type I) food hypersensitivity. In our environment, fish allergy is present in 22% of all patients with a diagnosis of food hypersensitivity. We studied the allergenic significance of the fish species considered most representative because of their greater consumption in our environment (flatfishes: Pleuronectiformes such as sole, whiff, and witch; Gadiformes such as hake; and Scombriformes such as albacore) or because of the results of previous studies of Gadiformes such as cod. Through the use of isoelectric focusing and sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting, we have observed that several allergens common to all these species are able to bind specific IgE from the sera of sensitized patients. This allergenic community has been confirmed by radioallergosorbent inhibition. Another group of species-specific allergens focuses in the regions at about pH 5 and with molecular weights less than 14 kilodaltons; these allergens correspond to sarcoplasmic parvoalbumins. From the results observed, which have been confirmed by various procedures and techniques, we conclude that hake is the fish with the capability to induce the strongest IgE response, followed by whiff; the witch seems to be the least allergenic of all flatfishes. Among all species studied, albacore was the least allergenic. These results may be considered when one introduces supplementary feeding with fish in infants, most particularly in infants at high risk for atopy.