Fish Allergy in Children

Abstract

Fish is a food with high nutritional value but also carries a high risk of allergy. Allergic reactions to fish typically occur within the first two years of life and usually at first consumption. Although there are diagnostic methods such as SPT and specific IgE, the gold standard diagnostic test is OPC as in other food allergies. The main treatment is the elimination of fish from the diet and the use of epinephrine autoinjectors in case of anaphylaxis. However, fish and shellfish that children can tolerate should be determined by diagnostic tests and unnecessarily restrictive diets should be avoided. Patients should be informed about alternative sources of omega-3 and a written nutrition plan should be provided. Therefore, the collaboration of pediatrics, allergists and dietitians is essential in the management of fish allergy.

Keywords

• Allergy
• children
• fish
• parvalbumin

References

1. Chen J, Jayachandran M, Bai W, Xu B. A critical review on the health benefits of fish consumption and its bioactive constituents. Food Chem. 2022;369:130874. google scholar
2. Swanson D, Block R, Mousa SA. Omega-3 FattY Acids EPA and DHA: Health Benefits Throughout Life. Advances in Nutrition. 2012;3(l):1-7. google scholar
3. Mohanty BP, Mahanty A, GangulY S, Mitra T, Karunakaran D, Anandan R. Nutritional composition of food fishes and their importance in providing food and nutritional security. Food Chem. 2019;293:561-70. google scholar
4. Malmir H, Larijani B, Esmaillzadeh A. Fish consumption during pregnancY and risk of allergic diseases in the offspring: A systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2022;62(27):7449-59. google scholar
5. Ruethers T, Taki AC, Johnston EB, Nugraha R, Le TTK, Kalic T, et al. Seafood allergy: A comprehensive review of fish and shellfish allergens. Mol Immunol. 2018;100:28-57. google scholar
6. Connett GJ, Gerez I, Cabrera-Morales EA, Yuenyongviwat A, Ngamphaiboon J, Chatchatee P, et al. A Population-Based Study of Fish Allergy in the Philippines, Singapore and Thailand. Int Arch Allergy Immunol. 2012;159(4):384-90. google scholar
7. Kim M, Lee JY, Jeon H young, Yang H kyoung, Lee KJ, Han Y, et al. Prevalence of Immediate-Type Food Allergy in Korean Schoolchildren in 2015: A Nationwide, Population-based Study. Allergy Asthma Immunol Res. 2017;9(5):410. google scholar
8. Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of seafood allergy in the United States determined by a random telephone survey. Journal of Allergy and Clinical Immunology. 2004;114(1):159-65. google scholar

9. Grimshaw KEC, Bryant T, Oliver EM, Martin J, Maskell J, Kemp T, et al. Incidence and risk factors for food hypersensitivity in UK infants: results from a birth cohort study. Clin Transl Allergy. 2015;6(1):1. google scholar
10. Botha M, Basera W, Facey-Thomas HE, Gaunt B, Gray CL, Ramjith J, et al. Rural and urban food allergy prevalence from the South African Food Allergy (SAFFA) study. Journal of Allergy and Clinical Immunology. 2019;143(2):662-668.e2. google scholar
11. Nwaru BI, Hickstein L, Panesar SS, Roberts G, Muraro A, Sheikh A. Prevalence of common food allergies in Europe: a systematic review and meta-analysis. Allergy. 2014;69(8):992-1007. google scholar
12. Orhan F, Karakas T, Cakir M, Aksoy A, Baki A, Gedik Y. Prevalence of immunoglobulin E-mediated food allergy in 6-9-year-old urban schoolchildren in the eastern Black Sea region of Turkey. Clinical & Experimental Allergy. 2009;39(7):1027-35. google scholar
13. Yu W, Freeland DMH, Nadeau KC. Food allergy: immune mechanisms, diagnosis and immunotherapy. Nat Rev Immunol. 2016;16(l2):751-65. google scholar
14. Carvalho S, Marcelino J, Cabral Duarte M, Costa C, Barbosa M, Pereira Dos Santos M. Role of Recombinant Parvalbumin Gad c 1 in the Diagnosis and Prognosis of Fish Allergy. J Investig Allergol Clin Immunol. 2020;30(5):340-5. google scholar
15. Xepapadaki P, Christopoulou G, Stavroulakis G, Freidl R, Linhart B, Zuidmeer L, et al. Natural History of IgE-Mediated Fish Allergy in Children. J Allergy Clin Immunol Pract. 2021;9(8):3147-3156.e5. google scholar
16. Lim DL, Neo KH, Yi FC, Chua KY, Goh DL, Shek LP, et al. Parvalbumin - the majör tropical fish allergen. Pediatric Allergy and Immunology. 2008;19(5):399-407. google scholar
17. Pastor-Vargas C, Maroto AS, Dıaz-Perales A, Villalba M, Esteban V, Ruiz-Ramos M, et al. Detection of major food allergens in amniotic fluid: initial allergenic encounter during pregnancy. Pediatric Allergy and Immunology. 2016;27(7):716-20. google scholar
18. Pastor-Vargas C, Maroto AS, Dıaz-Perales A, Villaba M, Casillas Diaz N, Vivanco F, et al. Sensitive detection of major food allergens in breast milk: first gateway for allergenic contact during breastfeeding. Allergy. 2015;70(8):1024-7. google scholar
19. Leung ASY, Wai CYY, Leung NYH, Ngai NA, Chua GT, Ho PK, et al. Real-World Sensitization and Tolerance Pattern to Seafood in Fish-Allergic Individuals. J Allergy Clin Immunol Pract. 2024;12(3):633-642.e9. google scholar
20. Turner P, Ng I, Kemp A, Campbell D. Seafood allergy in children: a descriptive study. Annals of Allergy, Asthma & Immunology. 2011;106(6):494-501. google scholar
21. Akarsu A, Ocak M, Köken G, Şahiner ÜM, Soyer Ö, Şekerel BE. IgE mediated food allergy in Turkey: different spectrum, similar outcome. Turk J Pediatr. 2021;63(4):554-63. google scholar
22. Walter G, Kalicinsky C. Adult-onset IgE-mediated food allergy at a Winnipeg allergy clinic: a case series. Allergy, Asthma & Clinical Immunology. 2020;16(1):85. google scholar
23. Buyuktiryaki B, Masini M, Mori F, Barni S, Liccioli G, Sarti L, et al. IgE-Mediated Fish Allergy in Children. Medicina (B Aires). 2021;57(1):76. google scholar
24. Feng C, Teuber S, Gershwin ME. Histamine (Scombroid) Fish Poisoning: a Comprehensive Review. Clin Rev Allergy Immunol. 2016;50(1):64-9. google scholar
25. Sumner SS, Roche F, Taylor SL. Factors Controlling Histamine Production in Swiss Cheese Inoculated with Lactobacillus buchneri. J Dairy Sci. 1990;73(11):3050-8. google scholar
26. Yuan KK, Li HY, Yang WD. Marine Algal Toxins and Public Health: Insights from Shellfish and Fish, the Main Biological Vectors. Mar Drugs. 2024;22(11):510. google scholar
27. Mastrorilli C, Arasi S, Barni S, Caimmi D, Chiera F, Comberiati P, et al. IgE-Mediated and Non-IgE-Mediated Fish Allergy in Pediatric Age: A Holistic Approach—A Consensus by Diagnostic Commission of the Italian Society of Pediatric Allergy and Immunology. Medicina (B Aires). 2023;59(9):1651. google scholar
28. Patton T, Chugh A, Padhye L, DeGeeter C, Guandalini S. Pediatric Celiac Disease and Eosinophilic Esophagitis. J Pediatr Gastroenterol Nutr. 2019;69(2). google scholar
29. Baker MG, Sampson HA. Recent trends in food protein-induced enterocolitis syndrome (FPIES). Journal of Allergy and Clinical Immunology. 2023;151(1):43-6. google scholar
30. Prattico C, Mule P, Ben-Shoshan M. A Systematic Review of Food Protein-Induced Enterocolitis Syndrome. Int Arch Allergy Immunol. 2023;184(6):567-75. google scholar
31. Elsayed S, Aas K. Characterization of a major allergen (cod). Observations on effect of denaturation on the allergenic activity. J Allergy. 1971;47(5):283-91. google scholar
32. Kuehn A, Hutt-Kempf E, Hilger C, Hentges F. Clinical monosensitivity to salmonid fish linked to specific IgE-epitopes on salmon and trout beta-parvalbumins. Allergy. 2011;66(2):299-301. google scholar
33. Kobayashi A, Tanaka H, Hamada Y, Ishizaki S, Nagashima Y, Shiomi K. Comparison of allergenicity and allergens between fish white and dark muscles. Allergy. 2006;61(3):357-63. google scholar
34. Kuehn A, Hilger C, Lehners-Weber C, Codreanu-Morel F, Morisset M, Metz-Favre C, et al. Identification of enolases and aldolases as important fish allergens in cod, salmon and tuna: component resolved diagnosis using parvalbumin and the new allergens. Clinical & Experimental Allergy. 2013;43(7):811-22. google scholar
35. Gonzâlez-Fernândez J, Alguacil-Guillen M, Cuellar C, Daschner A. Possible Allergenic Role of Tropomyosin in Patients with Adverse Reactions after Fish Intake. Immunol Invest. 2018;47(4):416-29. google scholar
36. Ruethers T, Taki AC, Karnaneedi S, Nie S, Kalic T, Dai D, et al. Expanding the allergen repertoire of salmon and catfish. Allergy. 2021;76(5):1443-53. google scholar
37. Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of seafood allergy in the United States determined by a random telephone survey. Journal of Allergy and Clinical Immunology. 2004;114(1):159-65. google scholar
38. Hilger C, Thill L, Grigioni F, Lehners C, Falagiani P, Ferrara A, et al. IgE antibodies of fish allergic patients cross-react with frog parvalbumin. Allergy. 2004;59(6):653-60. google scholar
39. Haroun-Dıaz E, Blanca-Lopez N, Vâzquez de la Torre M, Ruano FJ, Somoza Âlvarez ML, Labrador Horrillo M, et al. Severe anaphylaxis due to crocodile-meat allergy exhibiting wide cross-reactivity with fish allergens. J Allergy Clin Immunol Pract. 2018;6(2):669-670.e1. google scholar
40. Kuehn A, Codreanu-Morel F, Lehners-Weber C, Doyen V, Gomez-Andre S -A., Bienvenu F, et al. Cross-reactivity to fish and chicken meat - a new clinical syndrome. Allergy. 2016;71(12):1772-81. google scholar
41. Tanaka K, Kondo Y, Inuo C, Nakajima Y, Tsuge I, Doi S, et al. Allergen Analysis of Sea Urchin Roe Using Sera from Five Patients. Int Arch Allergy Immunol. 2014;164(3):222-7. google scholar
42. Minhas J, Saryan JA, Balekian DS. Salmon roe (ikura)-induced anaphylaxis in a child. Annals of Allergy, Asthma & Immunology. 2017;118(3):365-6. google scholar
43. Kuehn A, Hilger C, Hentges F. Anaphylaxis provoked by ingestion of marshmallows containing fish gelatin. Journal of Allergy and Clinical Immunology. 2009;123(3):708-9. google scholar
44. Andre F, Cavagna S, Andre C. Gelatin Prepared from Tuna Skin: A Risk Factor for Fish Allergy or Sensitization? Int Arch Allergy Immunol. 2003;130(1):17-24. google scholar
45. Taki AC, Ruethers T, Nugraha R, Karnaneedi S, Williamson NA, Nie S, et al. Thermostable allergens in canned fish: Evaluating risks for fish allergy. Allergy. 2023;78(12):3221-34. google scholar
46. Kobayashi Y, Kuriyama T, Nakagawara R, Aihara M, Hamada-Sato N. Allergy to fish collagen: Thermostability of collagen and IgE reactivity of patients’ sera with extracts of 11 species of bony and cartilaginous fish. Allergology International. 2016;65(4):450-8. google scholar
47. Jiang X, Rao Q. Effect of Processing on Fish Protein Antigenicity and Allergenicity. Foods. 2021;10(5):969. google scholar
48. Pecoraro L, Infante S, Fuentes-Aparicio V, Cabrera-Freitag P, Antonucci N, Alvarez-Perea A. IgE-mediated fish allergy in pediatric age: Does canned tuna have a chance for tolerance? Pediatric Allergy and Immunology. 2021;32(5):1114-7. google scholar
49. Sampson HA. Food allergy. Part 2: Diagnosis and management. Journal of Allergy and Clinical Immunology. 1999;103(6):981-9. google scholar
50. Waserman S, Watson W. Food allergy. Allergy, Asthma & Clinical Immunology. 2011;7(S1):S7. google scholar
51. Heinzerling L, Mari A, Bergmann K, Bresciani M, Burbach G, Darsow U, et al. The skin prick test - European standards. Clin Transl Allergy. 2013;3(1). google scholar
52. Kianifar HR, Pourreza A, Jabbari Azad F, Yousefzadeh H, Masomi F. Sensitivity Comparison of the Skin Prick Test and Serum and Fecal Radio Allergosorbent Test (RAST) in Diagnosis of Food Allergy in Children. Rep Biochem Mol Biol. 2016;4(2):98-103. google scholar
53. Kuehn A, Scheuermann T, Hilger C, Hentges F. Important Variations in Parvalbumin Content in Common Fish Species: A Factor Possibly Contributing to Variable Allergenicity. Int Arch Allergy Immunol. 2010;153(4):359-66. google scholar
54. Pitsios C, Dimitriou A, Kontou-Fili K. Allergic reactions during allergy skin testing with food allergens. Eur Ann Allergy Clin Immunol. 2009;41(4):126-8. google scholar
55. Pitsios C, Dimitriou A, Stefanaki EC, Kontou-Fili K. Anaphylaxis during skin testing with food allergens in children. Eur J Pediatr. 2010;169(5):613-5. google scholar
56. Novembre E, Bernardini R, Bertini G, Massai G, Vierucci A. Skin-prick-test-induced anaphylaxis. Allergy. 1995;50(6):511-3. google scholar
57. Bernstein DI, Wanner M, Borish L, Liss GM, the Immunotherapy Committee of th. Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990-2001. Journal of Allergy and Clinical Immunology. 2004;113(6):1129-36. google scholar
58. Liccardi G, D’Amato G, Canonica GW, Salzillo A, Piccolo A, Passalacqua G. Systemic reactions from skin testing: literature review. J Investig Allergol Clin Immunol. 2006;16(2):75-8. google scholar
59. Kalic T, Morel-Codreanu F, Radauer C, Ruethers T, Taki AC, Swoboda I, et al. Patients Allergic to Fish Tolerate Ray Based on the Low Allergenicity of Its Parvalbumin. J Allergy Clin Immunol Pract. 2019;7(2):500-508.e11. google scholar
60. Tedner SG, Asarnoj A, Thulin H, Westman M, Konradsen JR, Nilsson C. Food allergy and hypersensitivity reactions in children and adults—A review. J Intern Med. 2022;29l(3):283-302. google scholar
61. Peters R, Gurrin L, Dharmage S, Koplin J, Allen K. The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy? Int J Environ Res Public Health. 2013;10(l0):5039-61. Sharp MF, Lopata AL. Fish Allergy: In Review. Clin Rev Allergy Immunol. 2014;46(3):258-71. google scholar
62. Abrams EM, Sicherer SH. Diagnosis and management of food allergy. Can Med Assoc J. 2016;188(15):1087-93. google scholar
63. Celik-Bilgili S, Mehl A, Verstege A, Staden U, Nocon M, Beyer K, et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clinical & Experimental Allergy. 2005;35(3):268-73. google scholar
64. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. Journal of Allergy and Clinical Immunology. 2001;107(5):891-6. google scholar
65. Perry TT, Matsui EC, Kay Conover-Walker M, Wood RA. The relationship of allergen-specific IgE levels and oral food challenge outcome. Journal of Allergy and Clinical Immunology. 2004;114(1):144-9. google scholar
66. Chokshi NY, Sicherer SH. Interpreting IgE sensitization tests in food allergy. Expert Rev Clin Immunol. 2016;12(4):389-403. google scholar
67. Beale JE, Jeebhay MF, Lopata AL. Characterisation of purified parvalbumin from five fish species and nucleotide sequencing of this major allergen from Pacific pilchard, Sardinops sagax. Mol Immunol. 2009;46(15):2985-93. google scholar
68. Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J Am Acad Dermatol. 2011;64(1):175-92. google scholar
69. Wolthers OD. Component-Resolved Diagnosis in Pediatrics. ISRN Pediatr. 2012;2012:1-6. google scholar
70. Incorvaia C, Rapetti A, Aliani M, Castagneto C, Corso N, Landi M, et al. Food Allergy as Defined by Component Resolved Diagnosis. Recent Pat Inflamm Allergy Drug Discov. 2014;8(1):59-73. google scholar
71. Swoboda I, Bugajska-Schretter A, Verdino P, Keller W, Sperr WR, Valent P, et al. Recombinant Carp Parvalbumin, the Major Cross-Reactive Fish Allergen: A Tool for Diagnosis and Therapy of Fish Allergy. The Journal of Immunology. 2002;168(9):4576-84. google scholar
72. Kuehn A, Hilger C, Lehners-Weber C, Codreanu-Morel F, Morisset M, Metz-Favre C, et al. Identification of enolases and aldolases as important fish allergens in cod, salmon and tuna: component resolved diagnosis using parvalbumin and the new allergens. Clinical & Experimental Allergy. 2013;43(7):811-22. google scholar
73. Davis CM, Gupta RS, Aktas ON, Diaz V, Kamath SD, Lopata AL. Clinical Management of Seafood Allergy. J Allergy Clin Immunol Pract. 2020;8(1):37-44. google scholar
74. Chapman JA, Bernstein IL, Lee RE, Oppenheimer J, Nicklas RA, Portnoy JM, et al. Food allergy: a practice parameter. Annals of Allergy, Asthma & Immunology. 2006;96(3):S1-68. google scholar
75. Han X, Wang X, Chen X, Liu H, Liu J, Waye MMY, et al. Intervention Efficacy of Slightly Processed Allergen/Meat in Oral Immunotherapy for Seafood Allergy: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis in Mouse Models and Clinical Patients. Nutrients. 2024;16(5):667. google scholar
76. Pajno GB, Fernandez-Rivas M, Arasi S, Roberts G, Akdis CA, Alvaro-Lozano M, et al. EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy. Allergy. 2018;73(4):799-815. google scholar
77. Caglayan-Sozmen S, Santoro A, Cipriani F, Mastrorilli C, Ricci G, Caffarelli C. Hazardous Medications in Children with Egg, Red Meat, Gelatin, Fish, and Cow’s Milk Allergy. Medicina (B Aires). 2019;55(8):501. google scholar
78. Ng IE, Turner PJ, Kemp AS, Campbell DE. Parental perceptions and dietary adherence in children with seafood allergy. Pediatric Allergy and Immunology. 2011;22(7):720-8. google scholar
79. Dijkema D, Emons JAM, Van de Ven AAJM, Oude Elberink JNG. Fish Allergy: Fishing for Novel Diagnostic and Therapeutic Options. Clin Rev Allergy Immunol. 2022;62(1):64-71. google scholar
80. Mark BJ, Beaty AD, Slavin RG. Are fish oil supplements safe in finned fish-allergic patients? Allergy Asthma Proc. 2008;29(5):528-9. google scholar
81. Australasian Society of Clinical Immunology and Allergy. Dietary Guide - Fish Allergy. June 2023. https://www.allergy.org.au/images/pc/ASCIA_PC_Dietary_ Guide_Fish_Allergy_2023.pdf. (Accessed on March 13, 2025). google scholar