This study aimed to examine the clinical characteristics, immunological profile, and tolerance pattern to fish, crustaceans, and mollusks in fish-allergic individuals.
Patients presenting with IgE-mediated fish allergy between 2016 and 2021 were recruited. A comprehensive sensitization profile including specific IgE and skin prick test to various fish and shellfish species and a detailed clinical history including individuals\' recent seafood consumption were evaluated.
A total of 249 fish-allergic individuals (aged 4.2 ± 5.8 years) were recruited from 6 allergy clinics in Hong Kong, and they had experienced their fish-allergic reaction 2.2 ± 3.4 years before enrollment. Seventy-five subjects (30%) reacted to either grass carp, salmon, grouper, or cod in oral food challenges. We identified an IgE sensitization gradient that corresponded to the level of β-parvalbumin in fish. In total, 40% of fish-allergic individuals reported tolerance to 1 or more types of fish, more commonly to fish with a lower β-parvalbumin level such as tuna and salmon, compared with β-parvalbumin-rich fish such as catfish and grass carp. Despite fish and shellfish cosensitization, 41% of individuals reported tolerance to crustaceans, mollusks, or both, whereas shellfish avoidance occurred in half of the fish-allergic individuals, of whom 33% lacked shellfish sensitization.
Fish allergy commonly presents in early childhood. A considerable proportion of fish-allergic patients are selectively tolerant to certain fish, typically those with lower levels of β-parvalbumin. There is an unmet need to promote precision medicine for seafood allergies.
目的:本研究旨在检查临床特征,免疫学特征,和对鱼的宽容模式,甲壳类动物,和鱼类过敏个体的软体动物。
方法:招募了2016年至2021年患有IgE介导的鱼类过敏的患者。评估了全面的致敏概况,包括对各种鱼类和贝类的特异性IgE和皮肤点刺试验,以及包括个人最近食用海鲜在内的详细临床病史。
结果:共有249名鱼类过敏人士(年龄4.2±5.8岁)从香港的6个过敏诊所招募,他们在入组前2.2±3.4年经历过鱼类过敏反应。75名受试者(30%)对草鱼有反应,鲑鱼,石斑鱼,或鳕鱼在口服食物挑战。我们确定了与鱼中β-小白蛋白水平相对应的IgE致敏梯度。总的来说,40%的鱼类过敏个体报告对一种或更多种类型的鱼类有耐受性,更常见的是具有较低β-小白蛋白水平的鱼类,如金枪鱼和鲑鱼,与富含β-小白蛋白的鱼如鲶鱼和草鱼相比。尽管鱼类和贝类共致敏,41%的个体报告对甲壳类动物有耐受性,软体动物,或者两者兼而有之,而一半的鱼类过敏个体避免贝类,其中33%缺乏贝类敏感性。
结论:鱼过敏通常出现在儿童早期。相当比例的鱼类过敏患者对某些鱼类有选择性的耐受,通常是β-小清蛋白水平较低的那些。对于促进针对海鲜过敏的精准医学存在未满足的需求。