Admission and Emergency Pediatric Medicine and Surgery Unit, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70124 Bari, Italy.
Area of Translational Research in Pediatric Specialities, Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Medicina (Kaunas). 2023 Sep 12;59(9):1651. doi: 10.3390/medicina59091651.
Fish is one of the "big nine" foods triggering allergic reactions. For this reason, fish allergens must be accurately specified on food labels. Fish allergy affects less than 1% of the world population, but a higher prevalence is observed in pediatric cohorts, up to 7%. Parvalbumin is the main fish allergen found in the muscles. In childhood, sensitization to fish allergens occurs most frequently through the ingestion of fish, rarely transcutaneously or by inhalation. Fish allergy symptoms usually appear within two hours of the allergen contact. The diagnosis begins with the collection of the history. If it is suggestive of fish allergy, prick tests or the measurement of serum-specific IgE should be performed to confirm the suspicion. The oral food challenge is the gold standard for the diagnosis. It is not recommended in case of a severe allergic reaction. It is important to make a differential diagnosis with anisakiasis or scombroid poisoning, which have overlapping clinical features but differ in pathogenesis. Traditionally, managing fish allergy involves avoiding the triggering species (sometimes all bony fish species) and requires an action plan for accidental exposures. The present review will analyze IgE- and non-IgE-mediated fish allergy in children from epidemiology, pathogenesis to clinical features. Moreover, clinical management will be addressed with a particular focus on potential nutritional deficiencies.
鱼类是引发过敏反应的“九大”食物之一。因此，必须在食品标签上准确注明鱼类过敏原。鱼类过敏影响全世界不到 1%的人口，但在儿科人群中观察到更高的流行率，高达 7%。副肌球蛋白是肌肉中主要的鱼类过敏原。在儿童时期，通过摄入鱼类最常发生对鱼类过敏原的致敏，很少通过皮肤或吸入。鱼类过敏症状通常在接触过敏原后两小时内出现。诊断始于收集病史。如果提示有鱼类过敏，应进行皮试或血清特异性 IgE 测量以确认怀疑。口服食物挑战是诊断的金标准。对于严重过敏反应不建议进行。重要的是要与异尖线虫病或鲭鱼中毒进行鉴别诊断，它们具有重叠的临床特征，但发病机制不同。传统上，管理鱼类过敏需要避免触发物种（有时是所有有骨鱼类），并制定意外暴露的行动计划。本综述将从流行病学、发病机制到临床特征分析儿童 IgE 和非 IgE 介导的鱼类过敏。此外，还将特别关注潜在的营养缺乏症来讨论临床管理。
