Leung Agnes S Y, Wai Christine Y Y, Leung Nicki Y H, Ngai Noelle Anne, Chua Gilbert T, Ho Po Ki, Lam Ivan C S, Cheng James W C H, Chan Oi Man, Li Pui Fung, Au Ann W S, Leung Chloris H W, Cheng Nam Sze, Tang Man Fung, Fong Brian L Y, Rosa Duque Jaime S, Wong Joshua S C, Luk David C K, Ho Marco H K, Kwan Mike Y W, Yau Yat Sun, Lee Qun Ui, Chan Wai Hung, Wong Gary W K, Leung Ting Fan
Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of the People's Republic of China, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of the People's Republic of China, China.
Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of the People's Republic of China, China.
J Allergy Clin Immunol Pract. 2024 Mar;12(3):633-642.e9. doi: 10.1016/j.jaip.2023.09.038. Epub 2023 Oct 5.
Seafood is a common cause of food allergy and anaphylaxis, but there are limited published real-world data describing the clinical presentation of fish and shellfish allergies.
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.
海鲜是食物过敏和过敏反应的常见诱因，但关于鱼类和贝类过敏临床表现的真实世界数据有限。
本研究旨在探讨鱼类过敏个体对鱼类、甲壳类动物和软体动物的临床特征、免疫特征及耐受模式。
招募2016年至2021年间出现IgE介导的鱼类过敏的患者。评估包括针对各种鱼类和贝类的特异性IgE和皮肤点刺试验在内的全面致敏情况，以及包括个体近期海鲜食用情况在内的详细临床病史。
从香港6家过敏诊所招募了249名鱼类过敏个体（年龄4.2±5.8岁），他们在入组前2.2±3.4年出现过鱼类过敏反应。75名受试者（30%）在口服食物激发试验中对草鱼、三文鱼、石斑鱼或鳕鱼有反应。我们确定了与鱼类中β-副肌球蛋白水平相对应的IgE致敏梯度。总计40%的鱼类过敏个体报告对1种或更多种鱼类有耐受性，与鲶鱼和草鱼等富含β-副肌球蛋白的鱼类相比，更常见于β-副肌球蛋白水平较低的鱼类，如金枪鱼和三文鱼。尽管存在鱼类和贝类共同致敏情况，但41%的个体报告对甲壳类动物、软体动物或两者都有耐受性，而一半的鱼类过敏个体避免食用贝类，其中33%对贝类无致敏反应。
鱼类过敏常见于幼儿期。相当一部分鱼类过敏患者对某些鱼类具有选择性耐受性，通常是那些β-副肌球蛋白水平较低的鱼类。在促进海鲜过敏的精准医疗方面仍存在未满足的需求。
