TY - JOUR
T1 - Natural History of IgE-Mediated Fish Allergy in Children
AU - Xepapadaki, Paraskevi
AU - Christopoulou, Georgia
AU - Stavroulakis, George
AU - Freidl, Raphaela
AU - Linhart, Birgit
AU - Zuidmeer, Laurian
AU - Lakoumentas, John
AU - van Ree, Ronald
AU - Valenta, Rudolf
AU - Papadopoulos, Nikolaos G.
N1 - Funding Information: Conflicts of interest: P. Xepapadaki receives fees for medical consultations from GlaxoSmithKline, Novartis, Uriach, Galenica, Nestlé, Nutricia, and Menarini, outside the submitted work. R. van Ree receives fees, grants, and contract research from the European Commission, the Dutch Science Foundation, HAL Allergy BV, Citeq BV, Angany Inc., and Thermo Fisher Scientific, outside the submitted work. R. Valenta receives grants and personal fees from Viravaxx , Vienna , Austria ; and grants from HVD Life Sciences , Vienna , Austria , outside the submitted work. N. G. Papadopoulos receives personal fees and grants from Novartis , Nutricia , HAL , Sanofi , Menarini , Mylan / Meda , Biomay , AstraZeneca , GSK , MSD , ASIT biotech , Boehringer Ingelheim , Gerolymatos International SA , and Capricare , outside the submitted work. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: Conflicts of interest: P. Xepapadaki receives fees for medical consultations from GlaxoSmithKline, Novartis, Uriach, Galenica, Nestl?, Nutricia, and Menarini, outside the submitted work. R. van Ree receives fees, grants, and contract research from the European Commission, the Dutch Science Foundation, HAL Allergy BV, Citeq BV, Angany Inc., and Thermo Fisher Scientific, outside the submitted work. R. Valenta receives grants and personal fees from Viravaxx, Vienna, Austria; and grants from HVD Life Sciences, Vienna, Austria, outside the submitted work. N. G. Papadopoulos receives personal fees and grants from Novartis, Nutricia, HAL, Sanofi, Menarini, Mylan/Meda, Biomay, AstraZeneca, GSK, MSD, ASIT biotech, Boehringer Ingelheim, Gerolymatos International SA, and Capricare, outside the submitted work. The rest of the authors declare that they have no relevant conflicts of interest. No funding has been received for this study. Publisher Copyright: © 2021 American Academy of Allergy, Asthma & Immunology Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/8
Y1 - 2021/8
N2 - Background: Fish allergy is not uncommon, especially in countries with high fish consumption, it can frequently be severe and may affect dietetic and lifestyle choices. Nevertheless, data on its clinical course and natural history are scarce. Objective: To describe the natural history of immunoglobulin E–mediated fish allergy and the potential differential reactivity to various fish species and identify prognostic markers in children with confirmed disease. Methods: Clinical history, specific immunoglobulin E, and skin prick tests to various fish were recorded in 126 children with confirmed immunoglobulin E–mediated fish allergy. Immunoglobulin E reactivity was also evaluated by immunoblotting. Eligible participants proceeded to a series of food challenges to tuna, swordfish, and codfish. In total, 234 challenges were performed. Results: Fifty-eight children (9.7 ± 3.9 years) were included in the analysis. Age at first reaction was 0.5 to 5 years (median, 1.3 years). Thirteen children (22%) tolerated all fish tested, including cod, 1 to 14 years (mean, 8.2 ± 4.2 years) following their first reported reaction. Complete fish tolerance increased with age, ranging from 3.4% in preschool children to over 45% in adolescents (95% confidence interval, 26.3%-79.7%). Most children were able to tolerate swordfish (94%) and tuna (95%). Prechallenge specific immunoglobulin E to cod greater than 4.87 kUA/L was the best positive predictive marker for fish allergy persistence (94%), followed by skin prick tests to sardine greater than 6.5 mm (92%). Conclusions: A considerable proportion of fish-allergic children develop tolerance around adolescence. Most fish-allergic children can consume tuna and swordfish, which, thus, provide safe alternatives for a balanced diet.
AB - Background: Fish allergy is not uncommon, especially in countries with high fish consumption, it can frequently be severe and may affect dietetic and lifestyle choices. Nevertheless, data on its clinical course and natural history are scarce. Objective: To describe the natural history of immunoglobulin E–mediated fish allergy and the potential differential reactivity to various fish species and identify prognostic markers in children with confirmed disease. Methods: Clinical history, specific immunoglobulin E, and skin prick tests to various fish were recorded in 126 children with confirmed immunoglobulin E–mediated fish allergy. Immunoglobulin E reactivity was also evaluated by immunoblotting. Eligible participants proceeded to a series of food challenges to tuna, swordfish, and codfish. In total, 234 challenges were performed. Results: Fifty-eight children (9.7 ± 3.9 years) were included in the analysis. Age at first reaction was 0.5 to 5 years (median, 1.3 years). Thirteen children (22%) tolerated all fish tested, including cod, 1 to 14 years (mean, 8.2 ± 4.2 years) following their first reported reaction. Complete fish tolerance increased with age, ranging from 3.4% in preschool children to over 45% in adolescents (95% confidence interval, 26.3%-79.7%). Most children were able to tolerate swordfish (94%) and tuna (95%). Prechallenge specific immunoglobulin E to cod greater than 4.87 kUA/L was the best positive predictive marker for fish allergy persistence (94%), followed by skin prick tests to sardine greater than 6.5 mm (92%). Conclusions: A considerable proportion of fish-allergic children develop tolerance around adolescence. Most fish-allergic children can consume tuna and swordfish, which, thus, provide safe alternatives for a balanced diet.
KW - Fish allergy
KW - Fish species
KW - Food challenge
KW - IgE
KW - Natural history
UR - http://www.scopus.com/inward/record.url?scp=85105304787&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jaip.2021.04.007
DO - https://doi.org/10.1016/j.jaip.2021.04.007
M3 - Article
C2 - 33866031
SN - 2213-2198
VL - 9
SP - 3147-3156.e5
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 8
ER -