Fish Allergy Management: From Component-Resolved Diagnosis to Unmet Diagnostic Needs

• DOI: 10.1007/s40521-019-00235-w
• Publication Date: 2019-12-16T17:08:18Z
• Authors: Julia Klueber; Denise Schrama; Pedro Rodrigues; Heinrich Dickel; Annette Kuehn
• Keywords: 0301 basic medicine; 2. Zero hunger; Component-resolved diagnosis; 03 medical and health sciences; 0302 clinical medicine; Food; Allergen; Fish allergy; Parvalbumin; 3. Good health

Abstract

Purpose of review Fish is a common elicitor of IgE-mediated food allergy. Fish includes a large variety of foods, in terms of species and food processing, with marked distinction in local diets around the globe. Fish-allergic patients present with phenotypic diversity and major differences in levels of clinical cross-reactivity, features that pose an important challenge for the clinical diagnosis and management.

Recent findings Parvalbumin is the major fish allergen. However, a single molecule is not sufficient but several homologs, allergens different from parvalbumin and allergen extracts, are needed for IgE-based diagnosis.

Summary Parvalbumin-specific IgE are markers for clinical cross-reactions. Added value is provided by IgE typing to parvalbumin homologs from distantly related fish. IgE co-sensitization profiles (parvalbumin, enolase, aldolase) are referred as severity markers. The allergen panel seems to be not yet complete why fish extracts still play a crucial role in serum IgE analysis. Further clinical validation of a multiplex approach in molecular fish allergy diagnosis is needed for striving to avoid unnecessary food restrictions and in a further sense, improved patient care.