Fish allergy in atopic children.

Area of Science:

• Allergy and Immunology
• Pediatric Allergy
• Clinical Diagnostics

Background:

• Assessing fish allergy in atopic children is crucial due to potential severe reactions.
• Elevated specific immunoglobulin E (IgE) levels for cod were observed in 11 atopic children without a prior fish allergy history.
• All participants had co-existing conditions like asthma and allergic rhinitis, with some also having atopic dermatitis.

Observation:

• Children underwent various diagnostic tests including skin prick tests for multiple fish species, serum specific IgE measurements, and oral food challenges.
• Skin tests showed varied positivity for different fish species in cod-specific IgE-positive children.
• Specific IgE levels were elevated for several fish types, including salmon, trout, tuna, eel, and mackerel.

Findings:

• A positive oral fish challenge test was the sole definitive method for confirming fish allergy.
• Positive allergy skin tests and specific IgE tests demonstrated limited reliability in diagnosing fish allergy.
• Neither skin tests nor in vitro specific IgE assays correlated with clinical fish allergy symptoms or with each other.

Implications:

• Clinical food challenge remains the gold standard for diagnosing fish allergy.
• Relying solely on skin prick tests or specific IgE levels may lead to misdiagnosis in atopic pediatric populations.
• Further research is needed to understand the discrepancy between in vitro/in vivo tests and actual clinical reactivity in fish allergy.