Persistence, Severity, and Reactivity Thresholds in Fish-Allergic Patients Sensitized to Parvalbumin

Area of Science:

• Immunology
• Allergology
• Clinical Medicine

Background:

• Fish allergy is a global health concern affecting both children and adults.
• Distinct transient and persistent phenotypes characterize fish allergy.
• Parvalbumin sensitization is a key factor in persistent fish allergy.

Purpose of the Study:

• To investigate the persistence, severity, and reactivity thresholds in individuals with challenge-confirmed fish allergy.
• To analyze patients sensitized to parvalbumin, a common allergen in fish.

Main Methods:

• Recruited 42 patients aged 12-65 with immediate fish reactions and specific IgE levels.
• Utilized double-blind placebo-controlled food challenges (DBPCFC) with cod.
• Assessed reaction severity using the Food Allergy Severity Score and calculated eliciting doses (ED).

Main Results:

• Confirmed fish allergy in 71.4% of participants (30/42).
• Median allergy duration was 23 years, with 70% reporting prior anaphylaxis.
• Food challenges revealed milder reactions (oropharyngeal/mild systemic) than reported, with a low ED10 (0.99-2.54 mg protein).
• Male sex was linked to severe reactions (OR 5.44).

Conclusions:

• Adolescents and adults with persistent, parvalbumin-sensitized fish allergy experience severe reactions and exhibit low reactivity thresholds.
• Findings highlight the need for extensive research and novel therapeutic strategies for fish allergy management.