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Life-threatening fish allergy successfully treated with immunotherapy
G Casimir1, P Cuvelier, S Allard
1Department of Pulmonology and Allergy, University Children's Hospital Queen Fabiola, Free University of Brussels (ULB), Belgium.
Summary
This case study demonstrates successful rapid, high-dose (RUSH) immunotherapy for a life-threatening codfish allergy in a young child. The treatment enabled tolerance to codfish ingestion and inhalation, significantly improving the patient
Area of Science:
- Allergy and Immunology
- Pediatric Allergy
- Immunotherapy
Background:
- Fish allergy can present with severe, life-threatening reactions, including anaphylaxis.
- Even fish odors and cooking vapors can trigger allergic responses in highly sensitive individuals.
- Standard management typically involves strict dietary avoidance of fish.
Observation:
- A 39-month-old girl experienced recurrent episodes of severe allergic reactions, including Quincke edema, wheezing, cyanosis, and urticaria, following codfish consumption or inhalation.
- Skin prick tests confirmed IgE-mediated sensitivity to codfish.
- The severity of reactions necessitated exploring alternative treatment beyond avoidance.
Findings:
- Rapid, high-dose (RUSH) immunotherapy using codfish extract was administered, following a protocol adapted from insect venom allergy treatment.
- The immunotherapy involved serial subcutaneous injections, with dose adjustments based on observed local reactions to achieve tolerance.
- Following RUSH therapy, the child tolerated exposure to codfish odors and accidental small ingestions without any allergic manifestations.
Implications:
- RUSH immunotherapy can be a viable and effective treatment option for severe, life-threatening fish allergies, particularly in pediatric cases.
- This approach offers an alternative to lifelong avoidance for select patients with severe fish allergies.
- Further research into RUSH immunotherapy protocols for various food allergies is warranted to establish safety and efficacy.