Fish-allergic patients tolerate ray based on the low allergenicity of its parvalbumin

Publication date: Available online 22 November 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Tanja Kalic, Francoise Morel-Codreanu, Christian Radauer, Thimo Ruethers, Aya C. Taki, Ines Swoboda, Christiane Hilger, Karin Hoffmann-Sommergruber, Markus Ollert, Christine Hafner, Andreas L. Lopata, Martine Morisset, Heimo Breiteneder, Annette Kuehn

Abstract

Background

Clinical reactions to bony fish species are common in fish-allergic patients and caused by parvalbumins of the β-lineage. Cartilaginous fish such as rays and sharks contain mainly α-parvalbumins and their allergenicity is not well understood.

Objective

We investigated the allergenicity of cartilaginous fish and their α-parvalbumins in individuals allergic to bony fish.

Methods

Sensitization to cod, salmon and ray among cod- and/or salmon-allergic patients (n=18) was explored by prick-to-prick testing (PPT). Clinical reactivity to ray was assessed in 11 patients by food challenges or clinical work-up. IgE-binding to β-parvalbumins (cod, carp, salmon, barramundi, tilapia) and α-parvalbumins (ray, shark) was determined by IgE-ELISA. Basophil activation tests (BAT) and skin prick tests (SPT) were performed with β-parvalbumins from cod, carp and salmon, and α-parvalbumins from ray and shark.

Results

Tolerance of ray was observed in 10/11 patients. PPT to ray was markedly lower than to bony fish (median wheal diameter 2 mm with ray vs. 11 mm with cod and salmon). IgE to α-parvalbumins was lower (median 0.1 kU/L for ray and shark) than to β-parvalbumins (median ≥1.65 kU/L). Furthermore, α-parvalbumins demonstrated a significantly reduced basophil activation capacity compared to β-parvalbumins (e.g. ray vs. cod, p<0.001, n=18). SPT further demonstrated lower reactivity to α- compared to β-parvalbumins.

Conclusion

Most bony fish-allergic patients tolerated ray, a cartilaginous fish, due to low allergenicity of its α-parvalbumin. A careful clinical work-up and in vitro IgE-testing for cartilaginous fish will improve patient management and may introduce an alternative to bony fish into patients' diet.

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