Patients Allergic to Fish Tolerate Ray Based on the Low Allergenicity of Its Parvalbumin

February 2019 Volume 7, Issue 2, Pages 500–508.e11

Tanja Kalic, MSc

, 

Francoise Morel-Codreanu, MD

, 

Christian Radauer, PhD

, 

Thimo Ruethers, MSc

, 

Aya C. Taki, PhD

, 

Ines Swoboda, PhD

, 

Christiane Hilger, PhD

, 

Karin Hoffmann-Sommergruber, PhD

, 

Markus Ollert, MD, DMSc

, 

Christine Hafner, MD

, 

Andreas L. Lopata, PhD

, 

Martine Morisset, MD, PhD

, 

Heimo Breiteneder, PhDCorrespondence information about the author PhD Heimo BreitenederEmail the author PhD Heimo Breiteneder

, 

Annette Kuehn, PhD

Open Access

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DOI: https://doi.org/10.1016/j.jaip.2018.11.011

 

Article Info

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Background

Clinical reactions to bony fish species are common in patients with allergy to fish and are 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

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

Methods

Sensitization to cod, salmon, and ray among patients allergic to cod, salmon, or both (n = 18) was explored by prick-to-prick testing. Clinical reactivity to ray was assessed in 11 patients by food challenges or clinical workup. IgE-binding to β-parvalbumins (cod, carp, salmon, barramundi, tilapia) and α-parvalbumins (ray, shark) was determined by IgE-ELISA. Basophil activation tests and skin prick tests 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 of 11 patients. Prick-to-prick test reactions to ray were 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 with β-parvalbumins (eg, ray vs cod, P < .001; n = 18). Skin prick test further demonstrated lower reactivity to α-parvalbumins compared with β-parvalbumins.

Conclusions

Most patients allergic to bony fish tolerated ray, a cartilaginous fish, because of low allergenicity of its α-parvalbumin. A careful clinical workup 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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