Kalic, Tanja, Morel-Codreanu, Francoise, Radauer, Christian, Ruethers, Thimo, Taki, Aya C., Swoboda, Ines, Higer, Christiane, Hoffmann-Sommergruber, Karin, Ollert, Markus, Hafner, Christine, Lopata, Andreas L., Morisset, Martine, Breiteneder, Heimo, and Kuehn, Annette (2019) Patients allergic to fish tolerate ray based on the low allergenicity of its parvalbumin. Journal Of Allergy And Clinical Immunology: In Practice, 7 (2). pp. 500-508.

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Abstract

Background: Clinical reactions to bony fish species are common in patients with allergy to fish and are caused by parvalbumins of the beta-lineage. Cartilaginous fish such as rays and sharks contain mainly alpha-parvalbumins and their allergenicity is not well understood.

Objective: To investigate the allergenicity of cartilaginous fish and their alpha-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. IgEbinding to beta-parvalbumins (cod, carp, salmon, barramundi, tilapia) and alpha-parvalbumins (ray, shark) was determined by IgE-ELISA. Basophil activation tests and skin prick tests were performed with beta-parvalbumins from cod, carp, and salmon and alpha-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 alpha-parvalbumins was lower (median, 0.1 kU/L for ray and shark) than to beta-parvalbumins (median,.1.65 kU/L). Furthermore, alpha-parvalbumins demonstrated a significantly reduced basophil activation capacity compared with alpha-parvalbumins (eg, ray vs cod, P <.001; n = 18). Skin prick test further demonstrated lower reactivity to alpha-parvalbumins compared with beta-parvalbumins.

Conclusions: Most patients allergic to bony fish tolerated ray, a cartilaginous fish, because of low allergenicity of its alpha-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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