IgE-mediated fish allergy in Singaporean children

Lynette Liling Tan,¹ May Ping Lee,¹ Wenyin Loh,¹ Anne Goh,¹ Si Hui Goh,¹ Kok Wee Chong¹

Affiliation:
¹ Allergy Service, Department of Pediatric Medicine, KK Women’s and Children’s Hospital, Singapore

Abstract

Background: Fish is one of the common causes of food allergy and there is limited literature about fish allergy in Singapore.
Objective: We aimed to describe the demographics, clinical features, and natural history of children with IgE-mediated fish allergy.
Methods: A retrospective review was conducted for children diagnosed with fish allergy in a tertiary pediatric hospital in Singapore between 2015 and 2020.
Results: The diagnosis of fish allergy was made in 108 patients based on a convincing history of IgE-mediated allergic reaction and a positive skin prick test. The median age at first reaction was 12 months (range 6-168) with most reacting on first ingestion (62.0%). The most common fish causing reactions were threadfin (48.1%), salmon (33.3%) and cod (31.5%). Majority presented with cutaneous symptoms (97.2%). Anaphylaxis occurred in 6.5%. Five were mono-sensitized (4.6%), 77 were oligo-sensitized (71.3%) and 26 were polysensitized (24.1%). Most can tolerate another species of fish (75.9%), most commonly salmon (37.0%), tuna (24.1%) and cod (22.2%). Median duration of follow up was 24 months (range 0-176). Twenty-eight out of 108 children (25.9%) acquired natural tolerance to index fish at a median age of 60 months (range 18-159).
Conclusion: Most children with fish allergy can tolerate at least one other species of fish and resolution of fish allergy is possible. Thus, it is important to follow-up with an allergist to evaluate which fish species can be included in their diet to avoid unnecessary dietary restrictions.
Key words: fish allergy, IgE-mediated food allergy, anaphylaxis, natural history, Singaporean children