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Role of Recombinant Parvalbumin Gad c 1 in the Diagnosis and Prognosis of Fish Allergy

Carvalho S1, Marcelino J1, Cabral Duarte MF1, Costa C1, Barbosa MA1, Pereira Dos Santos MC2

1Imunoallergology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital Santa Maria, Lisbon, Portugal
2Clinical Immunology Unit – Instituto de Medicina Molecular, Faculdade de Medicina – Universidade de Lisboa, Lisbon, Portugal

J Investig Allergol Clin Immunol 2020; Vol 30(5) : 340-345
doi: 10.18176/jiaci.0437

Background: The prevalence of fish allergy has increased in recent years. The parvalbumin Gad c 1 is a major cod allergen that is used as a follow-up marker in patients with fish allergy.
Objectives: To determine the clinical and laboratory characteristics of a population of patients with fish allergy. To analyze the role of the specific IgE (sIgE) of recombinant Gad c 1 (rGad c 1) and skin prick tests (SPTs) in confirming the acquisition of tolerance to fish.
Methods: We performed a retrospective study of patients with fish allergy from July 1, 2005 to December 31, 2016. The population was characterized according to demographic data, species of fish associated with allergic reactions, and symptoms. The SPT wheal diameter and sIgE for fish and rGad c 1 were evaluated before acquisition of tolerance (T0) and afterwards (T1).
Results: The study population comprised 81 patients (68% male). Most reactions were triggered by hake (51%), mackerel (30%), and cod (26%). The most frequent manifestations were urticaria/angioedema (72%), gastrointestinal symptoms (35%), and eczema (33%); 42% of patients experienced anaphylaxis. At T0, the average sIgE values were as follows: cod, 32.2 kUA/L; sardine, 18.4 kUA/L; hake, 17.5 kUA/L; salmon, 13.9 kUA/L; tuna, 4.5 kUA/L; and rGad c 1, 22.9 kUA/L. In patients who acquired tolerance to at least 1 fish species (n=60; 74%), the mean value of rGad c 1 at T1 (5.1 kUA/L) was significantly lower than at T0 (16.8 kUA/L) (P=.001). Significant values were also recorded for the average diameter of the SPT wheal and the evaluations at T0 and T1 for hake (9.42 mm/3.79 mm) and salmon (7.8 mm/2.8 mm) (P=.002 and P=.026, respectively).
Conclusion: The decrease in sIgE to rGad c 1 and the mean wheal diameter of SPT for hake and salmon can be used as markers of prognosis in the acquisition of tolerance by fish-allergic patients.

Key words: Food allergy, Fish allergy, Parvalbumin, Cross-reactivity, Recombinant allergen, rGad c 1