Identification of Potentially Tolerated Fish Species by Multiplex IgE Testing of a Multinational Fish-Allergic Patient Cohort

Tanja Kalic, Annette Kuehn, Martina Aumayr, Joan Bartra, Carsten Bindslev-Jensen, Françoise Codreanu-Morel, Olga Domínguez, Peter Forstenlechner, Wolfgang Hemmer, Sandip D. Kamath, Agnes Leung, Nicki Leung, Yuri Lifanov, Charlotte G. Mortz, Mariona Pascal, Robin Ristl, Martin Sørensen, Öykü Üzülmez, Lusine Yeghiazaryan, Gary WongChristine Hafner, Heimo Breiteneder*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)


Background: Although recent studies indicated that many fish-allergic patients may safely consume certain fish species, no clinical guidelines are available for identification of the exact species tolerated by specific patients. Objective: To investigate whether multiplex immunoglobulin E (IgE) testing reveals potentially tolerated fish through absence of IgE to parvalbumin (PV) and extracts from specific species. Methods: Sera from 263 clinically well-defined fish-allergic patients from Austria, China, Denmark, Luxembourg, Norway, and Spain were used in a research version of the ALEX2 multiplex IgE quantification assay. Specific IgE to PVs from 10 fish species (9 bony and 1 cartilaginous), and to extracts from 7 species was quantified. The IgE signatures of individual patients and patient groups were analyzed using SPSS and R. Results: Up to 38% of the patients were negative to cod PV, the most commonly used molecule in fish allergy diagnosis. Forty-five patients (17%) tested negative to PVs but positive to the respective fish extracts, underlining the requirement for extracts for accurate diagnosis. Between 60% (Spain) and 90% (Luxembourg) of the patients were negative to PV and extracts from ray, a cartilaginous fish, indicating its potential tolerance. Up to 21% of the patients were negative to at least 1 bony fish species. Of the species analyzed, negativity to mackerel emerged as the best predictive marker of negativity to additional bony fish, such as herring and swordfish. Conclusions: Parvalbumins and extracts from multiple fish species relevant for consumption should be used in fish-allergy diagnosis, which may help identify potentially tolerated species for individual patients.

Original languageEnglish
Pages (from-to)3284-3292
Number of pages9
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number12
Early online date21 Aug 2022
Publication statusPublished - Dec 2022


  • Fish allergy
  • Fish extracts
  • Fish tolerance
  • Food allergy
  • IgE
  • Multiplex allergy diagnosis
  • Parvalbumin
  • Patient management


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