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

Tanja Kalic, Francoise Morel-Codreanu, Christian Radauer, Thimo Ruethers, Aya C. Taki, Ines Swoboda, Christiane Hilger, Karin Hoffmann-Sommergruber, Markus Ollert, Christine Hafner, Andreas L. Lopata, Martine Morisset, Heimo Breiteneder*, Annette Kuehn

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

38 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)500-508.e11
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number2
Publication statusPublished - Feb 2019


  • Basophil activation
  • Cod
  • Fish allergy
  • Food challenge
  • IgE
  • Parvalbumin
  • Ray
  • Skin prick test


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