Fish Allergenicity Ladder and Parvalbumin Epitopes for Predicting
Clinical Cross-reactivity and Reintroduction
- Christine Yee Yan Wai,
- Nicki Y.H. Leung,
- Agnes Sze Yin Leung,
- Man Fung Tang,
- Asa Marknell-DeWitt,
- Jaime Rosa Duque,
- Gilbert Chua,
- Yat S. Yau,
- Wai Hung Chan,
- Po K. Ho,
- Mike Kwan YW,
- Qun U. Lee,
- Joshua S.C. Wong,
- Ivan C.S. Lam,
- James W.C.H. Cheng,
- David C.K. Luk,
- Zhongyi Liu,
- Noelle Anne Ngai,
- Oi M. Chan,
- Patrick S C Leung,
- Gary Wong,
- Ting Fan Leung
Christine Yee Yan Wai
The Chinese University of Hong Kong Department of Paediatrics
Author ProfileNicki Y.H. Leung
The Chinese University of Hong Kong Department of Paediatrics
Author ProfileAgnes Sze Yin Leung
The Chinese University of Hong Kong Department of Paediatrics
Author ProfileMan Fung Tang
The Chinese University of Hong Kong Department of Paediatrics
Author ProfileAsa Marknell-DeWitt
Thermo Fisher Scientific ImmunoDiagnostics Division
Author ProfileJaime Rosa Duque
The University of Hong Kong Department of Paediatrics and Adolescent Medicine
Author ProfileGilbert Chua
The Chinese University of Hong Kong Department of Paediatrics
Author ProfileMike Kwan YW
Princess Margaret Hospital and Yan Chai Hospital
Author ProfileQun U. Lee
Princess Margaret Hospital and Yan Chai Hospital
Author ProfileJoshua S.C. Wong
Princess Margaret Hospital and Yan Chai Hospital
Author ProfileIvan C.S. Lam
Princess Margaret Hospital and Yan Chai Hospital
Author ProfileZhongyi Liu
The Chinese University of Hong Kong Department of Paediatrics
Author ProfileNoelle Anne Ngai
The Chinese University of Hong Kong Department of Paediatrics
Author ProfileOi M. Chan
The Chinese University of Hong Kong Department of Paediatrics
Author ProfileGary Wong
The Chinese University of Hong Kong Department of Paediatrics
Author ProfileAbstract
not-yet-known
not-yet-known
not-yet-known
unknown
Background: IgE-mediated fish allergy has long been considered
an umbrella term due to the high cross-reactivity of parvalbumin, the
major fish allergen. Yet, clinical tolerance to certain fish highlights
allergenicity differences. In this study, we sought to construct a fish
allergenicity ladder and identify fish parvalbumin epitopes to improve
the diagnosis of fish allergy. Methods: Reported clinical
history and the serum-specific IgE (sIgE) responses of 200 fish allergic
patients were collected and analyzed, while the relative parvalbumin
content in different fish were measured for the construction of fish
allergenicity ladder. Double-blind placebo-controlled food challenge
(DBPCFC) and open challenge against salmon, grass carp and grouper were
performed in 58 selected patients for validation of the ladder. Epitope
mapping was performed by peptide array against parvalbumins of salmon
(both β-1 and β-2), cod, grouper, and grass carp with sera from fish
allergic (n=11), partial fish tolerant (n=12), and complete fish
tolerant (n=5) patients diagnosed based on oral food challenge outcome.
Results: The distribution pattern of clinical, sIgE and
molecular data and their strong positive correlation led to the
construction of a 4-step fish allergenicity ladder comprising: step 1 of
the least allergenic fishes (tuna, halibut, salmon), steps 2 (cod) and 3
(herring and grouper) of moderately allergenic fishes to step 4 of
highly allergenic fishes (catfish, grass carp and tilapia). Epitope
mapping revealed one epitope from grouper parvalbumin (AA64-78) for
diagnosing general fish allergy and one epitopic region from salmon
parvalbumin (AA19-33) as biomarker of specific fish tolerance. Only
epitope-specific IgE differentiated these patients but not sIgE to fish
extract or parvalbumin. Conclusion: The fish ladder and
epitopes discovery can precisely differentiate fish-allergic and
tolerant subjects and guide fish reintroduction by stepping up the
ladder, which innovate fish allergy care in the next millennium.19 Aug 2024Submitted to Allergy 20 Aug 2024Submission Checks Completed
20 Aug 2024Assigned to Editor
20 Aug 2024Review(s) Completed, Editorial Evaluation Pending
23 Aug 2024Reviewer(s) Assigned
30 Sep 2024Editorial Decision: Revise Minor