Allergy Assessment
Skin prick tests were performed using fish mix (containing cod, halibut and flounder) and salmon extracts (ALK-Abelló) according to the manufacturer’s instructions with histamine and normal saline as controls. A prototype ImmunoCAP Grass carp test for research use only was developed as described previously 14 and specific IgE (sIgE) levels against nine fish extract ImmunoCAP tests (f3 cod, f40 tuna, f41 salmon, f205 herring, f303 halibut, f369 catfish, f410 grouper, f414 tilapia and grass carp), as well as fish parvalbumins (f355 rCyp c 1 and f426 rGad c 1) were measured on a Phadia 200 system. DBPCFCs with grass carp and salmon were performed in selected subjects as previously described, while a subgroup of patients (n = 9) also underwent open-labeled food challenges with grouper. The severity of allergic symptoms to fish was calculated based on the Ordinal Food Allergy Severity Score (oFASS)15 . Briefly, grade 1 includes reactions restricted to oral cavity. Grades 2 to 5 may include oral symptoms but with other target organs affected, by which grades 2 and 3 reactions involve skin, eye/nose and/or digestive system. Reactions involving the larynx and/or bronchi are considered grade 4 reactions while grade 5 reactions would involve the cardiovascular and/or nervous systems.