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Gummy shark is tolerated by children with IgE-mediated bony fish allergy
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  • Kathryn Dawes,
  • joanne smart,
  • Thimo Ruethers,
  • Andreas Lopata,
  • Paulina Alhucema,
  • Dianne Campbell E,
  • John Ainsworth,
  • Bridget Simpson,
  • Samara Baldwin,
  • Gabby Mahoney,
  • JoJo Baumgratner,
  • Sam Mehr
Kathryn Dawes
Epworth Richmond
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joanne smart
Epworth Richmond
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Thimo Ruethers
James Cook University - Singapore Campus
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Andreas Lopata
James Cook University - Singapore Campus
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Paulina Alhucema
Epworth Richmond
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Dianne Campbell E
Centre for Food and Allergy Research
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John Ainsworth
Epworth Richmond
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Bridget Simpson
The Royal Children's Hospital Melbourne Department of Allergy & Immunology
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Samara Baldwin
Perth Children's Hospital
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Gabby Mahoney
Epworth Richmond
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JoJo Baumgratner
Epworth Richmond
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Sam Mehr
Epworth Richmond

Corresponding Author:[email protected]

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Abstract

Background: Fish is a leading trigger of food anaphylaxis. Co-sensitisation to various bony fish species is common due to similar beta-parvalbumin allergens, leading many fish-allergic individuals avoiding all types of fish. Cartilaginous fish, like sharks and rays, predominantly contain alpha-parvalbumin as the major allergen. This unique allergen profile suggests that cartilaginous fish could be a safe alternative for bony fish allergic individuals. We aimed to determine the rate of oral tolerance to gummy shark ( Mustelus antarcticus) among children with IgE-mediated bony fish allergy and evaluate the predictive value of raw gummy shark skin prick testing (SPT). Methods: Children aged 1-18 years with an IgE-mediated bony fish allergic reaction within the past 3 years underwent medical evaluation and SPTs to cartilaginous and bony fish species. All participants underwent an open challenge with 100g cooked gummy shark. Follow-up at 2 weeks and 6 months assessed ongoing tolerance and dietary incorporation. Results: All 21 children with bony fish allergy tolerated gummy shark during the challenge, despite seven (33%) children having a positive SPT (>3mm) to gummy shark (median 5mm). Six months post-challenge, 7 out of the 21 children (33%) did not incorporate gummy shark in their diet, citing taste aversion and difficulties finding a reliable source. There was one reported reaction in the community to gummy shark following the OFC. Conclusion: Bony-fish allergic children demonstrated tolerance to gummy shark. SPT to gummy shark showed limited predictive value in this cohort. Gummy shark may be a safe alternative in children with bony fish allergy.