Fish allergy and fish allergens: advances in component-resolved diagnosis of fish allergy

Fish is one of the main elicitors for food allergies. For a long time, the clinical picture of fish allergy was reduced to the following features. First, fish-allergic patients suffer from a high IgE cross-reactivity among fishes so that they have to avoid all species. Second, clinically relevant symptoms are linked to the presence of IgE-antibodies recognizing parvalbumin, the fish panallergen. This view was challenged by results from recent studies as follows. 1. Allergic reactions which are limited to single or several fish species (mono- or oligosensitisations) apply not only to single cases but patients with this phenotype constitute an important sub-group among fish-allergic individuals. 2. Newly identified fish allergens, enolases, aldolases, and fish gelatin, are of high relevance as the majority of the fish-allergic individuals seem to develop specific IgE against these proteins. The present review gives an overview on the clinical characteristics of fish allergy and the molecular properties of relevant fish allergens. The advancement of the IgE-based diagnosis using a panel of well-defined fish allergens from different species is in the focus of the discussion.