Evaluation of a severe state of fish allergy: A case report

Background: Individual variability in allergic response to specific allergens is an important factor in the clinical management of each patient approach. In this case it is relevant to present a special case of severe allergy to fish in order to expand the knowledge of health professionals through the complex allergic responses as this substract presents an important broad panel of potential allergens.

Methods: Case report of a severe state of fish allergy.

Results: Child, 3 years old, male, presenting a clinical frame of early atopic dermatitis and severe form of fish allergy. The mother reports that the child had the first symptoms very early with topic allergic recurrent seizures since 10 months old. Initially, she suspected of food allergy to fish, because of its presence in the menu of the day. However, similar episodes also occurred during a fishing trip when the child came into direct contact with animals caught by his father. At this moment the child was medicated with oral antihistamine and corticosteroids. The mother reports that the child appears to present the symptoms of the flu during all year long with intermittent cough and nasal congestion, which got worse at different times of the year, followed by lacrimation, nasal pruritus, and ocular erythema. The skin is extremely dry all year round with predominant flexural dryness. The worst crisis occurred when the child was in an environment in which roasted fish was being served, showing signs of angioedema associated with erythematous lesions of the extremities progressing to anaphylaxis that was treated in the emergency room. In the diagnostic work up, the CBC presented relative eosinophilia (10%), high levels of total IgE (64.8 kU/L) and impressive high levels of specific IgE against fish (13.40kU/L), hake (6.30kU/L), tuna (4.69 kU/L), salmon (3.41 kU/L), sardines (12.80kU/L), fish-mackerel (4.10kU/L) and trout (7.90kU/L). 

Conclusions: In the evaluation of patients presenting early atopic dermatitis and food allergy, could be important to keep in mind the concept of an allergic march, as progression and worsening of these early allergic manifestations to later respiratory allergy, especially by airborne allergens. This evaluation helped to conduct this child´s case and may help identify other similar patients more quickly on clinical practice and on adoption of preventive measures for environmental control and therapy that may help to delay allergy progression and improve quality of life for them since childhood.