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Increased Ratio of Pollock Roe-Specific Ige to Salmon Roe-Specific

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Increased Ratio of Pollock Roe-Specific Ige to Salmon Roe-Specific Allergology International 67 (2018) 364e370 Contents lists available at ScienceDirect Allergology International journal homepage: http://www.elsevier.com/locate/alit Original Article Increased ratio of pollock roe-specific IgE to salmon roe-specific IgE levels is associated with a positive reaction to cooked pollock roe oral food challenge Eishi Makita a, Noriyuki Yanagida a, Sakura Sato b, Tomoyuki Asaumi a, * Motohiro Ebisawa b, a Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan b Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan article info abstract Article history: Background: Anaphylaxis and immediate-type fish roe allergies have been reported worldwide, and, Received 6 August 2017 in Japan, fish roe is the sixth most common food allergen. No oral food challenges (OFCs) have used Received in revised form pollock roe (PR), which is reported to have high cross-reactivity with salmon roe (SR). Therefore, we 23 October 2017 administered an OFC using cooked PR to evaluate PR- and SR-specific immunoglobulin E (IgE) levels and Accepted 30 October 2017 allergic reactions in patients with PR sensitivity. Available online 11 December 2017 Methods: This retrospective study evaluating patient characteristics and responses to OFCs was conducted with 10e20 g of cooked PR, between April 2006 and November 2016. Keywords: Fish roe Results: We assessed 51 patients (median age: 6.8 years). All had PR sensitization, 6 (12%) with a fi Food allergy history of immediate reactions to PR, and 18 (35%) of immediate reactions to SR. Median PR-speci c and Food challenge SR-specific IgE values were 3.4 kUA/L and 9.9 kUA/L, respectively. Seven patients (14%) had a positive IgE OFC. There was no anaphylaxis. Induced symptoms were mild and included localized urticaria, throat Pollock roe pruritus, intermittent cough, and mild abdominal pain. We treated one patient with mild abdominal pain with oral antihistamines. There were no significant differences in history of immediate reaction to Abbreviations: PR and PR-specific IgE titers between OFC-positive and OFC-negative patients, although significant AUC, Area under the curve; CIs, confidence differences were found for PR-specific IgE titers adjusted for SR-specific IgE (p ¼ 0.025) and PR-specific intervals; EAACI, European Academy of IgE/SR-specific IgE ratio (p ¼ 0.009). Allergy and Clinical Immunology; Conclusions: Increased PR-specific IgE/SR-specific IgE ratio or PR-specific IgE levels adjusted for IgE, Immunoglobulin E; OFC, Oral food SR-specific IgE levels were risk factors for OFC positivity. challenge; PR, Pollock roe; ROC Copyright © 2017, Japanese Society of Allergology. Production and hosting by Elsevier B.V. This is an open access curves, Receiver operating characteristic curves; SR, Salmon roe article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Introduction which are frequent components of Japanese food. In Sweden, processed roe of Pacific cod, which belongs to the same family as In Japan, fish roe is the sixth most common food allergen.1 pollock, is commonly served.2 Moreover, among new-onset immediate-type food allergies, Cases of immediate-type allergy and anaphylaxis in reaction to e fish roe is the most common food allergen of 2- to 3-year-old caviar and SR have been reported worldwide.3 5 In Japan, the children.1 majority of allergic reactions to fish roe are to SR, and there has Fish roe used in cooking includes caviar, herring roe, salmon been one report of an SR oral food challenge (OFC).6 However, roe (SR), pollock roe (PR), and flying fish roe. In Japan, SR is often there have been no reports of cross-reactivity between PR and SR ingested in the form of sushi rolls. PR is a popular food in Japan on an OFC.7 and Korea, and is often an ingredient in rice balls and pasta sauces, PR is often served cooked in school meals and in meals eaten out in Japan; therefore, if children with suspected PR allergy could eat cooked PR, their quality of life would improve. Thus, the aim of * Corresponding author. Department of Allergy, Clinical Research Center for our study was to evaluate the safety of an OFC with cooked PR and Allergology and Rheumatology, Sagamihara National Hospital, 18-1, Sakuradai to evaluate the risk factors for OFC positivity. Minami-ku, Sagamihara, Kanagawa 252-0392, Japan. E-mail address: [email protected] (M. Ebisawa). Peer review under responsibility of Japanese Society of Allergology. https://doi.org/10.1016/j.alit.2017.11.005 1323-8930/Copyright © 2017, Japanese Society of Allergology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/). E. Makita et al. / Allergology International 67 (2018) 364e370 365 Methods Receiver operating characteristic (ROC) curves were generated for PR-specific IgE levels and PR-specific IgE/SR-specific IgE ratios. Subjects Performance of the model was assessed using the area under the curve (AUC). Specificity and sensitivity were calculated for each We retrospectively evaluated PR-sensitized patients who had cut-off value. We analyzed the relationship between OFC results undergone an OFC with 10e20 g of cooked PR to diagnose a PR and PR or SR-specific IgE levels using logistic regression. allergy or confirm their tolerance, between April 2006 and Probability curves and 95% confidence intervals (CIs) were November 2016. Sensitization to PR was defined as PR-specific estimated from PR-specific IgE values and PR-specific IgE/SR- immunoglobulin E (IgE) > 0.35 (kUA/L) observed within one year specific IgE ratios using logistic regression according to the prior to the OFC. methods used by Soderstro et al.11 and Grabenhenrich et al.12 All data were statistically analyzed using SPSS version 24 (IBM, Methods Armonk, NY, USA). The total amount of challenge food was 10e20 g of cooked Ethical considerations PR (protein: 2830e5660 mg), which was cooked either at the Sagamihara National Hospital or in the patients' homes. Patients In accordance with the tenets of the Declaration of Helsinki, the who had been prescribed anti-allergy drugs (e.g., antihistamines) study design and the risks of symptom provocation were fully were excluded from the study because they could influence the explained to the patients and the children's guardians both verbally results of the OFC. This OFC involving PR was an open challenge, and in writing. Written informed consent was obtained from the because PR is usually eaten in a simple cooked form. We employed guardians prior to participation. The study design was approved by three different protocols in our study. For the first, the dosing the institutional review board of Sagamihara National Hospital. interval was 15 min, and five doses were administered, starting with 1/16 of the total load, followed by 1/8, 1/4, and 1/2. For the Results second protocol, the dosing interval was 30 min, and three doses were administered, starting with 1/8 of the total load, followed by Baseline subject characteristics 3/8 and 1/2. For the third protocol, the dosing interval was 60 min, and two doses were administered, starting with 1/4 of the total Sixty-five patients underwent OFCs with 10e20 g of cooked PR. load, followed by 3/4. Until March 2014, we used the first protocol The following 14 patients were excluded: 13 patients who had no in our inpatient department and the second in our outpatient sensitization and no history of immediate reaction, and 1 patient department. However, from April 2014, we used the third protocol for whom PR-specific IgE had not been measured. Therefore, we for all patients. Follow-up of patients for 3 h from the beginning of analyzed 51 patients in total (Fig. 1). the OFC. Table 1 shows patients' characteristics and immunological Positive symptoms of OFC were defined as skin symptoms parameters. The median age of all patients was 6.8 years, and 59% (urticaria, exanthema, and pruritus), oral mucosal symptoms were male. Six patients (12%) had a history of immediate reactions (pruritus of the throat or oral cavity), respiratory symptoms to PR, and 1 patient (2%) had a history of anaphylaxis to PR. Forty- (cough, wheezing, hoarseness, and dyspnea), gastrointestinal five patients (88%) were already avoiding SR due to possible cross- symptoms (emesis, diarrhea, and persistent abdominal pain), reactivity with PR, and 18 patients (35%) had a history of cardiovascular symptoms (hypotension), and neurological immediate reactions to SR. Twenty-nine patients (57%) had a symptoms (confusion), as reported by Sampson et al.8 The severity history of immediate reactions to hens' egg whites. Complications of symptoms was evaluated using the Japanese anaphylaxis from other allergic diseases included atopic dermatitis (24 guidelines (Supplementary Table 1).9 When adverse symptoms patients, 47%), bronchial asthma (9 patients, 18%), and allergic occurred, treatments such as antihistamines, steroids, beta-2 rhinitis (6 patients, 12%). stimulant inhalation, or adrenaline injection were administered The median total IgE value was 1460 kIU/L, the PR-specific IgE on the basis of the European Academy of Allergy and Clinical value was 3.4 kUA/L, the SR-specific IgE value was 9.9 kUA/L, Immunology (EAACI) food allergy and anaphylaxis guidelines.10 If the hens' egg white-specific IgE value was 11.7 kUA/L, and the the patient had no symptoms or only mild symptoms that did not codfish-specific IgE value was 0.18 kUA/L. require treatment, they were asked to consume cooked PR at home. We then judged the results of OFC based on symptoms Relationship of specific IgE values shown at home.
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