Q:

10/16/2012
We have a 60 yr. old Caucasian lady w/ hx. of throat, eyes and face swellings, an hour after eating ''halibut'' in 1975, for which she had to go the ER. Second time, she had red and puffy eyes and ''itchy feeling in the chest'', after having a fish soup, 1985. But an ER trip was ruled out by her PMD. She denies prior hx. of clear asthma and her ImmunoCAP for sea food panel of cod, blue mussel, shrimp, and tuna were all <0.35kU/L in 10/2011.

Her intra-dermal skin tests to shrimp and scallop were ''strongly positive, > histamine in 12/2011. A few months later, another of her ImmunoCAP for crab, shrimp, tuna and salmon were all <.10kU/L. Could she have outgrown sea food allergy? Am I right in advising her to continue avoidance of sea foods and other fish?

A:

Thank you for your inquiry.

Unfortunately, the gold standard to determine whether or not a patient can eat a food is an oral challenge. The information that you supplied is insufficient alone to make a definitive decision as to whether or not your patient should avoid seafood. Thus, you have two choices:

1. Decide, as you have done, for safety sake, to simply continue to have her avoid seafood.
2. Perform an oral challenge to selected seafood that she might wish to eat, and is upset about eliminating from her diet.

The decision to perform an oral challenge is always one based upon the patient’s desire to eat the food, the potential necessity of the food in the diet, and the potential risk. It can only be decided on the basis of your clinical judgment, of course influenced by a discussion with your patient.

From what you have told me, I think the risk of a reaction would be minimal, but certainly not absent. A very thoughtful and complete discussion regarding the indications for an oral challenge, and detailed instructions as to how to perform such a challenge is available in a readily accessible article which is the result of the deliberations of the American Academy of Allergy, Asthma, and Immunology Working Group on oral food challenge testing. The lead author is Anna Nowak-Wegrzyn. It can be found in the Journal of Allergy and Clinical Immunology, Volume 123, Issue 6, Pages S365-S383, June, 2009. It is a supplement to the journal.

What I would advise you to do is have the patient avoid seafood as you have presently suggested until which time you can discuss the issues involved with an oral challenge and determine, with your patient’s input, whether or not you would like to proceed with a challenge to selected individual seafood.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology