LIFE-THREATENING FISH ALLERGY SUCCESSFULLY TREATED WITH IMMUNOTHERAPY

Manifestations of fish allergy can include near-fatal anaphylactic rea ction. In very sensitive patients, fish odors and cooking vapors may h ave some allergenic activity. We reported a case of life-threatening f ish allergy in a girl of 39 months referred for three episodes of Quin cke edema with wheezing, cyanosis and severe urticaria after fish cons umption or inhalation. Reagins were found against codfish and direct s kin prick test with fresh food (codfish) showed important local reacti on. Strict avoidance of fish in the diet is usually the only recommend ed procedure. However, in this particular case, the life-threatening n ature of the allergic reaction was the major consideration to perform a desensitization. The child was treated by RUSH immunotherapy using c odfish extracts from BENCARD company, following the schedule for insec t venom allergy described by Pharmacia. Immunotherapy was performed im mediately after determination of the threshold of sensitivity by speci fic skin prick tests and intra-dermal injections. Desensitization was initiated with a 1/10 dilution of the cut-off solution and 5 subcutane ous injections were administered daily. When important local reactions were observed, additional doses were necessary to obtain tolerance. A fter the RUSH therapy, the child was submitted to uncooked codfish odo rs without any reaction. No reaction has been observed even when the c hild has accidentally eaten a little piece of codfish.