ALLERGIC REACTIONS ASSOCIATED WITH AIRBORNE FISH PARTICLES IN IGE-MEDIATED FISH HYPERSENSITIVE PATIENTS

We evaluated the clinical characteristics found in 21 children who sho wed allergic reactions upon incidental inhalation of fish odors or fum es, from 197 diagnosed with IgE-mediated fsh hypersensitivity. Allergi c reactions to fish via ingestion began in most patients (86%) within the first 24 months of life. The vast majority (19/21) of patients sho wed cutaneous symptoms, either alone or, less frequently, associated w ith other clinical manifestations. Hake and flounder were the species of fish most frequently implicated in eliciting clinical manifestation s upon ingestion. After diagnosis, all these patients were placed on a strict fish-avoidance diet. During this period of avoidance, patients reported allergic reactions (mean age 7 years) after incidental expos ure to airborne fish odors or fumes, Clinical manifestations through i nhalation were respiratory (mainly wheezing) in 12 patients and cutane ous (mainly urticaria) in nine patients. Nineteen of 21 patients repor ted three or more episodes upon exposure to fish aerosols; in most cas es, these episodes occurred at home when other people were eating fsh, In conclusion, incidental inhalation of fish odors or fumes could pla y an important role in accidental and unknown encounters with fish in children on fish-avoidance diets for fish IgE-mediated hypersensitivit y. Such exposures could elicit clinical symptoms and could have some e ffect in delaying the development of tolerance.