Philippe Cuvelier

Life-threatening fish allergy successfully treated with immunotherapy.

Manifestations of fish allergy can include near‐fatal anaphylactic reaction. In very sensitive patients, fish odors and cooking vapors may have some al‐lergenic activity. We reported a case of life‐threatening fish allergy in a girl of 39 months referred for three episodes of Quincke edema with wheezing, cyanosis and severe urticaria after fish consumption or inhalation. Reagins were found against codfish and direct skin prick test with fresh food (cod fish) showed important local reaction. Strict avoidance of fish in the diet is usually the only recommended procedure. However, in this particular case, the life‐threatening nature of the allergic reaction was the major considera tion to perform a desensitization. The child was treated by RUSH immuno therapy using codfish extracts from BENCARD company, following the schedule for insect venom allergy described by Pharmacia. Immunotherapy was performed immediately after determination of the threshold of sensi tivity by specific skin prick tests and intra‐dermal injections. Desensitiza tion was initiated with a 1/10 dilution of the cut‐off solution and 5 subcuta neous injections were administered daily. When important local reactions were observed, additional doses were necessary to obtain tolerance. After the RUSH therapy, the child was submitted to uncooked codfish odors without any reaction. No reaction has been observed even when the child has accidentally eaten a little piece of codfish.