魚類過敏：概述、診斷與治療

閱讀有關此食物過敏的更多信息，包括正確的診斷和管理。

... 上不同的魚類也是如此。

1對鰭魚類(例如鮪魚、鮭魚和鱈魚) 過敏的患者可能需要避免食用這整個族群的魚類， ... Areyouahealthcareprofessional? Theinformationinthiswebsiteisintendedonlyforhealthcareprofessionals.Byenteringthissite,youareconfirmingthatyouareahealthcareprofessional. EnterSite ✕ Areyoualaboratoryprofessional? Theinformationinthiswebsiteisintendedonlyforlaboratoryprofessionals.Byenteringthissite,youareconfirmingthatyouarealaboratoryprofessional. EnterSite ✕ Allergy AllergyOverview RespiratoryAllergies RespiratoryAllergiesOverview AllergicRhinitis IndoorAllergies FoodAllergies FoodAllergiesOverview Cow'sMilkAllergy EggAllergy PeanutAllergy TreeNutAllergy FishAllergy ShellfishAllergy WheatAllergy SoyAllergy AtopicDermatitis Urticaria PetAllergy VenomAllergy DrugAllergy LatexAllergy ChronicOtitisMedia Mastocytosis Asthma AutoimmuneDisease AutoimmuneDiseaseOverview AntiphospholipidSyndrome ConnectiveTissueDiseases GastrointestinalDiseases RheumatoidArthritis AutoimmuneThyroidDisease Vasculitis HowtoTest HowtoTestOverview AllergyTestingOptions AutoimmunityTestingOptions ResourceCenter AllergenEncyclopedia ContactUs Home Allergy FoodAllergies FishAllergy     FishAllergy:Overview,Diagnosis,andTreatment Symptoms Diagnosis Management PracticeParameters TestingInformation AboutFishAllergy Itisestimatedthatupto0.2percentofthegeneralpopulationisaffectedbyfishallergy.1,2Fishallergydoesoccurinchildren,butismoreprevalentinadolescentsandadults:Nearly40percentofpatientswithfishallergyfirstreactduringadulthood.3Becausefishallergyisoftennotedinadults,itisconsideredalife-longallergythatisnotusuallyoutgrown.3-5 Patientsbecomesensitizedtofishinthefollowingways:Byexposureviathegastrointestinaltractduringingestion(themajorrouteofsensitization),viatherespiratorysystembyaeroallergens(animportanttriggerofatopicdermatitis),orbyskincontact.2For8.6percentofpatientswithfishallergy,theworstreactionsweretoskincontactand/orinhalation,andsomeofthesepatientswereabletoeatfishwithoutreaction.3 Seafoodallergy,includingfish,ispotentiallysevere,andinsomecases,canevenleadtolife-threateninganaphylaxis.2,3 40%ofpatients Nearly40percentofpatientswithfishallergyfirstreactduringadulthood.3   Commonclinicalmanifestationsoffishallergyinclude:2 Oralallergysyndrome Rhinitis Abdominalpain Diarrhea Urticaria Angioedema Asthma Identifyingindividualswithfishallergyisimportant,asthesepatientsareatriskforseverereactions.2,3 Fishallergydiagnosis:Testingfordifferentialdiagnosis Acommonclinicalapproachtofishallergydiagnosisincludesaphysicalexamination,skin-pricktesting,specificIgEbloodtesting,and,inselectedcases,anoralfoodchallenge.1,2Likeallfoodallergies,diagnosingafishallergystartswithaphysicalexaminationand,ofcriticalimportance,afood-allergy-focusedpatienthistory.6,7 Thefindingsofthisfish-allergy-focusedpatienthistorycanbeusedtoguidetestingdecisionsandresultsinterpretation.  Thissystematicapproachcanhelpdeterminewhetherthereportedhistoryoffoodallergy,combinedwithlaboratorydata,issufficienttodiagnosefishallergy,orifanoralfoodchallengeshouldbeconsidered.1,8   Whoshouldbetested? Identifyingindividualswithfishallergyisimportant,asthesepatientsareatriskforseverereactions.2,3Asallergytofishisusuallylifelong,makingeffectiveandaccuratediagnosticworkupfortheallergyessentialforcliniciansandpatients.1,3-5 × Diagnosticalgorithmandclinicalmanagementforseafoodallergy Clinicalassessment: Relatedsymptomsandhistoryofadversereactions SuspectedIgE-mediatedseafoodallergy IgEtestand/orSPT Positive(+) DecisionpointforIgEtestand/orSPT IgElevelabovedecisionpoint Dietrestriction IgElevelbelowdecisionpoint OralFoodChallenge Positive(+) Dietrestriction Negative(-) Nodietrestriction     Clinicalassessment: Relatedsymptomsandhistoryofadversereactions SuspectedIgE-mediatedseafoodallergy IgEtestand/orSPT Negative(-) OralFoodChallenge Positive(+) Dietrestriction Negative(-) Nodietrestriction     Clinicalassessment: Relatedsymptomsandhistoryofadversereactions Delayedsymptoms: IntoleranceorFoodPoisoning DBPCFCandovernightobservationforsuspectedfoodpoisoning Seafoodtoxinanalysisforsuspectedpoisoning ClicktoViewAlgorithm Theevaluationforapatientwithapossiblefoodallergybeginswithathoroughhistoryandphysicalexam.IftheclinicalhistorysuggestsanIgE-mediatedfoodallergy,skin-prickorspecificIgEtestsareneededtohelpconfirmthediagnosis.AlgorithmdatafromNiggemannandBeyerandLopataetal. Fishallergyandqualityoflife Foodallergy,includingfishallergy,canhaveadramaticeffectonqualityoflife.9Manystudieshavedetailedthenegativeeffectoffoodallergyonhealth-relatedqualityoflife(HRQoL),aswellasthefinancialandemotionaltollafoodallergytakes.8Identifiedissuesincludefeelingdifferentbecauseofthediet,worryingaboutfoods,thepresenceofphysicalandemotionaldistress,increasedresponsibility,effectonsocialactivities(socialrestrictions,school,travel,anddiningout),anxiety,stress,bullying,andhavingtoconsistentlyexercisegreatercaution.8 Fishcanbefoundinprocessedfoodsinraw,powder,oroil.10FishmaybefoundinCaesarsaladdressingandinWorcestershiresauceiftheycontainanchovies.10Ithasbeenreportedthatfishallergenshiddeninotherfoodscausedreactionsin35percentofpatientswithfishallergy.11 Cross-reactivity Thediagnosisoffishallergyiscomplicatedbycross-reactivityamongfishallergens.1Clinicalcross-reactivityamongfishspeciesiscommon,eveninfishfromtaxonomicallydistinctorders.1Patientsallergictofinnedfish(e.g.,tuna,salmon,andcod)mayneedtoavoidthatentirefoodgroupbecauseofhighratesofcross-reactivity.5Allergiccross-reactivityamongfishishigh,butvariable:Patientsmayhaveclinicalmonosensitivitytoasinglefishorfishfamily,forexample,onlytoswordfish.1,5,11 TestingConfidence TestingIncreasesDiagnosticConfidence Addingdiagnostictestingtoaidinadifferentialdiagnosishasbeenshowntoincreaseconfidenceindiagnosisto90percent.i,ii Conventionally,adiagnosisofallergicorautoimmunediseasereliesonthecasehistoryandaphysicalexamination.However,addingdiagnostictestingtoaidinadifferentialdiagnosishasbeenshowntoincreaseconfidenceindiagnosis.i,ii Diagnostictestingcanalsohelptoimprovethepatient’squalityoflifeandproductivity,reducecostsassociatedwithabsenteeism,andoptimizeuseofmedication,inadditiontodecreasingunscheduledhealthcarevisits.iii,iv  i.Duran-TauleriaE,VignatiG,GuedanMJ,etal.TheutilityofspecificimmunoglobulinEmeasurementsinprimarycare.Allergy.2004;59(Suppl78):35-41. ii.NiggemannB,NilssonM,FriedrichsF.PaediatricallergydiagnosisinprimarycareisimprovedbyinvitroallergenspecificIgEtesting.PediatrAllergyImmunol.2008;19:325-331 iii.WelshN,etal.TheBenefitsofSpecificImmunoglobulinETestinginthePrimaryCareSetting.JAmPharmAssoc.2006;46:627. iv.SzeinbachSL,WilliamsB,MuntendamP,etal.Identificationofallergicdiseaseamongusersofantihistamines.JManagCarePharm.2004;10(3):234-238 Learnmoreabouttesting.   AllergyTestingOptions Getscientificinformationonmorethan550allergens. AllergenEncyclopedia Managementandcareofpatientswithfishallergy Currently,optimalmanagementofseafoodallergydoesnotexist.Themanagementoffishallergyreliesontheeliminationoffishfromthedietofthesensitizedpatientandsymptomatictreatmentofaccidentalallergicreactions.2,11Asmanifestationsoffishallergymaybelife-threateningandarefrequentlylife-long,patientswithpotentiallylife-threateningfoodallergyshouldbeprescribedanepinephrineauto-injectorandeducatedinitsuse.5 Practiceparametershavebeendevelopedtohelpguidethemanagementandtreatmentofpatientswithfoodallergies,includingfish. Practiceparametersandguidelines forfishallergy: SummaryoftheNewFoodAllergyGuidelinesforPrimaryCarePhysicians(January2012) SummaryoftheNewFoodAllergyGuidelinesforPediatricians(September2011) EuropeanAcademyofAllergyandClinicalImmunology(EAACI)FoodAllergyandAnaphylaxisGuidelines NationalInstituteforHealthandCareExcellence(NICE)foodallergyguideline Managementoffoodallergyintheschoolsetting(AAPclinicalreport,2010) GuidelinesforthediagnosisandmanagementoffoodallergyintheUnitedStates:ReportoftheNIAID-sponsoredexpertpanel(2010) Foodallergy:apracticeparameterupdate(2014) ReadPatientCaseStudies References TongWS,YuenAW,WaiCY,LeungNY,ChuKH,LeungPS.Diagnosisoffishandshellfishallergies. JAsthmaAllergy.2018;11:247–260. KuehnA, SwobodaI, ArumugamK, HilgerC, HentgesF.Fishallergensataglance:variableallergenicityofparvalbumins,themajorfishallergens.FrontImmunol. 2014Apr22;5:179 SichererSH,Muñoz-FurlongA,SampsonHA.PrevalenceofseafoodallergyintheUnitedStatesdeterminedbyarandomtelephonesurvey.JAllergyClinImmunol. 2004Jul;114(1):159-65. WoodRA:Thenaturalhistoryoffoodallergy. Pediatrics.2003,111(6Pt3):1631-1637. AbramsEM,SichererSH.Diagnosisandmanagementoffoodallergy. CMAJ.2016;188(15):1087–1093. KurowskiK,BoxerRW.Foodallergies:detectionandmanagement. AmFamPhysician. 2008;77:1678-1688.  BurksAW,TankM, Sicherer S,etal.ICON:Foodallergy. JAllergyClinImmunol.2012;129:906-920.  SichererSH, SampsonHA.Foodallergy:A reviewandupdateonepidemiology,pathogenesis,diagnosis,prevention,andmanagement.JAllergyClinImmunol. 2018Jan;141(1):41-58. Antolín‐Amérigoetal.Qualityoflifeinpatientswithfoodallergy.ClinMolAllergy.2016;14:4. SteinmanHA."Hidden"allergensinfoods.JAllergyClinImmunol. 1996Aug;98(2):241-50. PresterL.SeafoodAllergy,Toxicity,andIntolerance:AReview.JAmCollNutr. 2016;35(3):271-83.