People with food allergies should be careful about the meals and drinks they consume. However, a case report published today shows that some allergic attacks can be triggered by unexpected sources.
Annabelle Rowland, a physician in Atlanta, Georgia, detailed a case of anaphylaxis in a 15-year-old boy caused by an energy drink. The boy suffered from an unknown allergy to fish collagen, an ingredient in the drink. Fortunately, he made a full recovery, but the incident illustrates the complexity of a fish allergy, Rowland said.
“This case demonstrates nuances of fish allergy that are important to consider as fish collagen is included in an increasing number of products,” Rowland wrote in her case report, presented today at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting.
A fish affair
According to the report, the teen had a history of eczema, asthma, hay fever and a rare immune-related lung disease called idiopathic pulmonary hemosiderosis.
He had never tried this energy drink before. Within minutes, he began experiencing hives all over his body, wheezing and difficulty breathing, signs of a serious, life-threatening allergic reaction or anaphylaxis. He received emergency care at an allergy clinic, which included two injections of epinephrine and other anti-allergy medications, and his symptoms subsided.
Afterwards, Rowland tried to understand the cause of the attack. The patient felt normal before the episode and denied exercising or using NSAIDs (nonsteroidal anti-inflammatory drugs) that day, both of which are potential, although rare, triggers for anaphylaxis. The energy drink was therefore the most likely cause. He reported past episodes of itchy throat and mild swelling of the lips after eating canned tuna. And a review of the drink’s ingredients revealed the presence of fish collagen derived from cod (per five grams).
The boy’s fish allergy was even stranger than expected, however. For starters, he has already been able to eat salmon without any problems. And when Rowland performed a skin test for tuna, cod and flounder on the boy, it came back negative. The patient’s family has been asked to bring fresh cod for further testing, but for now the working hypothesis is that the boy is specifically allergic to the collagen protein found in cod and possibly other fish.
“This case shows how tricky fish allergy can be,” Rowland, an ACAAI member and physician at Emory University School of Medicine, said in an ACAAI news release.
About 95% of fish allergy cases are caused by an entirely different protein called parvalbumin. As rare as a fish collagen allergy may be, it’s something that’s becoming increasingly difficult for those who suffer from it to avoid, Rowland said. And doctors must be careful not to miss such cases.
“Fish collagen is showing up in an increasing number of products, from drinks to supplements. Standard fish allergy tests primarily look for a different fish protein and contain very little collagen, so a person can test negative and still react,” she said.
Gn Health
