A case of pediatric anaphylaxis caused by gummy tablets containing fish collagen

Abstract

Fish collagen is one of the major allergens involved in fish allergies; however, it has not been well-established whether fish collagen can cause anaphylaxis among individuals with fish allergies, especially children. A 9-year-old girl experienced anaphylaxis after consuming 2 fruit-flavored gummy tablets. Contacting the manufacturing company revealed that fishderived collagen was used in the gummy tablets, and an oral fish collagen challenge test confirmed that the anaphylaxis was induced by fish collagen. Immunoblot analysis showed a 120-kDa band in a sample of the fish collagen in the gummy tablets, and no reactive band of the pork gelatin was observed. Additionally, salmon collagen and other fish samples that provoked symptoms were detected as a 120-kDa band in the immunoblot analysis. The 120-kDa band was identified as fish collagen by mass spectrometry confirming that it was the causative antigen of our patient's allergy. This case study confirms that fish collagen can cause anaphylaxis in children with fish allergies. Physicians and allergic individuals need to be aware that processed foods may contain fish collagen to avoid allergic reactions.

Fish Allergy Around the World—Precise Diagnosis to Facilitate Patient Management

“…Besides in food products and supplements (marshmallows, edible films and coatings, drinks etc. ), fish collagen and its denatured form gelatin are found in various cosmetic and pharmaceutical products including wound dressings and dental applications (78)(79)(80). Inclusion of this allergen in detection kits is therefore urgently required for increased patient safety.…”

Fish collagen as a potential indicator of severe allergic reactions among patients with fish allergies

“…8 In the past decade, a few cases of fish collageninduced allergy have been reported in the literature. [3][4][5] Notably, all patients in the case reports experienced severe symptoms after intake of fish collagen and/or heated fish. Recently, the clinical relevance of fish collagen was investigated in a large patient population (n = 101).…”

“…Specific IgE to fish gelatin was measured in the two published case reports, and one of two patients tested positive. 3,4 A limitation of this study is that fish collagen sensitivity has been tested using a limited number of fish species, and the cross-reactivity remains unclear. There is an urgent need for more comprehensive studies with a greater number of patients, various fish species against which reactivity is observed, collagen preparation from various fishes and other fish allergic components, such as enolase, aldolase and glyceraldehyde 3-phosphate dehydrogenase.…”

“…β-parvalbumin and collagen, which are both well-known fish allergens, are cross-reactive allergens present in various species of fish (reviewed in Kuehn 1 ). 2 A few recent case studies reported that fish collagen induced severe allergies [3][4][5] ; however, no significant relationship was evident between the severity of the symptoms and the collagen-specific IgE reactivity. In this study, we investigated, for the first time, the relationship between the severity of the symptoms and sensitization to fish collagen in Japanese patients with fish allergy.…”

Effect of Processing on Fish Protein Antigenicity and Allergenicity

“…Some researchers have recently pointed out the urgency and necessity of further characterizing other fish allergens. For example, the first case of anaphylaxis due to the ingestion of gummy candy containing fish collagen was reported [ 132 , 133 ]. Kalic et al [ 26 ] further proposed the relevance of investigating fish collagen.…”