Background: Fish allergy is the third most common food allergy after milk and egg in parts of Europe, but there is little data about prevalence in South East Asia where it is an important part of regular diets. Objective: We aimed to obtain an estimate of the population prevalence of fish allergy among older children in the Philippines, Singapore and Thailand. Methods: The population prevalence of fish allergy in 14- to 16-year-old children in the 3 countries was evaluated using a structured written questionnaire which was distributed to students of randomly selected secondary schools. An extended questionnaire to determine convincing fish allergy on the basis of typical clinical manifestations within 2 h of ingestion was administered to those with positive responses. Results: From acohort of 25,842 students, responses were 81.1% in the Philippines (n = 11,434), 67.9% in Singapore (n = 6,498) and 80.2% (n = 2,034) in Thailand. Using criteria for convincing food allergy, fish allergy was much higher in the Philippines [2.29%, 95% confidence interval (CI) 2.02–2.56] than in Singapore (0.26%, 95% CI 0.14–0.79) and Thailand (0.29%, 95% CI 0.06–0.52). Weighted multiple logistic regression analyses showed that compared to the Philippines, prevalence rates were lower in Singapore [odds ratio (OR) 0.40, 95% CI 0.27–0.60, p < 0.0001] and Thailand (OR 0.13, 95% CI 0.05–0.33, p < 0.0001). Females were more likely to have fish allergy compared to males for all children combined (OR 1.32, 95% CI 1.11–1.58, p = 0.002). Most allergies appeared mild, as only 28% of cases sought medical consultation at the time of the reaction and 31.2% of cases reported continued exposure despite allergic symptoms. Conclusion: Fish allergy in late childhood is more common in the Philippines compared to Singapore and Thailand. Differences in food processing, dietary habits and other cultural practices might be important risk factors for the development of fish allergy in these populations.

Keywords:
Fish allergy, Food allergy, South East Asia
1.
Dominguez C, Ojeda I, Crespo JF, Pascual C, Ojeda A, Martin-Esteban M: Allergic reactions following skin contact with fish. Allergy Asthma Proc 1996;17:83–87.
2.
Taylor AV, Swanson MC, Jones RT, Vives R, Rodriguez J, Yunginger JW, Crespo JF: Detection and quantitation of raw fish aeroallergens from an open-air fish market. J Allergy Clin Immunol 2000;105:166–169.
3.
O’Neil C, Helbling AA, Lehrer SB: Allergic reactions to fish. Clin Rev Allergy 1993;11:183–200.
4.
Crespo JF, Pascual C, Burks AW, Helm RM, Esteban MM: Frequency of food allergy in a pediatric population from Spain. Pediatr Allergy Immunol 1995;6:39–43.
5.
Sicherer SH, Munoz-Furlong A, Sampson HA: Prevalence of seafood allergy in the United States determined by a random telephone survey. J Allergy Clin Immunol 2004;114:159–165.
6.
Pascual CY, Reche M, Fiandor A, Valbuena T, Cuevas T, Esteban MM: Fish allergy in childhood. Pediatr Allergy Immunol 2008;19:573–579.
7.
Leung TF, Yung E, Wong YS, Lam CW, Wong GW: Parent-reported adverse food reactions in Hong Kong Chinese pre-schoolers: epidemiology, clinical spectrum and risk factors. Pediatr Allergy Immunol 2009;20:339–346.
8.
Shek LP, Cabrera-Morales EA, Soh SE, Gerez I, Ng PZ, Yi FC, Ma S, Lee BW: A population-based questionnaire survey on the prevalence of peanut, tree nut, and shellfish allergy in 2 Asian populations. J Allergy Clin Immunol 2010;126:324–331.
9.
Sicherer SH, Munoz-Furlong A, Sampson HA: Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol 2003;112:1203–1207.
10.
Food and Agriculture Organization of the United Nations Corporate Document Repository: The State of World Fisheries and Agriculture (SOFIA) 2002. Available at http://www.Fao.Org/sof/sofia/index_en.Htm (accessed May 2011).
11.
Lim DL, Neo KH, Yi FC, Chua KY, Goh DL, Shek LP, Giam YC, Van Bever HP, Lee BW: Parvalbumin – the major tropical fish allergen. Pediatr Allergy Immunol 2008;19:399–407.
12.
Stratta P, Badino G: Scombroid poisoning. CMAJ 2012;184:674.
13.
Hungerford JM: Scombroid poisoning: a review. Toxicon 2010;56:231–243.
14.
Goh DL, Lau YN, Chew FT, Shek LP, Lee BW: Pattern of food-induced anaphylaxis in children of an Asian community. Allergy 1999;54:84–86.
15.
Kull I, Bergstrom A, Lilja G, Pershagen G, Wickman M: Fish consumption during the first year of life and development of allergic diseases during childhood. Allergy 2006;61:1009–1015.
16.
Peat JK, Salome CM, Woolcock AJ: Factors associated with bronchial hyperresponsiveness in Australian adults and children. Eur Respir J 1992;5:921–929.
17.
Chua KL, Soh SE, Ma S, Lee BW: Pediatric asthma mortality and hospitalization trends across Asia Pacific. WAO J 2009:77–82.
18.
Pascual C, Martin Esteban M, Crespo JF: Fish allergy: evaluation of the importance of cross-reactivity. J Pediatr 1992;121:S29–S34.
19.
de Martino M, Peruzzi M, de Luca M, Amato AG, Galli L, Lega L, Azzari C, Vierucci A: Fish allergy in children. Ann Allergy 1993;71:159–165.
20.
Ashworth A, Feachem RG: Interventions for the control of diarrhoeal diseases among young children: weaning education. Bull World Health Organ 1985;63:1115–1127.
21.
Ocampo MB, Kyoshi M: A comparative study of the nutritional beliefs and practices of mothers in Japan and the Philippines. Annu Rep Educ Sci 1994;62:37–82.
22.
Nafstad P, Nystad W, Magnus P, Jaakkola JJ: Asthma and allergic rhinitis at 4 years of age in relation to fish consumption in infancy. J Asthma 2003;40:343–348.
23.
Mondoulet L, Paty E, Drumare MF, Ah-Leung S, Scheinmann P, Willemot RM, Wal JM, Bernard H: Influence of thermal processing on the allergenicity of peanut proteins. J Agric Food Chem 2005;53:4547–4553.
24.
Chiang WC, Kidon MI, Liew WK, Goh A, Tang JP, Chay OM: The changing face of food hypersensitivity in an Asian community. Clin Exp Allergy 2007;37:1055–1061.
25.
Van Do T, Elsayed S, Florvaag E, Hordvik I, Endresen C: Allergy to fish parvalbumins: studies on the cross-reactivity of allergens from 9 commonly consumed fish. J Allergy Clin Immunol 2005;116:1314–1320.
26.
Ben-Shoshan M, Harrington DW, Soller L, Fragapane J, Joseph L, St Pierre Y, Godefroy SB, Elliott SJ, Clarke AE: A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada. J Allergy Clin Immunol 2010;125:1327–1335.
27.
Osterballe M, Hansen TK, Mortz CG, Host A, Bindslev-Jensen C: The prevalence of food hypersensitivity in an unselected population of children and adults. Pediatr Allergy Immunol 2005;16:567–573.
28.
Rance F, Grandmottet X, Grandjean H: Prevalence and main characteristics of schoolchildren diagnosed with food allergies in France. Clin Exp Allergy 2005;35:167–172.
29.
Eggesbo M, Halvorsen R, Tambs K, Botten G: Prevalence of parentally perceived adverse reactions to food in young children. Pediatr Allergy Immunol 1999;10:122–132.
30.
Orhan F, Karakas T, Cakir M, Aksoy A, Baki A, Gedik Y: Prevalence of immunoglobulin E-mediated food allergy in 6- to 9-year-old urban schoolchildren in the eastern Black Sea region of Turkey. Clin Exp Allergy 2009;39:1027–1035.
31.
Chen J, Hu Y, Allen KJ, Ho MH, Li H: The prevalence of food allergy in infants in Chongqing, China. Pediatr Allergy Immunol 2011;22:356–360.
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2012
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