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Allergic responses to a variety of seafood have been described, including fish.1–6 We report the evaluation of a 31-year-old worker who developed occupational asthma following exposure to sole fish (Yellowfin sole). She had been working in a restaurant's kitchen, cooking different types of products including fish, most often sole.
In the last 3 years, this worker had developed erythema and pruritus of the hands and forearms while she was manipulating fishes such as sole. In the month before being assessed at our Centre, she had increasing symptoms of dyspnoea, chest tightness and wheezing when she was exposed to cooking fumes from sole fish. She also reported symptoms suggestive of localised angioedema developing when she was eating fish. She had no nocturnal respiratory symptoms. She had used inhaler salbutamol on a PRN basis, taken usually up to twice a day most of the days, montelukast 10 mg daily, nasal saline and she also had been given injectable epinephrine on demand, although she never used it. She had smoked about 10 cigarettes per day since the age of 18.
Allergen skin prick tests were positive to animals, house dust mites and pollens, in addition to sole fish extract. Physical examination was normal, as were screening blood tests and chest radiograph. She had mild-to-moderate airway obstruction, with a forced expiratory volume in 1 s over forced vital capacity (FEV1/FVC) of 1.89 L/3.33 L (67 and 95% of predicted value, FEV1/FVC ratio: 57). After bronchodilator, her FEV1 increased to 2.71 L (43% increase). Total lung capacity was 6.15 L (122% predicted) and total lung diffusion capacity was normal. Non-allergic airway responsiveness was moderately increased with a provocative concentration of methacholine causing a 20% fall in FEV1 of 20% (PC20) of 0.67 mg/mL.
She had a specific bronchoprovocation test with sole fish extract (figure 1). The control day showed no changes in her baseline expiratory flows but when she was exposed to fish extract at a 1/126 dilution for 30 s, she developed a cough, chest tightness and dyspnoea, associated with a 30% fall in FEV1 compared to baseline, with a slow recovery over a period of 2 h. No late response was observed. The day after challenge, FEV1 was 1.95 L (68%) and PC20 methacholine was 0.38 mg/mL. Induced sputum eosinophil count was 3% of 10.8×106 cells/g. No increase in induced sputum eosinophils was noted after the challenge.
We report a case of occupational asthma to sole fish in a restaurant worker. Most previous cases were described in fish processing workers.2 Jeebhay et al2 previously reported that allergic sensitisation to fish was present in 7% of workers while 2.6% had occupational allergic rhinoconjunctivitis and 1.8% had occupational asthma due to fish. The patient described in this case report was both atopic and smoking; two reported risk factors associated with sensitisation to fish.
In conclusion, although fish sensitisation is often suspected in the fish processing industry, it may affect restaurant workers.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.
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