Anaphylactic reaction to manioc: cross‐reactivity to latex

shellfish and anisakis. Prick-by-prick test showed positive reaction to raw angler fish, and negative to cooked angler fish. The handling tests were negative to cooked angler fish, and positive to raw angler fish with immediate development of urticaria in areas of contact. Total serum IgE was 216 kU/L. Fish extracts (angler fish and hake) were extracted in phosphate buffered saline (PBS) by mixing 109 of extract in 100 ml of PBS. Raw angler fish and hake were extracted at 4°C, and cooked angler fish at 80°C. After it had been stirred for 90 min, the solution was centrifuged and then passed through a Millipore filter (0.22 ,.un),withafinaldilutionofl/IO w/v. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis of fish extracts and IgE immunoblotting with the patient's serum were performed. IgE immunoblotting (Fig. I) showed specific recognition of several bands by the patient's IgE. In raw angler fish, and faintly in hake, bands between 37 and 50 kDa were observed. No bands were seen in cooked angler fish. In the majority of allergic reactions to fish the responsible allergens are low molecular weight heat-resistant proteins that belong to the parvalbumins (1-3), and the reactions occur after fish ingestion. It has been reported that fish antigens of > 40 kDa molecular weight are more heat-sensitive (4, 5), and are probably responsible for isolated contact urticaria without allergic symptoms after oral intake (6). These allergens are not well characterized. In conclusion, this patient has contact urticaria for isolated allergy to angler fish, with a good tolerance to its ingestion. This study demonstrates a type-I hypersensitivity to heat-sensitive angler fish allergens.