A recent Phase 3 clinical trial has demonstrated that oral immunotherapy (OIT) can effectively desensitize a majority of children and adults with fish allergies. Published in The Lancet, the study involved 150 participants aged 6 to 45 who were randomly assigned to receive either gradually increasing doses of fish protein or a placebo over 12 months. By the end of the trial, 60% of the treatment group could safely consume at least one serving of cooked fish without severe reactions, compared to just 8% in the placebo group.
Fish allergies are among the most persistent and dangerous food allergies, with a high risk of anaphylaxis. Unlike milk or egg allergies, which children often outgrow, fish allergies tend to persist into adulthood. OIT, which involves carefully controlled exposure to the allergen to build tolerance, has shown success with other foods, but this is one of the largest and most rigorous trials focusing specifically on fish.
Participants in the treatment group started with tiny amounts of powdered cod protein, which was incrementally increased under medical supervision. Those who reached the maintenance phase—about two-thirds of the group—were able to tolerate up to 4 grams of fish protein, equivalent to a small fillet. Importantly, the therapy was not without risks: 20% of participants experienced moderate allergic reactions during the trial, though none were life-threatening.
Dr. Lars Bergström, the principal investigator, noted, “While OIT isn’t a cure, it can significantly reduce the risk of severe reactions from accidental exposure. For many patients, even being able to tolerate trace amounts of fish can dramatically improve their quality of life.”
Despite the promising results, experts caution that OIT should only be administered in specialized clinics due to the risk of adverse reactions. Additionally, long-term tolerance remains uncertain—some patients may need ongoing exposure to maintain their desensitization.
The findings have sparked optimism among allergists, who see OIT as a viable option for fish allergy management in the near future. Further studies are underway to refine dosing protocols and explore combination therapies, such as OIT paired with biologics like omalizumab, to improve safety and efficacy.
These two developments—the new diagnostic biomarker and the success of OIT—represent significant strides in understanding and managing fish allergies, offering hope for more accurate diagnosis and effective treatment in the years to come.
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