Practitioner's Corner J Investig Allergol Clin Immunol 2019; Vol. 29(2): 132-167 © 2019 Esmon Publicidad Salmon Roe as an Emerging Allergen in Western Countries Cosme J 1 , Spínola-Santos A 1 , Bartolomé B 2 , Pastor-Vargas C 3 , Branco-Ferreira M 1,4 , Pereira-Santos MC 4,5 , Pereira-Barbosa M 1,4 1 Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal 2 R&D Department, Roxall, Bilbao, Spain 3 Department of Immunology, Instituto de Investigación Sanitaria Hospital, Universitario Fundación Jiménez Díaz. (IIS-FJD, UAM), Madrid, Spain. RETIC ARADyAL, Instituto de Salud Carlos III, Spain 4 Clínica Universitária de Imunoalergologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal 5 Laboratório de Imunologia Clínica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal J Investig Allergol Clin Immunol 2019; Vol. 29(2): 139-141 doi: 10.18176/jiaci.0347 Key words: Anaphylaxis. Food allergy. Immunoblotting. Lipovitellin. Salmon roe. Palabras clave: Anafilaxia. Alergia alimentaria. Immunoblotting. Lipovitellin. Huevas de salmón. Salmon roe, which is also known as salmon caviar, red caviar, or ikura and is frequently consumed in countries such as Japan or Russia, is a delicacy commonly served in sushi- based meals [1,2]. Allergic reactions to salmon roe have been reported in Japan [3,4], and a few cases were recently described in western countries (3 cases in France [5], 2 cases in the USA [2,6]). Nevertheless, studies on the allergenicity of salmon roe are rare [7]. We report the frst case of salmon roe anaphylaxis in a young adult in Portugal. A 26-year-old man with a history of mild controlled persistent asthma and persistent, moderate- severe allergic rhinitis who was sensitized to house dust mites was admitted to our emergency department complaining of dyspnea, rhinorrhea, ocular pruritus, epigastric pain, and nausea. The symptoms began a few minutes after the ingestion of a sushi meal comprising rice, salmon, salmon roe, wasabi, soy, and ginger and were treated with intramuscular epinephrine, intravenous corticosteroids, and antihistamines. Uvular edema persisted in the emergency department. The patient denied having eaten other foods, taken any drugs (including nonsteroidal anti-infammatory drugs), being infected, or having recently exercised. Skin prick tests with commercial food extracts were negative for salmon and other fsh, shellfsh, soy, rice, total egg, egg white, egg yolk, ovalbumin, and ovomucoid. Skin prick-prick tests were positive for chum salmon (Oncorhynchus keta) roe (17×10 mm) and negative for egg (white and yolk), ginger, salmon, fying fsh roe (tobiko), sturgeon roe (caviar), and black scabbard fsh roe. Specifc IgE (sIgE) was 0.28 kU A /L 7. Bagnasco D, Ferrando M, Varricchi G, Passalacqua G, Canonica GW. A Critical Evaluation of Anti-IL-13 and Anti- IL-4 Strategies in Severe Asthma. Int Arch Allergy Immunol. 2016;170:122-31. 8. Sastre J, Dávila I. Dupilumab: A New Paradigm for the Treatment of Allergic Diseases. J Invest Allergol Clin Immunol. 2018;28:139-50. 9. Kim H, Ellis AK, Fischer D, Noseworthy M, Olivenstein R, Chapman KR, et al. Asthma biomarkers in the age of biologics. Allergy Asthma Clin Immunol. 2017;17:13-48. 10. Phillips-Angles E, Barranco P, Lluch-Bernal M, Dominguez- Ortega J, López-Carrasco V, Quirce S. Aspirin tolerance in patients with nonsteroidal anti-infammatory drug- exacerbated respiratory disease following treatment with omalizumab. J Allergy Clin Immunol Pract. 2017;5:842-84. Manuscript received August 30, 2018; accepted for publication October 21, 2019. Marta Sánchez-Jareño Allergy Department, Hospital Universitario La Paz E-mail: martasanchezjare@gmail.com 139