This dissertation is devoted to the age-related features and clinical-immunological characteristics of sensitization to fish, crustaceans, and mollusks in children with allergic conditions. The medical and social significance of the problem is due to the increasing prevalence of food allergies, the high risk of severe systemic reactions, including anaphylaxis, and diagnostic difficulties due to the presence of asymptomatic sensitization, the detection rate of which has increased with the prevalence of Precision Molecular Allergy Diagnosis (PAMD@). With the use of PAMD@, an increasing number of patients may be identified with sensitization to foods for which there is no sufficiently convincing clinical picture to confirm the diagnosis of food allergy; therefore, there is a need for expensive and risky oral food challenges. Predictive models can serve as an alternative for a number of patients, allowing for the non-invasive determination of the risk of developing clinical manifestations of food allergy. Following allergies to cow's milk protein and eggs, allergy to fish, crustaceans, and mollusks occupies a leading place in the structure of potentially dangerous allergic reactions in children. Avoiding these allergens is difficult due to their widespread presence in the food industry and crossreactivity between species. The management of such patients requires a comprehensive, scientifically grounded approach using modern capabilities of precision molecular allergy diagnosis and statistical methods for stratifying patient data by risk groups.
The aim of the research: To optimize the diagnosis of food allergy in children with sensitization to fish, crustaceans, and mollusks based on the study of age-related sensitization features, clinical-anamnestic, and immunological studies using precision molecular allergy diagnosis.
Objectives of the research:
1. To study the structure of sensitization to fish, crustaceans, and mollusks in children of different ages with allergic conditions from different regions of Ukraine based on precision molecular allergy diagnosis.
2. To analyze clinical-anamnestic data in children of different ages with sensitization to fish, crustaceans, and mollusks.
3. To investigate the relationship between clinical-anamnestic and immunological indicators in children with sensitization to fish, crustaceans, and mollusks, taking into account age and the severity of clinical manifestations.
4. To determine risk factors and develop a diagnostic model based on logistic regression to identify patients with existing sensitization who have a high risk of developing allergic reactions.
5. To investigate the effectiveness of the developed diagnostic model based on logistic regression.
To fulfill the research tasks, in the first stage, aiming to study the spectrum of sensitization to fish, crustaceans, and mollusks in children of different ages, a retrospective evaluation was conducted on the results of precision molecular allergy diagnosis in 3513 patients suspected of having allergic conditions (food allergy, allergic rhinitis, bronchial asthma, atopic dermatitis), aged 1 to 18 years, from different regions of Ukraine. The diagnosis of allergic diseases was established according to EAACI criteria. Patients were examined using the molecular multicomponent enzyme-linked immunosorbent assay venous blood test system ALEX2 (Macro Array Diagnostics GmbH, Austria). Levels of specific IgE exceeding 0.3 kUA/L to extracts and allergenic molecules of fish (β-parvalbumins), crustaceans, and mollusks (tropomyosins, arginine kinases, etc.) were determined.
Among the 3513 examined children, in the first stage, sensitization to fish and seafood was detected in 529 (15.1%) patients. Sensitization was most frequently observed in children aged 6–8 years (32.7%) and 3–5 years (23.3%). In examined patients from the Southern and Central regions, sensitization to seafood was noted significantly more frequently (21.2% and 19.8%, respectively) compared to the Western (8.8%), Northern (13.9%), and Eastern (15.3%) regions of residence. Among sensitized children, sensitivity to fish predominated. Sensitization to β-parvalbumins was most common: carp (Cyp c 1) — 55.0%, cod (Gad m 1) — 52.2%, salmon (Sal s 1) — 45.2%; sensitization levels were also established for lobsters (14.9%), crabs (14.4%), and oysters (13.8%).
