Anaphylaxis to European Perch (Perca fluviatilis) Due to a-Actin Protein

Fish allergy is one of the most prevalent allergies in both children and adults. Cross-reaction between allergens from different fish species is common, although a minority of patients are selectively allergic to 1 fish species, with tolerance to other fish. While parvalbumin proteins are the major allergens, others, such as aldolases, enolases, collagen, tropomyosins, and vitellogenin, have been identified as clinically relevant fish allergens. We present the case of a 39-year-old woman with a personal history of lip and eyelid angioedema after eating walnut due to sensitization to albumin 2S storage protein and seasonal rhinoconjunctivitis due to sensitization to grass, olive, and Arizona cypress pollen. She experienced an episode of generalized urticaria, intense abdominal pain, and dizziness 20 minutes after dinner in a Peruvian restaurant. She was treated in the emergency department with intravenous fluids, antihistamines, corticosteroids, and antiemetics. Her condition improved gradually, and her blood pressure was 120/87 mmHg within the following hour. No vital signs were collected on arrival. No cofactors, such as concomitant infection, menstruation, NSAIDs, exercise, or alcohol, were recorded.