Fish roe triggers anaphylaxis in alpha-gal syndrome patients, Sri Lankan case series finds

Patients with alpha-gal syndrome, an allergy long associated with red meat, may also face life-threatening reactions to fish roe, according to a case series from Sri Lanka published in Allergy, Asthma & Clinical Immunology. The report describes three women who developed anaphylaxis within five minutes to one hour of eating fish roe, making it what the authors describe as the first South Asian case series linking this atypical trigger to the syndrome.

It classically causes delayed allergic reactions after people eat mammalian-derived foods such as beef or pork. Fish roe has recently emerged as a potential but under-recognized trigger in sensitized individuals, and the new report adds clinical detail from a region where the syndrome has been little documented.

The researchers retrospectively reviewed patients seen at a tertiary allergy clinic in Sri Lanka between January 2025 and May 2026 who reacted after fish roe ingestion and met diagnostic criteria for alpha-gal syndrome: a compatible clinical history, positive skin prick testing, elevated serum alpha-Gal-specific IgE, and symptom resolution after dietary avoidance. The three patients were women aged 19, 45, and 53 years.

All three had clinical features suggestive of the syndrome, including delayed reactions to mammalian meat, gastrointestinal symptoms after consuming dairy, recurrent unexplained allergic episodes, and a history of tick exposure. Skin prick testing showed sensitization to fish roe and mammalian-derived allergens, and serum alpha-Gal-specific IgE concentrations ranged from 1.55 to 12.7 kUA/L. Oral food challenges were not performed because of the risk of severe reactions, a limitation the authors acknowledge.

After avoiding mammalian meat, dairy products, gelatin, and fish roe, all patients remained free of further allergic reactions during follow-up. The authors conclude that fish roe may represent an important and under-recognized trigger of immediate anaphylaxis in patients with alpha-gal syndrome, and that recognizing this atypical presentation is essential for timely diagnosis, dietary counselling, and prevention of recurrent life-threatening reactions. They call for larger mechanistic and epidemiological studies to determine prevalence and clarify the underlying pathophysiology. As a small retrospective case series from a single clinic, the findings cannot establish how common fish roe reactions are among people with the syndrome.

Subject of Research: Fish roe as an atypical anaphylaxis trigger in alpha-gal syndrome patients in Sri Lanka

Article Title: Beyond red meat: fish roe-associated reactions in patients with alpha-gal syndrome—a case series from Sri Lanka

Article References: Badanasinghe, C. N., Suriapperuma, T., de Silva, S. R., Bolarugoda, V. C., Madhushanka, W. D. S., Salpitikorala, E., & Weeraratne, A. C. (2026). Beyond red meat: fish roe-associated reactions in patients with alpha-gal syndrome—a case series from Sri Lanka. Allergy, Asthma & Clinical Immunology. https://doi.org/10.1186/s13223-026-01059-5

Image Credits: AI Generated

DOI: 10.1186/s13223-026-01059-5

Keywords: alpha-gal syndrome, fish roe, anaphylaxis, food allergy, Sri Lanka, case series, IgE-mediated allergy, mammalian meat allergy, tick exposure, allergy clinic, Beyond, meat