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Clinical and Translational Allergy
Published in: Clinical and Translational Allergy 1/2011

Open Access 01-12-2011 | Review

Not all shellfish "allergy" is allergy!

Authors: Chee K Woo, Sami L Bahna

Published in: Clinical and Translational Allergy | Issue 1/2011

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Abstract

The popularity of shellfish has been increasing worldwide, with a consequent increase in adverse reactions that can be allergic or toxic. The approximate prevalence of shellfish allergy is estimated at 0.5-2.5% of the general population, depending on degree of consumption by age and geographic regions. The manifestations of shellfish allergy vary widely, but it tends to be more severe than most other food allergens.
Tropomyosin is the major allergen and is responsible for cross-reactivity between members of the shellfish family, particularly among the crustacea. Newly described allergens and subtle differences in the structures of tropomyosin between different species of shellfish could account for the discrepancy between in vitro cross-antigenicity and clinical cross-allergenicity. The diagnosis requires a thorough medical history supported by skin testing or measurement of specific IgE level, and confirmed by appropriate oral challenge testing unless the reaction was life-threatening.
Management of shellfish allergy is basically strict elimination, which in highly allergic subjects may include avoidance of touching or smelling and the availability of self-administered epinephrine. Specific immunotherapy is not currently available and requires the development of safe and effective protocols.
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Literature
1.
2.
Woods RK, Abramson M, Bailey M, Walters EH: International prevalences of reported food allergies and intolerances. Comparisons arising from the European Community Respiratory Health Survey (ECRHS) 1991-1994. Eur J Clin Nutr. 2001, 55 (4): 298-304. 10.1038/sj.ejcn.1601159.CrossRefPubMed
3.
Sicherer SH, Munoz-Furlong A, Sampson HA: Prevalence of seafood allergy in the United States determined by a random telephone survey. J Allergy Clin Immunol. 2004, 114 (1): 159-165. 10.1016/j.jaci.2004.04.018.CrossRefPubMed
4.
Chiang WC, Kidon MI, Liew WK, Goh A, Tang JP, Chay OM: The changing face of food hypersensitivity in an Asian community. Clin Exp Allergy. 2007, 37 (7): 1055-1061. 10.1111/j.1365-2222.2007.02752.x.CrossRefPubMed
5.
Shek LP, Cabrera-Morales EA, Soh SE, Gerez I, Ng PZ, Yi FC, Ma S, Lee BW: A population-based questionnaire survey on the prevalence of peanut, tree nut, and shellfish allergy in 2 Asian populations. J Allergy Clin Immunol. 2010, 126 (2): 324-331. 10.1016/j.jaci.2010.06.003. 331 e321-327.CrossRefPubMed
6.
Wood RA: The natural history of food allergy. Pediatrics. 2003, 111 (6 Pt 3): 1631-1637.PubMed
7.
Daul CB, Morgan JE, Lehrer SB: The natural history of shrimp hypersensitivity. J Allergy Clin Immunol. 1990, 86 (1): 88-93. 10.1016/S0091-6749(05)80127-7.CrossRefPubMed
8.
Ayuso R, Sanchez-Garcia S, Lin J, Fu Z, Ibanez MD, Carrillo T, Blanco C, Goldis M, Bardina L, Sastre J, Sampson HA: Greater epitope recognition of shrimp allergens by children than by adults suggests that shrimp sensitization decreases with age. J Allergy Clin Immunol. 2010, 125 (6): 1286-1293. 10.1016/j.jaci.2010.03.010. e1283.CrossRefPubMed
9.
James KJ, Carey B, O'Halloran J, van Pelt FN, Skrabakova Z: Shellfish toxicity: human health implications of marine algal toxins. Epidemiol Infect. 2010, 138 (7): 927-940. 10.1017/S0950268810000853.CrossRefPubMed
10.
Hungerford JM: Scombroid poisoning: a review. Toxicon. 2010, 56 (2): 231-243. 10.1016/j.toxicon.2010.02.006.CrossRefPubMed
11.
Chegini S, Metcalfe DD: Contemporary issues in food allergy: seafood toxin-induced disease in the differential diagnosis of allergic reactions. Allergy Asthma Proc. 2005, 26 (3): 183-190.PubMed
12.
Twiner MJ, Rehmann N, Hess P, Doucette GJ: Azaspiracid shellfish poisoning: a review on the chemistry, ecology, and toxicology with an emphasis on human health impacts. Mar Drugs. 2008, 6 (2): 39-72. 10.3390/md6020039.PubMedCentralCrossRefPubMed
13.
14.
Hoffman DR, Day ED, Miller JS: The major heat stable allergen of shrimp. Ann Allergy. 1981, 47 (1): 17-22.PubMed
15.
Daul CB, Slattery M, Reese G, Lehrer SB: Identification of the major brown shrimp (Penaeus aztecus) allergen as the muscle protein tropomyosin. Int Arch Allergy Immunol. 1994, 105 (1): 49-55. 10.1159/000236802.CrossRefPubMed
16.
Shanti KN, Martin BM, Nagpal S, Metcalfe DD, Rao PV: Identification of tropomyosin as the major shrimp allergen and characterization of its IgE-binding epitopes. J Immunol. 1993, 151 (10): 5354-5363.PubMed
17.
Leung PS, Chu KH, Chow WK, Ansari A, Bandea CI, Kwan HS, Nagy SM, Gershwin ME: Cloning, expression, and primary structure of Metapenaeus ensis tropomyosin, the major heat-stable shrimp allergen. J Allergy Clin Immunol. 1994, 94 (5): 882-890. 10.1016/0091-6749(94)90156-2.CrossRefPubMed
18.
Leung PS, Chow WK, Duffey S, Kwan HS, Gershwin ME, Chu KH: IgE reactivity against a cross-reactive allergen in crustacea and mollusca: evidence for tropomyosin as the common allergen. J Allergy Clin Immunol. 1996, 98 (5 Pt 1): 954-961.CrossRefPubMed
19.
Ayuso R, Lehrer SB, Tanaka L, Ibanez MD, Pascual C, Burks AW, Sussman GL, Goldberg B, Lopez M, Reese G: IgE antibody response to vertebrate meat proteins including tropomyosin. Ann Allergy Asthma Immunol. 1999, 83 (5): 399-405. 10.1016/S1081-1206(10)62837-2.CrossRefPubMed
20.
Restani P, Fiocchi A, Beretta B, Velona T, Giovannini M, Galli CL: Meat allergy: III--Proteins involved and cross-reactivity between different animal species. J Am Coll Nutr. 1997, 16 (4): 383-389.CrossRefPubMed
21.
Reese G, Tracey D, Daul CB, Lehrer SB: IgE and monoclonal antibody reactivities to the major shrimp allergen Pen a 1 (tropomyosin) and vertebrate tropomyosins. Adv Exp Med Biol. 1996, 409: 225-230.CrossRefPubMed
22.
Nowak-Wegrzyn A, Fiocchi A: Rare, medium, or well done? The effect of heating and food matrix on food protein allergenicity. Curr Opin Allergy Clin Immunol. 2009, 9 (3): 234-237. 10.1097/ACI.0b013e32832b88e7.CrossRefPubMed
23.
Carnes J, Ferrer A, Huertas AJ, Andreu C, Larramendi CH, Fernandez-Caldas E: The use of raw or boiled crustacean extracts for the diagnosis of seafood allergic individuals. Ann Allergy Asthma Immunol. 2007, 98 (4): 349-354. 10.1016/S1081-1206(10)60881-2.CrossRefPubMed
24.
Li ZX, Lin H, Cao LM, Jameel K: Effect of high intensity ultrasound on the allergenicity of shrimp. J Zhejiang Univ Sci B. 2006, 7 (4): 251-256. 10.1631/jzus.2006.B0251.PubMedCentralCrossRefPubMed
25.
Garcia-Orozco KD, Aispuro-Hernandez E, Yepiz-Plascencia G, Calderon-de-la-Barca AM, Sotelo-Mundo RR: Molecular characterization of arginine kinase, an allergen from the shrimp Litopenaeus vannamei. Int Arch Allergy Immunol. 2007, 144 (1): 23-28. 10.1159/000102610.CrossRefPubMed
26.
Yu CJ, Lin YF, Chiang BL, Chow LP: Proteomics and immunological analysis of a novel shrimp allergen, Pen m 2. J Immunol. 2003, 170 (1): 445-453.CrossRefPubMed
27.
Uda K, Fujimoto N, Akiyama Y, Mizuta K, Tanaka K, Ellington WR, Suzuki T: Evolution of the arginine kinase gene family. Comp Biochem Physiol Part D Genomics Proteomics. 2006, 1 (2): 209-218. 10.1016/j.cbd.2005.10.007.CrossRefPubMed
28.
29.
Ayuso R, Grishina G, Bardina L, Carrillo T, Blanco C, Ibanez MD, Sampson HA, Beyer K: Myosin light chain is a novel shrimp allergen, Lit v 3. J Allergy Clin Immunol. 2008, 122 (4): 795-802. 10.1016/j.jaci.2008.07.023.CrossRefPubMed
30.
Ayuso R, Grishina G, Ibanez MD, Blanco C, Carrillo T, Bencharitiwong R, Sanchez S, Nowak-Wegrzyn A, Sampson HA: Sarcoplasmic calcium-binding protein is an EF-hand-type protein identified as a new shrimp allergen. J Allergy Clin Immunol. 2009, 124 (1): 114-120. 10.1016/j.jaci.2009.04.016.CrossRefPubMed
31.
Leung PS, Chen YC, Gershwin ME, Wong SH, Kwan HS, Chu KH: Identification and molecular characterization of Charybdis feriatus tropomyosin, the major crab allergen. J Allergy Clin Immunol. 1998, 102 (5): 847-852. 10.1016/S0091-6749(98)70027-2.CrossRefPubMed
32.
Leung PS, Chen YC, Mykles DL, Chow WK, Li CP, Chu KH: Molecular identification of the lobster muscle protein tropomyosin as a seafood allergen. Mol Mar Biol Biotechnol. 1998, 7 (1): 12-20.PubMed
33.
Jirapongsananuruk O, Sripramong C, Pacharn P, Udompunturak S, Chinratanapisit S, Piboonpocanun S, Visitsunthorn N, Vichyanond P: Specific allergy to Penaeus monodon (seawater shrimp) or Macrobrachium rosenbergii (freshwater shrimp) in shrimp-allergic children. Clin Exp Allergy. 2008, 38 (6): 1038-1047. 10.1111/j.1365-2222.2008.02979.x.CrossRefPubMed
34.
Lehrer SB, McCants ML: Reactivity of IgE antibodies with crustacea and oyster allergens: evidence for common antigenic structures. J Allergy Clin Immunol. 1987, 80 (2): 133-139. 10.1016/0091-6749(87)90121-7.CrossRefPubMed
35.
Waring NP, Daul CB, deShazo RD, McCants ML, Lehrer SB: Hypersensitivity reactions to ingested crustacea: clinical evaluation and diagnostic studies in shrimp-sensitive individuals. J Allergy Clin Immunol. 1985, 76 (3): 440-445. 10.1016/0091-6749(85)90724-9.CrossRefPubMed
36.
Aki T, Kodama T, Fujikawa A, Miura K, Shigeta S, Wada T, Jyo T, Murooka Y, Oka S, Ono K: Immunochemical characterization of recombinant and native tropomyosins as a new allergen from the house dust mite, Dermatophagoides farinae. J Allergy Clin Immunol. 1995, 96 (1): 74-83. 10.1016/S0091-6749(95)70035-8.CrossRefPubMed
37.
Reese G, Ayuso R, Lehrer SB: Tropomyosin: an invertebrate pan-allergen. Int Arch Allergy Immunol. 1999, 119 (4): 247-258. 10.1159/000024201.CrossRefPubMed
38.
Ayuso R, Lehrer SB, Reese G: Identification of continuous, allergenic regions of the major shrimp allergen Pen a 1 (tropomyosin). Int Arch Allergy Immunol. 2002, 127 (1): 27-37. 10.1159/000048166.CrossRefPubMed
39.
Santos AB, Chapman MD, Aalberse RC, Vailes LD, Ferriani VP, Oliver C, Rizzo MC, Naspitz CK, Arruda LK: Cockroach allergens and asthma in Brazil: identification of tropomyosin as a major allergen with potential cross-reactivity with mite and shrimp allergens. J Allergy Clin Immunol. 1999, 104 (2 Pt 1): 329-337.CrossRefPubMed
40.
Witteman AM, Akkerdaas JH, van Leeuwen J, van der Zee JS, Aalberse RC: Identification of a cross-reactive allergen (presumably tropomyosin) in shrimp, mite and insects. Int Arch Allergy Immunol. 1994, 105 (1): 56-61. 10.1159/000236803.CrossRefPubMed
41.
Fernandes J, Reshef A, Patton L, Ayuso R, Reese G, Lehrer SB: Immunoglobulin E antibody reactivity to the major shrimp allergen, tropomyosin, in unexposed Orthodox Jews. Clin Exp Allergy. 2003, 33 (7): 956-961. 10.1046/j.1365-2222.2003.01722.x.CrossRefPubMed
42.
Boquete M, Iraola V, Morales M, Pinto H, Francisco C, Carballas C, Carnes J: Seafood hypersensitivity in mite sensitized individuals: is tropomyosin the only responsible allergen?. Ann Allergy Asthma Immunol. 2011, 106 (3): 223-229. 10.1016/j.anai.2010.11.014.CrossRefPubMed
43.
Villalta D, Tonutti E, Visentini D, Bizzaro N, Roncarolo D, Amato S, Mistrello G: Detection of a novel 20 kDa shrimp allergen showing cross-reactivity to house dust mites. Eur Ann Allergy Clin Immunol. 2010, 42 (1): 20-24.PubMed
44.
Binder M, Mahler V, Hayek B, Sperr WR, Scholler M, Prozell S, Wiedermann G, Valent P, Valenta R, Duchene M: Molecular and immunological characterization of arginine kinase from the Indianmeal moth, Plodia interpunctella, a novel cross-reactive invertebrate pan-allergen. J Immunol. 2001, 167 (9): 5470-5477.CrossRefPubMed
45.
Pajno GB, La Grutta S, Barberio G, Canonica GW, Passalacqua G: Harmful effect of immunotherapy in children with combined snail and mite allergy. J Allergy Clin Immunol. 2002, 109 (4): 627-629. 10.1067/mai.2002.122844.CrossRefPubMed
46.
van Ree R, Antonicelli L, Akkerdaas JH, Pajno GB, Barberio G, Corbetta L, Ferro G, Zambito M, Garritani MS, Aalberse RC, Bonifazi F: Asthma after consumption of snails in house-dust-mite-allergic patients: a case of IgE cross-reactivity. Allergy. 1996, 51 (6): 387-393.CrossRefPubMed
47.
van Ree R, Antonicelli L, Akkerdaas JH, Garritani MS, Aalberse RC, Bonifazi F: Possible induction of food allergy during mite immunotherapy. Allergy. 1996, 51 (2): 108-113.CrossRefPubMed
48.
Peroni DG, Piacentini GL, Bodini A, Boner AL: Snail anaphylaxis during house dust mite immunotherapy. Pediatr Allergy Immunol. 2000, 11 (4): 260-261. 10.1034/j.1399-3038.2000.00001.x.CrossRefPubMed
49.
Asero R: Lack of de novo sensitization to tropomyosin in a group of mite-allergic patients treated by house dust mite-specific immunotherapy. Int Arch Allergy Immunol. 2005, 137 (1): 62-65. 10.1159/000085105.CrossRefPubMed
50.
Lopata AL, O'Hehir RE, Lehrer SB: Shellfish allergy. Clin Exp Allergy. 2010, 40 (6): 850-858. 10.1111/j.1365-2222.2010.03513.x.CrossRefPubMed
51.
Asturias JA, Eraso E, Moneo I, Martinez A: Is tropomyosin an allergen in Anisakis?. Allergy. 2000, 55 (9): 898-899. 10.1034/j.1398-9995.2000.00734.x.CrossRefPubMed
52.
Moneo I, Caballero ML, Gomez F, Ortega E, Alonso MJ: Isolation and characterization of a major allergen from the fish parasite Anisakis simplex. J Allergy Clin Immunol. 2000, 106 (1 Pt 1): 177-182.CrossRefPubMed
53.
Guarneri F, Guarneri C, Benvenga S: Cross-reactivity of Anisakis simplex: possible role of Ani s 2 and Ani s 3. Int J Dermatol. 2007, 46 (2): 146-150.PubMed
54.
Johansson E, Aponno M, Lundberg M, van Hage-Hamsten M: Allergenic cross-reactivity between the nematode Anisakis simplex and the dust mites Acarus siro, Lepidoglyphus destructor, Tyrophagus putrescentiae, and Dermatophagoides pteronyssinus. Allergy. 2001, 56 (7): 660-666. 10.1034/j.1398-9995.2001.00798.x.CrossRefPubMed
55.
Arlian LG, Morgan MS, Quirce S, Maranon F, Fernandez-Caldas E: Characterization of allergens of Anisakis simplex. Allergy. 2003, 58 (12): 1299-1303. 10.1046/j.1398-9995.2003.00344.x.CrossRefPubMed
56.
Hayashi D, Aoki T, Shibata R, Ichikawa K: [Case of food protein-induced enterocolitis syndrome caused by short-neck clam ingestion]. Arerugi. 2010, 59 (12): 1628-1633.PubMed
57.
Maulitz RM, Pratt DS, Schock : Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol. 1979, 63 (6): 433-434. 10.1016/0091-6749(79)90218-5.CrossRefPubMed
58.
Tokunaga H, Kokubu F, Okamoto M, Miyamoto M, Hanyuuda M, Adachi M: [A case of food-dependent exercise-induced anaphylaxis induced by shrimp]. Arerugi. 1995, 44 (11): 1297-1304.PubMed
59.
Vidal C, Bartolome B, Gonzalez-Quintela A, Rodriguez V, Armisen M: Prawns, barnacles, and nonsteroidal anti-inflammatory drugs: effect modifiers or diagnostic confounders [corrected]. J Investig Allergol Clin Immunol. 2007, 17 (2): 113-118.PubMed
60.
61.
Weytjens K, Cartier A, Malo JL, Chretien P, Essiembre F, Lehrer S, Swanson M: Aerosolized snow-crab allergens in a processing facility. Allergy. 1999, 54 (8): 892-893. 10.1034/j.1398-9995.1999.00120.x.CrossRefPubMed
62.
63.
Nagano T, Kanao K, Sugai T: Allergic contact urticaria caused by raw prawns and shrimps: three cases. J Allergy Clin Immunol. 1984, 74 (4 Pt 1): 489-493.CrossRefPubMed
64.
Bahna SL: Food challenge procedure: optimal choices for clinical practice. Allergy Asthma Proc. 2007, 28 (6): 640-646. 10.2500/aap.2007.28.3068.CrossRefPubMed
65.
Nowak-Wegrzyn A, Assa'ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS: Work Group report: oral food challenge testing. J Allergy Clin Immunol. 2009, 123 (6 Suppl): S365-383.CrossRefPubMed
66.
Sicherer SH, Furlong TJ, Munoz-Furlong A, Burks AW, Sampson HA: A voluntary registry for peanut and tree nut allergy: characteristics of the first 5149 registrants. J Allergy Clin Immunol. 2001, 108 (1): 128-132. 10.1067/mai.2001.115755.CrossRefPubMed
67.
Atkins D, Bock SA: Fatal anaphylaxis to foods: epidemiology, recognition, and prevention. Curr Allergy Asthma Rep. 2009, 9 (3): 179-185. 10.1007/s11882-009-0027-0.CrossRefPubMed
Metadata
Title
Not all shellfish "allergy" is allergy!
Authors
Chee K Woo
Sami L Bahna
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Clinical and Translational Allergy / Issue 1/2011
Electronic ISSN: 2045-7022
DOI
https://doi.org/10.1186/2045-7022-1-3

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