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Background: Allergy to mollusks has been the focus of fewer studies than allergy to crustaceans. Furthermore, allergy to mollusks is less well characterized. Objectives: To describe the clinical characteristics of mollusk-allergic patients, to identify the responsible allergens, and to assess crossreactivity. Methods: We performed a prospective multicenter study including 45 patients with mollusk allergy, which was diagnosed based on a suggestive clinical history and a positive skin test result with the agent involved. Fractions were identified using SDS-PAGE and immunoblotting. The proteins responsible were subsequently identified using mass spectrometry. ELISA inhibition studies were performed with mollusks, dust mites, and crustaceans. Results: We found that 25 patients (55%) were allergic to cephalopods, 14 (31%) to bivalves, and 11 (24%) to gastropods. Limpet was the third most frequent cause of allergy (15% of cases). In 31 patients (69%), the manifestation was systemic; 10 (22%) exhibited oral allergy syndrome, and 7 (15%) experienced contact urticaria. Most major allergens were found between 27 kDa and 47 kDa. ELISA inhibition assays revealed a high degree of inhibition of cephalopods and bivalves from all the groups of mollusks, mites, and crustaceans. Mass spectrometry identified tropomyosin, actin, and myosin as the major allergens. Conclusions: Cephalopods, especially squid, are the mollusks that most frequently trigger allergic symptoms. The very frequent occurrence of allergy to limpets is striking, given their low consumption in our area. It is worth highlighting the heterogeneity observed, exemplified by the gastropods. Tropomyosin appears to be responsible for the high cross-reactivity found between mollusks, mites, and crustaceans. Three new mollusk allergens were also identified, namely, actin, enolase, and a putative C1q domain-containing protein.

Iontophoresis involves percutaneous administration of a drug (e.g. anti-inflammatory and local anaesthetics) with galvanic current. Case ReportA 46-year-old woman developed a pruritic micropapular erythematous rash on the right shoulder after topical application of Voltaren ® (diclofenac) and Inzitan ® [lidocaine, dexamethasone, cyanocobalamin (vitamin B 12 ) and thiamine (vitamin B 1 )] by iontophoresis. It resolved over several weeks with desquamation.Patch tests were performed according to International Contact Dermatitis Research Group guidelines (1), with the TRUE Test ® system and the implicated drugs, with occlusion for 48 hours and with readings on D2 and D4. On D4, only nickel (++) and epoxy resin (++) gave positive reactions. Skin tests (prick and intradermal; Table 1) (2) showed no sensitization to diclofenac and Inzitan ® at immediate and delayed readings (made at 24 hr). Therefore, once informed consent had been obtained from the patient, challenge tests were performed. She tolerated oral diclofenac (50 mg). One hour after the application of intramuscular Inzitan ® (one half-ampoule) (the usual method of administration), she developed skin itching, and 24 hr later, erythematous plaques in the forearms and right shoulder (the application area of the iontophoresis treatment).Taking into account these results, skin tests were repeated with each of the components of Inzitan ® [lidocaine, dexamethasone, cyanocobalamin (vitamin B 12 ),