IgE-Mediated Shellfish Allergy in Children

Abstract

Shellfish, including various species of mollusks (e.g., mussels, clams, and oysters) and crustaceans (e.g., shrimp, prawn, lobster, and crab), have been a keystone of healthy dietary recommendations due to their valuable protein content. In parallel with their consumption, allergic reactions related to shellfish may be increasing. Adverse reactions to shellfish are classified into different groups: (1) Immunological reactions, including IgE and non-IgE allergic reactions; (2) non-immunological reactions, including toxic reactions and food intolerance. The IgE-mediated reactions occur within about two hours after ingestion of the shellfish and range from urticaria, angioedema, nausea, and vomiting to respiratory signs and symptoms such as bronchospasm, laryngeal oedema, and anaphylaxis. The most common allergenic proteins involved in IgE-mediated allergic reactions to shellfish include tropomyosin, arginine kinase, myosin light chain, sarcoplasmic calcium-binding protein, troponin c, and triosephosphate isomerase. Over the past decades, the knowledge gained on the identification of the molecular features of different shellfish allergens improved the diagnosis and the potential design of allergen immunotherapy for shellfish allergy. Unfortunately, immunotherapeutic studies and some diagnostic tools are still restricted in a research context and need to be validated before being implemented into clinical practice. However, they seem promising for improving management strategies for shellfish allergy. In this review, epidemiology, pathogenesis, clinical features, diagnosis, and management of shellfish allergies in children are presented. The cross-reactivity among different forms of shellfish and immunotherapeutic approaches, including unmodified allergens, hypoallergens, peptide-based, and DNA-based vaccines, are also addressed.

The Natural History and Risk Factors for the Development of Food Allergies in Children and Adults

“…The onset of peanut, tree nut, fish, and shellfish allergies tends to be later than milk, egg, soy, and wheat, with estimated peak prevalence at 1 ½ to 3 years of age [ 19 , 21 , 56 , 57 ], although the shift towards early introduction of these foods has led to a corresponding reduction in age at diagnosis of these allergies. In addition to presenting later, nut and seafood allergies also tend to persist into adulthood, which will be covered more in the following sections (Table 1 ).…”

Mutation of Disulfide Bond Sites Reduces the Immunoreactivity of Cra a 4 by Changing the Structural Characteristics

“…25 The hypoallergenic mutant of Cra a 4 based on the structural characteristics is expected to be applied in the prevention and control of food allergies caused by oyster products. 26 The main purpose of this study was to systematically investigate the association of disulfide bonds, conformational epitopes, and the Ca 2+ -binding region with immunoreactivity of Cra a 4. To identify the structure−allergenicity relationship of Cra a 4, different chemical denaturants were used to destroy the structure of Cra a 4.…”

“…It had been reported that hypoallergenic mutants of pollen allergen (Parietaria judaica) had lower IgE-binding activity and allergenicity in mice by site-directed mutation . The hypoallergenic mutant of Cra a 4 based on the structural characteristics is expected to be applied in the prevention and control of food allergies caused by oyster products …”

Gastropod Allergy: A Comprehensive Narrative Review

“…Seafood, including fish and shellfish, is a rich source of nutrients and antioxidants, making it a key component of the Mediterranean diet [1,2]. Known for providing essential protein and omega-3 fatty acids, seafood offers numerous cardiovascular health benefits [3][4][5].…”

“…Known for providing essential protein and omega-3 fatty acids, seafood offers numerous cardiovascular health benefits [3][4][5]. As a result, its consumption has surged in recent years, paralleling an increase in allergic reactions to seafood [1,2]. While shellfish includes both crustaceans and mollusks, research has traditionally focused on crustaceans, leaving studies on mollusk allergies, particularly gastropod allergies, notably sparse.…”