REFERATE GENERALE

Alergia la fructele de mare – abordare diagnostică

 Shellfish allergy – diagnostic approach

First published: 31 octombrie 2023

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/Aler.7.3.2023.8792

Abstract

Shellfish allergy is one of the most common food allergies, with an estimated prevalence of 3% in the general population. Crustaceans and mollusks are part of this food category, being capable of immunologic hypersensitivity reactions (IgE-mediated, as well as non-IgE-mediated), but also non-immunologic reactions, based on intoxication with certain neurotoxins from contaminated seafood, in which neurological but also gastrointestinal symptoms predominate. The clinical picture in IgE-mediated hypersensitivity reactions can vary in severity, from mild reactions such as oral allergy syndrome to severe reactions such as anaphylaxis. Among the delayed, non-IgE mediated reactions, we can identify food protein-induced enterocolitis syndrome, food protein-induced enteropathy and food protein-induced allergic proctocolitis, which mainly involve gastrointestinal symptoms. Over the past decades, the knowledge gained regarding the characteristics of different allergens has improved the diagnostic approach. Thus, for an accurate diagnosis of seafood-induced allergy, a thorough history, along with skin prick testing and specific IgE dosing are essential, and when these are insufficient, an oral challenge test can disentangle causality.
 

Keywords
shellfish allergy, crustaceans, molluscs, diagnosis, food allergy

Rezumat

Alergia la fructele de mare este una dintre cele mai frecvente alergii alimentare, cu o prevalenţă estimată de 3% în populaţia generală. Crustaceele şi moluştele fac parte din această categorie de alimente, fiind capabile să inducă atât reacţii de hipersensibilitate imunologice (IgE-mediate sau non-IgE-mediate), cât şi reacţii nonimunologice, bazate pe intoxicaţia cu anumite neurotoxine din fructele de mare contaminate, în care predomină simptomele neurologice, dar şi gastrointestinale. Tabloul clinic în reacţiile de hipersensibilitate IgE-mediate poate varia în severitate, de la reacţii uşoare precum sindromul de alergie orală până la reacţii severe, cum ar fi anafilaxia. Printre reacţiile tardive, non-IgE mediate, regăsim sindromul enterocolitei induse de proteinele alimentare, enteropatia indusă de proteinele alimentare şi proctocolita alergică indusă de proteinele alimentare, acestea implicând în special simptome gastrointestinale. În ultimele decenii, cunoştinţele acumulate cu privire la identificarea caracteristicilor diferitelor alergene au condus la îmbunătăţirea abordării diagnostice. Astfel, pentru un diagnostic de precizie al alergiei alimentare induse de fructele de mare, istoricul amănunţit, alături de testarea cutanată prick şi dozarea de IgE specifice sunt esenţiale, iar când acestea nu sunt suficiente, un test de provocare orală poate tranşa cauzalitatea.
 

Bibliografie

  1. Dramburg S, Hilger C, Santos AF, et al. EAACI Molecular Allergology User’s Guide 2.0. Pediatr Allergy Immunol. 2023 Mar;34 Suppl 28:e13854. doi: 10.1111/ pai.13854. PMID: 37186333.
  2. Gelis S, Rueda M, Valero A, Fernández EA, Moran M, Fernández-Caldas E. Shellfish Allergy: Unmet Needs in Diagnosis and Treatment. J Investig Allergol Clin Immunol. 2020;30(6):409-420. doi: 10.18176/jiaci.0565. .
  3. Shellfish allergen fact Sheet. Allergy Insider (n.d.).  https://corporate.thermofisher.com/content/diagnostics/patient/global/en/allergy-resources/allergen-fact-sheet.html?allergen=shellfish.
  4. Wang HT, Warren CM, Gupta RS, Davis CM. Prevalence and Characteristics of Shellfish Allergy in the Pediatric Population of the United States. J Allergy Clin Immunol Pract. 2020 Apr;8(4):1359-1370.e2. doi: 10.1016/j.jaip.2019.12.027. 5.
  5. Warren CM, Aktas ON, Gupta RS, Davis CM. Prevalence and characteristics of adult shellfish allergy in the United States. J Allergy Clin Immunol. 2019 Nov;144(5):1435-1438.e5. doi: 10.1016/j.jaci.2019.07.031. .
  6. Pascal M, Kamath SD, Faber M. Diagnosis and Management of Shellfish Allergy: Current Approach and Future Needs. Curr Treat Options Allergy. 2018;5:470–486. https://doi.org/10.1007/s40521-018-0186-0. 
  7. Wong L, Tham EH, Lee BW. An update on shellfish allergy. Curr Opin Allergy Clin Immunol. 2019 Jun;19(3):236-242. doi: 10.1097/ACI.0000000000000532. .
  8. Giovannini M, Beken B, Buyuktiryaki B, Barni S, Liccioli G, Sarti L, Lodi L, Pontone M, Bartha I, Mori F, Sackesen C, du Toit G, Lopata AL, Muraro A. IgE-Mediated Shellfish Allergy in Children. Nutrients. 2023 Jun 11;15(12):2714. doi: 10.3390/nu15122714. .
  9. Giannetti A, Pession A, Bettini I, Ricci G, Giannì G, Caffarelli C. IgE Mediated Shellfish Allergy in Children-A Review. Nutrients. 2023 Jul 12;15(14):3112. doi: 10.3390/nu15143112. PMID: 37513530; PMCID: PMC10386692.
  10. Ruethers T, Taki AC, Johnston EB, Nugraha R, Le TTK, Kalic T, McLean TR, Kamath SD, Lopata AL. Seafood allergy: A comprehensive review of fish and shellfish allergens. Mol Immunol. 2018 Aug;100:28-57. doi: 10.1016/j.molimm.2018.04.008. .
  11. Gámez C, Zafra MP, Sanz V, Mazzeo C, Ibáñez MD, Sastre J, del Pozo V. Simulated gastrointestinal digestion reduces the allergic reactivity of shrimp extract proteins and tropomyosin. Food Chem. 2015 Apr 15;173:475-81. doi: 10.1016/j.foodchem.2014.10.063. .
  12. Khulal U, Stojadinovic M, Prodic I, Rajkovic A, Cirkovic Velickovic T. Comparative digestion of thermally treated vertebrates and invertebrates allergen pairs in real food matrix. Food Chem. 2023 Mar 30;405(Pt B):134981. doi: 10.1016/j.foodchem.2022.134981. .
  13. Lopata AL, Kleine-Tebbe J, Kamath SD. Allergens and molecular diagnostics of shellfish allergy: Part 22 of the Series Molecular Allergology. Allergo J Int. 2016;25(7):210-218. doi: 10.1007/s40629-016-0124-2. .
  14. Wai CYY, Leung NYH, Chu KH, Leung PSC, Leung ASY, Wong GWK, Leung TF. Overcoming Shellfish Allergy: How Far Have We Come? Int J Mol Sci. 2020 Mar 23;21(6):2234. doi: 10.3390/ijms21062234. 5.
  15. Pascal M, Grishina G, Yang AC, Sánchez-García S, Lin J, Towle D, Ibañez MD, Sastre J, Sampson HA, Ayuso R. Molecular Diagnosis of Shrimp Allergy: Efficiency of Several Allergens to Predict Clinical Reactivity. J Allergy Clin Immunol Pract. 2015 Jul-Aug;3(4):521-9.e10. doi: 10.1016/j.jaip.2015.02.001. .
  16. Piboonpocanun S, Jirapongsananuruk O, Tipayanon T, Boonchoo S, Goodman RE. Identification of hemocyanin as a novel non-cross-reactive allergen from the giant freshwater shrimp Macrobrachium rosenbergii. Mol Nutr Food Res. 2011 Oct;55(10):1492-8. doi: 10.1002/mnfr.201000602. .
  17. Huffaker MF, McGhee SA. Four cases of delayed onset systemic reaction to shellfish. J Allergy Clin Immunol Pract. 2018 Mar-Apr;6(2):656-657. doi: 10.1016/j.jaip.2017.06.004. .
  18. Jeebhay MF, Moscato G, Bang BE, Folletti I, Lipińska-Ojrzanowska A, Lopata AL, Pala G, Quirce S, Raulf M, Sastre J, Swoboda I, Walusiak-Skorupa J, Siracusa A. Food processing and occupational respiratory allergy-  An EAACI position paper. Allergy. 2019 Oct;74(10):1852-1871. doi: 10.1111/all.13807. 1.
  19. Thalayasingam M, Gerez IF, Yap GC, Llanora GV, Chia IP, Chua L, Lee CJ, Ta LD, Cheng YK, Thong BY, Tang CY, Van Bever HP, Shek LP, Curotto de Lafaille MA, Lee BW. Clinical and immunochemical profiles of food challenge proven or anaphylactic shrimp allergy in tropical Singapore. Clin Exp Allergy. 2015 Mar;45(3):687-97. doi: 10.1111/cea.12416. 2.
  20. Steensma DP. The kiss of death: a severe allergic reaction to a shellfish induced by a good-night kiss. Mayo Clin Proc. 2003 Feb;78(2):221-2. doi: 10.4065/78.2.221. .
  21. Akimoto S, Yokooji T, Ogino R, Chinuki Y, Taogoshi T, Adachi A, Morita E, Matsuo H. Identification of allergens for food-dependent exercise-induced anaphylaxis to shrimp. Sci Rep. 2021 Mar 8;11(1):5400. doi: 10.1038/s41598-021-84752-2. 2.
  22. Anvari S, Ruffner MA. Adult Food Protein-Induced Enterocolitis Syndrome. Front Allergy. 2022 May 26;3:889879. doi: 10.3389/falgy.2022.889879. .
  23. Li DH, Wong-Pack A, Macikunas AL, Kim H. Adults with possible food protein-induced enterocolitis syndrome with crustacean ingestion. Allergy Asthma Clin Immunol. 2020 Nov 11;16(1):99. doi: 10.1186/s13223-020-00497-z. .
  24. Labrosse R, Graham F, Caubet JC. Non-IgE-Mediated Gastrointestinal Food Allergies in Children: An Update. Nutrients. 2020 Jul 14;12(7):2086. doi: 10.3390/nu12072086. .
  25. Feuille E, Nowak-Węgrzyn A. Food Protein-Induced Enterocolitis Syndrome, Allergic Proctocolitis, and Enteropathy. Curr Allergy Asthma Rep. 2015 Aug;15(8):50. doi: 10.1007/s11882-015-0546-9. .
  26. Alonso LL, Armstrong L, Warrington SJ. Shellfish Allergy. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448089/.
  27. Hurley W, Wolterstorff C, MacDonald R, Schultz D. Paralytic shellfish poisoning: a case series. West J Emerg Med. 2014 Jul;15(4):378-81. doi: 10.5811/westjem.2014.4.16279. .
  28. Watkins SM, Reich A, Fleming LE, Hammond R. Neurotoxic shellfish poisoning. Mar Drugs. 2008;6(3):431-55. doi: 10.3390/md20080021. .
  29. Ansdell V. Seafood Poisoning. In: Keystone JS, Kozarsky PE, Connor BA, et al. (Editors). Travel Medicine, Fourth Edition. Elsevier, 2019, pp. 449-456.
  30. 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 May 7;6(2):39-72. doi: 10.3390/md20080004. 1.
  31. Tong WS, Yuen AW, Wai CY, Leung NY, Chu KH, Leung PS. Diagnosis of fish and shellfish allergies. J Asthma Allergy. 2018;11:247-260.  doi:10.2147/JAA.S142476.
  32. Asero R, Scala E, Villalta D, et al. Shrimp allergy: Analysis of commercially available extracts for in vivo diagnosis. J Investig Allergol Clin Immunol. 2017;27:175–182. doi: 10.18176/jiaci.0127.
  33. Gámez C, Sánchez-García S, Ibáñez MD, et al. Tropomyosin IgE-positive results are a good predictor of shrimp allergy. Allergy. 2011;66(10):1375-1383. doi:10.1111/j.1398-9995.2011.02663.x.
  34. Ruethers T, Johnston EB, Karnaneedi S, et al. Commercial shellfish skin prick test extracts show critical variability in allergen repertoire. Allergy. 2023;10.1111/all.15853. doi:10.1111/all.15853.
  35. Jirapongsananuruk O, Sripramong C, Pacharn P, Udompunturak S, Chinratanapisit S, Piboonpocanun S, et al. Specific allergy to Penaeus monodon (seawater shrimp) or Macrobrachium rosenbergii (freshwater shrimp) in shrimp-allergic children. Clin Exp Allergy. 2008;38(6):1038-47.
  36. Carnés J, Ferrer Á, Huertas ÁJ, Andreu C, Larramendi CH, Fernández-Caldas E. The use of raw or boiled crustacean extracts for the diagnosis of seafood allergic individuals. Ann Allergy Asthma Immunol. 2007;98(4):349-54.
  37. Myrset HR, Barletta B, Di Felice G, Egaas E, Dooper MM. Structural and immunological characterization of recombinant Pan b 1, a major allergen of northern shrimp, Pandalus borealis. Int Arch Allergy Immunol. 2013;160(3):221-232. doi:10.1159/000339740.
  38. Ayuso R, Sánchez-Garcia S, Lin J, Fu Z, Ibáñez MD, Carrillo T, et al. 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):1286-93.
  39. Muraro A, Halken S, Arshad SH, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy. 2014;69(5):590-601. doi:10.1111/all.12398.
  40. Nordlee JA, Remington BC, Ballmer-Weber BK, Lehrer SB, Baumert JL, Taylor SL. Threshold Dose for Shrimp: A Risk Characterization Based On Objective Reactions in Clinical Studies. J Allergy Clin Immunol. 2013;131(2):AB88.
  41. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI Food Allergy and Anaphylaxis Guidelines: Diagnosis and management of food allergy. Allergy Eur J Allergy Clin Immunol. 2014;69(8):1008-25.
  42. Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141(1):41-58. doi:10.1016/j.jaci.2017.11.003.
  43. Wai CYY, Leung NYH, Leung PSC, Chu KH. Immunotherapy of Food Allergy: A Comprehensive Review. Clin Rev Allergy Immunol. 2019;57(1):55-73. doi:10.1007/s12016-017-8647-y.
  44. Wai CYY, Leung NYH, Leung PSC, Chu KH. Modulating Shrimp Tropomyosin-Mediated Allergy: Hypoallergen DNA Vaccines Induce Regulatory T Cells to Reduce Hypersensitivity in Mouse Model. Int J Mol Sci. 2019 Sep 19;20(18):4656. doi: 10.3390/ijms20184656. .
  45. Zhang J, Liu W, Zhang R, Zhao X, Fang L, Qin X, Gu R, Lu J, Li G. Hypoallergenic mutants of the major oyster allergen Cra g 1 alleviate oyster tropomyosin allergenic potency. Int J Biol Macromol. 2020 Dec 1;164:1973-1983. doi: 10.1016/j.ijbiomac.2020.07.325. .
  46. Kubo K, Takeda S, Uchida M, et al. Lit-LAMP-DNA-vaccine for shrimp allergy prevents anaphylactic symptoms in a murine model. Int Immunopharmacol. 2022;113(Pt A):109394. doi:10.1016/j.intimp.2022.109394.

Articole din ediţiile anterioare

RUBRICA SPECIALISTULUI | Ediţia 3 6 / 2021

Rolul diagnosticului molecular în anafilaxie

Carmen Panaitescu, Maria Bodnari, Carmen Tatu, Laura Haidar

Anafilaxia reprezintă o reacţie alergică severă, cu potenţial letal, caracterizată prin debutul acut al simptomelor şi care necesită intervenţie me...

22 octombrie 2021
LUCRĂRI ORIGINALE | Ediţia 4 4 / 2020

Diagnosticul molecular al alergiilor în practica clinică

Laura Haidar, Maria Roxana Buzan, Camelia Felicia Bănărescu, Anca-Daniela Cotuna-Coste, Raluca Maria Giurgiu, Carmen Panaitescu

Prevalenţa bolilor alergice este în creştere, atât în ţările dezvoltate, cât şi în cele în curs de dezvoltare (Pawankar et al., 2013).

22 decembrie 2020
RUBRICA SPECIALISTULUI | Ediţia 3 6 / 2021

Abordarea diagnostică moleculară în aspergiloza bronhopulmonară alergică

Mariana Vieru, Bucur Irina‑Gabriela , Carmen Saviana Ganea, Neagu Diana-Luiza , Lorena Mihaela Gheorghiţă, Florin-Dan Popescu

Aspergiloza bronhopulmonară alergică (ABPA) este o afecţiune care apare la pacienţi cu astm sau fibroză chistică şi care prezintă teste cutanate de...

22 octombrie 2021
LUCRARI ORIGINALE | Ediţia 2 5 / 2021

Alergia alimentară la oul de găină. Actualizări în diagnosticul şi abordarea terapeutică

Carina Petricău, Adriana Muntean, Irena Nedelea, Prof. dr. Diana Deleanu

Alergia alimentară la ou este frecventă în rândul populaţiei pediatrice, manifestându-se prin diferite fenotipuri clinice. Lucrarea de faţă are ca ...

27 aprilie 2021