Shrimp-Induced Anaphylaxis
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Anaphylaxis (M Sanchez-Borges, Section Editor)
Shrimp-Induced Anaphylaxis Riccardo Asero1,* Valerio Pravettoni2 Enrico Scala3 Danilo Villalta4 Address *,1 Ambulatorio di Allergologia, Clinica San Carlo, Via Ospedale 21, 20037, Paderno Dugnano, MI, Italy Email: [email protected] 2 General Medicine Immunology and Allergology Department, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy 3 Experimental Allergy Unit, IDI-IRCCS FLMM, Rome, Italy 4 Immunologia e Allergologia, Ospedale. S.Maria degli Angeli, Pordenone, Italy
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Anaphylaxis Keywords Shrimp allergy I Food allergy I Allergens I Anaphylaxis
Abstract Purpose of Review Shrimp and other crustaceans and molluscs are one of the most frequent causes of food allergy and anaphylaxis at all ages. Molecular biology has paved the way to a better understanding of the allergen profile of invertebrates that is much more complex than thought only one decade ago. Recent Findings While tropomyosin has been traditionally considered as the dominating major allergen in crustaceans and other invertebrates, recent research demonstrated that IgE to this allergen can be detected in about 50% of shrimp-allergic patients only. Many of these allergens are conserved ones and, hence, potentially cross-reacting across different invertebrates, including house dust mites. Patients not sensitized to tropomyosin frequently experience anaphylactic reactions, suggesting that also the so-called minor allergens may have an extreme clinical relevance. Summary This review focuses on the clinical features of shrimp allergy and highlights the recent findings on shrimp allergens. The use of epinephrine, which remains a cornerstone of the treatment of anaphylaxis, is reviewed as well.
Introduction Anaphylaxis is an acute, dramatic clinical event characterized by the abrupt onset of an illness involving the skin, mucosal tissue, or both associated with either
respiratory compromise, reduced blood pressure and associated symptoms of end-organ dysfunction (coll a p s e , s y n c o p e , i n c o n t i n e n ce ) , or pe r s i s t e n t
Anaphylaxis (M Sanchez-Borges, Section Editor) gastrointestinal symptoms [1]. Food allergy represents one of the most frequent causes of anaphylaxis worldwide [2–4], and food-induced anaphylaxis is responsible for hundreds of fatalities every year [4]. Crustaceans and shellfish rank among the main offending foods virtually in all countries where anaphylaxis recordings exist, including the USA [5, 6], the Far East [7], and Australia [8]. In Italy, crustaceans represent the second cause of primary food allergy [9] and the second cause of food-induced anaphylaxis [10] after the plant food panallergen LTP, the nonspecific lipid transfer protein. This observation is confirmed by epidemiologic studies carried out in different geographical areas [6, 11]. Further, Spanish epidemiologic studies suggest that shellfish allergy is on the rise [12]. A very recent analysis on
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