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Diagnosis of parent-reported shellfish allergy and other parent-reported food allergies among children
Source publication
Although shellfish allergy frequently results in emergency department visits, national prevalence studies focusing on shellfish allergy in children are scarce. This study describes parent reports of shellfish allergy among children in the United States. Data from shellfish-allergic children were identified for analysis from a randomized, cross-sect...
Context in source publication
Context 1
... proportion of parent-reported shellfish allergy diagnosed by a physician was 58.5% (35.0% confirmed with testing and 23.5% without testing), significantly lower than the rate of diagnosis for other parent-re- ported food allergies (72.7%; Table 2). Among cases of physician-diagnosed shellfish allergy, 27.0% were as- sessed with a skin test and 20.8% with a blood test, both also significantly lower than the rates for other parent-reported food allergies. ...
Citations
... Previous studies report the average age of diagnosis is in adulthood, 13 whereas others analyzed age of onset in children and adults separately. 20,21 Another possible explanation for this young age of diagnosis is that shellfish has become gradually more ubiquitous in the US diet 22 and more children may be exposed at an earlier age. ...
Background:
Shellfish allergy (SA) is one of the most common food allergies causing anaphylaxis in adults and children. There is limited data showing the prevalence of SA in US children.
Objective:
To determine the prevalence and reaction characteristics of SA in the US pediatric population.
Methods:
A cross-sectional food allergy prevalence survey was administered via phone and web by the National Opinion Research Center at the University of Chicago from 2015-2016. Point prevalence SA estimates, complex survey weighted proportions and 95% confidence intervals were determined. Relative proportions of demographic characteristics were compared using weighted Pearson chi-square statistics.
Results:
The prevalence of SA was 1.3% (95% CI 1.1-1.5) with more children allergic to crustacean (1.2%; 95% CI 1.0-1.3) than mollusk (0.5%; 95% CI 0.4-0.6). Mean ages of shellfish, crustacean, and mollusk allergy diagnosis were 5.0 (95% CI, 4.4-5.6), 5.1 (95% CI, 4.6-5.6), and 7.7 years old (95% CI, 5.7-9.7), respectively. More than half (54.9%; 95% CI 48.1-61.4) of SA pediatric patients had >1 lifetime food allergy related emergency room visit but only 45.7% (95% CI 39.2-52.4) carried an epinephrine auto-injector. Children with shellfish allergy were more likely to be Black/Hispanic/Latino, and have comorbid asthma, allergic rhinitis or a parental history of asthma, environmental or other food allergies (p<0.001).
Conclusion:
The epidemiology of SA in the US pediatric population shows crustacean allergy is more common than mollusk allergy. A disparity in SA children and epinephrine auto-injector carriage exists. Results from this study will lead to increased awareness of the need for detailed histories, specific diagnostic tests, and rescue epinephrine for anaphylaxis in US children with SA.
... The prevalence of shellfish allergy among 14-to 16-year-old children was 5.12% in the Philippines and 5.23% in Singapore, 20 whereas it was 1.3% in the US. 36 Although its prevalence was only 0.84% in the current study, crustaceans were ranked at the second most common food allergen, indicating that shrimp and crab are important food allergens in Korean children. A meta-analysis of 10 studies on anaphylaxis showed an incidence of 4.93 per 100 person-years in children aged 0-19 years. ...
Purpose:
This study aimed to determine the prevalence of immediate-type food allergy (FA) among schoolchildren in Korea.
Methods:
A nationwide, cross-sectional study was performed in September 2015. A stratified random sample of 50,000 participants was selected from children and adolescents aged 6-7 years (n=17,500), 9-10 years (n=17,500), 12-13 years (n=7,500), and 15-16 years (n=7,500). Parents were asked to complete a questionnaire on the detailed history of immediate-type FA.
Results:
A total of 32,001 (64.0%) responded to the questionnaire survey, and 29,842 children (59.7%) were analyzed after adjusting for missing data. The number of the cases in each age group was 9,671 (6-7 years), 9,756 (9-10 years), 5,169 (12-13 years), and 5,246 (15-16 years). The prevalence of lifetime perceived FA was 15.82%. The prevalence of current immediate-type FA was 4.06% in total, with 3.15% in 6- to 7-year-olds, 4.51% in 9- to 10-year-olds, 4.01% in 12- to 13-year-olds, and 4.49% in 15- to 16-year-olds. Among individual food items, peanut (0.22%) was the most frequent causative food, followed by hen's egg (0.21%), cow's milk (0.18%), and buckwheat (0.13%). Among the food groups, fruits (1.41%), crustaceans (0.84%), tree nuts (0.32%), and fish (0.32%) were the most common offending foods. The prevalence of food-induced anaphylaxis was 0.97%. The most frequent causative food of anaphylaxis was peanut (0.08%), followed by cow's milk (0.07%), buckwheat (0.06%), and hen's egg (0.06%), while fruits (0.28%), crustaceans (0.18%), tree nuts (0.12%), and fish (0.09%) were the most commonly responsible food groups.
Conclusions:
The prevalence of current immediate-type FA and food-induced anaphylaxis in Korean schoolchildren in 2015 was 4.06% and 0.97%, respectively. Peanuts, cow's milk, hen's egg, fruits, crustaceans, and tree nuts are common allergens.
... The prevalence of food allergy widely varies geographically and racially across the United States ( Gupta et al. 2011Gupta et al. , 2012Lau et al. 2012;Liu et al. 2010;Warren et al. 2013); however, based on estimates from nationally representative surveys, the prevalence of clinical food allergy (based on a combination of clinical criteria and IgE sensitization) in all age groups is estimated to be 2.5% (1.3% for peanut, 0.4% milk, and 0.2% egg; Liu et al. 2010). In other nationally representative samples, the prevalence of self-reported food allergy among children has been estimated at 8% for any food allergy, 2% peanut, 1.7% milk, 1.4% shellfish, 1% tree nuts, 0.8% egg, 0.5% fish, and 0.4% wheat and soy ( Gupta et al. 2011Gupta et al. , 2012Lau et al. 2012;Warren et al. 2013). ...
... The prevalence of food allergy widely varies geographically and racially across the United States ( Gupta et al. 2011Gupta et al. , 2012Lau et al. 2012;Liu et al. 2010;Warren et al. 2013); however, based on estimates from nationally representative surveys, the prevalence of clinical food allergy (based on a combination of clinical criteria and IgE sensitization) in all age groups is estimated to be 2.5% (1.3% for peanut, 0.4% milk, and 0.2% egg; Liu et al. 2010). In other nationally representative samples, the prevalence of self-reported food allergy among children has been estimated at 8% for any food allergy, 2% peanut, 1.7% milk, 1.4% shellfish, 1% tree nuts, 0.8% egg, 0.5% fish, and 0.4% wheat and soy ( Gupta et al. 2011Gupta et al. , 2012Lau et al. 2012;Warren et al. 2013). Among adults, the prevalence of any self-reported food allergy is estimated at 0.7%, shellfish 0.4%, peanut 0.2%, tree nuts 0.1%, and fish 0.05% (Agarwal and Wang 2014). ...
... Shellfish allergy is a life-threatening allergy that is commonly underdiagnosed. 16 Tropomyosins from shellfish and fish have a high degree of homology with house dust mite (HDM) and cockroaches. 17 Shrimp tropomyosin (Pen a 1) has more than 80% amino acid sequence similarity with HDM (Der p 10), 17 and cockroach (Per a 7). ...
Background:
Food allergy (FA) is a prevalent condition in the United States, but little is known about its phenotypes in racial minority groups.
Objective:
The objective of this study was to characterize disease phenotypes and disparities in health care utilization among African American (AA), Hispanic, and white children with FA.
Methods:
We conducted a large, 2-center, retrospective cohort study of children aged 0-17 years with FA seen in allergy/immunology clinics at 2 urban tertiary care centers in the United States. We used multiple logistic regression analyses adjusted for age, gender, and insurance.
Results:
The cohort of 817 children was composed of 35% AA, 12% Hispanic, and 53% non-Hispanic white. Compared with non-Hispanic white children, AA children had significantly higher odds of having asthma and eczema (P < .01), and significantly higher odds of allergy to wheat, soy, corn, fish, and shellfish (P < .01). Compared with non-Hispanic white children, Hispanic children had significantly higher odds of allergy to corn, fish, and shellfish (P < .01), and higher odds of eczema (P < .01), but a similar rate of asthma (P = .44). In this cohort, 55%, 18%, and 11% of AA, Hispanic, and white children were covered by Medicaid, respectively (P < .00001). Compared with whites, AA and Hispanic children had a shorter duration of follow-up for FA with an allergy specialist and higher rates of FA-related anaphylaxis and emergency department visits (P < .01).
Conclusions:
FA phenotypes and health care utilization differ among children of different racial and/or ethnic backgrounds in the United States that put AA and Hispanic children at higher risks of adverse outcome than white children. These differences include coexistent atopic conditions, less well recognized food allergens, and higher rates of anaphylaxis.
... Shellfish allergy is an immune-mediated adverse reaction to substances derived from shellfish. It is the most frequent cause of food allergy, affecting more than 2% of the US adult population and is responsible for the majority of emergency department visits related to severe food allergy [1][2][3][4]. The prevalence of shellfish allergy appears to be increasing more recently worldwide because of a substantial increase of sea food consumption over the last decade [1][2][3][4] The mild adverse reactions, which might persist throughout life, include hives, vomiting, abdominal pain and diarrhea. ...
... It is the most frequent cause of food allergy, affecting more than 2% of the US adult population and is responsible for the majority of emergency department visits related to severe food allergy [1][2][3][4]. The prevalence of shellfish allergy appears to be increasing more recently worldwide because of a substantial increase of sea food consumption over the last decade [1][2][3][4] The mild adverse reactions, which might persist throughout life, include hives, vomiting, abdominal pain and diarrhea. The severe and life threatening systemic anaphylactic reactions include a dramatic fall in blood pressure, wheezing, severe upper airway obstruction and even death. ...
... The severe and life threatening systemic anaphylactic reactions include a dramatic fall in blood pressure, wheezing, severe upper airway obstruction and even death. Currently, the only treatments for shellfish allergy are food avoidance and prompt effective management of severe reactions caused by allergen exposure [1][2][3][4]. ...
Shellfish allergy is an immune-mediated adverse reaction to allergenic shellfish and is responsible for significant morbidity and mortality. CD4 T cell responses play an important role in the pathophysiological mechanisms of sensitization and in production of IgE.
We sought to identify and validate CD4 T cell shrimp tropomyosin-derived epitopes and characterize CD4 T cell responses in subjects with a clinical history of shellfish allergy.
Using an in vitro MHC-peptide binding assay, we screened 91 overlapping peptides and identified 28 epitopes with moderate and strong binding capacities; 3 additional peptides were included based on MHC binding prediction score. These peptides were then examined in proliferation and cytokine release assays with T cells from allergic subjects.
17 epitopes restricted to DRB∗01:01, DRB1∗03:01, DRB1∗04:01, DRB1∗09:01, DQB1∗02:01, DQB1∗03:02 and DQB1∗05:01 alleles were identified and validated by both the MHC binding and the functional assays. Two peptides showed specificities to more than one MHC class II allele. We demonstrated that these peptides exert functional responses in an epitope specific manner, eliciting predominantly IL-6 and IL-13.
The identified epitopes are specific to common MHC class II alleles in the general population. Our study provides important data for the design of peptide-based immunotherapy of shrimp-allergic patients.
This review summarizes (1) the U.S. status quo for aquatic food animal production and marketing; (2) major food safety and quality issues/concerns for aquatic food animals in the United States, including fish misbranding, finfish/shellfish allergies, pathogens, toxins and harmful residues, microplastics, and genetically engineered salmon; and (3) various U.S. regulations, guidances, and detection methods for the surveillance of fishery products. Overall, fish misbranding is the biggest challenge in the United States due to the relatively low inspection rate. In addition, due to the regulatory differences among countries, illegal animal drugs and/or pesticide residues might also be identified in imported aquatic food animals. Future regulatory and research directions could focus on further strengthening international cooperation, enhancing aquatic food animal inspection, and developing reliable, sensitive, and highly efficient detection methods.
Purpose of review:
Shellfish is an important cause of food allergy worldwide, and a major cause of food-triggered anaphylaxis. Despite the wide variety of shellfish, there is considerable serological and clinical cross-reactivity of major shellfish allergens, and accurate diagnosis remains a challenge in the management of shellfish allergy.
Recent findings:
Novel minor allergens have been discovered and characterized, and advances in component resolved diagnostics have provided insights into the prevalence of sensitization and their clinical importance in shellfish allergy. The extensive cross-reactivity between tropomyosin of house-dust mite and crustacean shellfish has been postulated to be the cause of a proposed mite-shellfish oral allergy syndrome.
Summary:
More studies in food challenge-proven patients are required to establish the true prevalence and natural history of shellfish allergy. Refinement of component resolved diagnostics and testing for minor allergens may be helpful in developing more precise species-specific tests. Further investigation into the role of tropomyosin in house-dust mite and shellfish allergies may provide novel immunotherapeutic approaches for shellfish allergy.
Background:
Shellfish (SF) allergy is a leading cause of systemic anaphylaxis in humans. An adjuvant-free mouse model to evaluate allergenicity and oral anaphylaxis to SF is currently unavailable. Here, we tested the hypothesis that transdermal exposure (TDE) to SF protein extract (SFPE) not only elicits a systemic allergic immune response but also will clinically sensitize mice for oral anaphylaxis.
Methods:
Adult BALB/c female mice (6-8 weeks of age) were exposed to saline or SFPE once a week for 4 weeks using a transdermal sensitization method. Systemic SF-specific IgE, IgG1 and IgG2a and total (t)IgE responses were measured using ELISA. Systemic anaphylaxis upon oral SFPE administration was assessed according to clinical symptoms and the hypothermia shock response (HSR). Using individual mouse data, the correlation between the readouts of allergenicity was determined using Pearson's analysis. Spleen-cell IL-4 and IFN-x03B3; responses were determined using primary cell culture and ELISA.
Results:
TDE to SFPE resulted in marked systemic specific (s)IgE, tIgE, IgG1 and IgG2a responses. Oral challenge with SFPE in sensitized mice (but not controls) elicited systemic anaphylactic clinical reactions and HSR. A strong correlation was observed between sIgE, tIgE and HSR. Spleen cells isolated from allergic mice (but not controls) exhibited memory IL-4 and IFN-x03B3; cytokine responses.
Conclusion:
We report a novel adjuvant-free mouse model of SF allergy with robust quantifiable and correlated readouts of allergenicity that may be used in basic biomedical, preclinical and applied food/nutrition research on SF allergy.
The prevalence of shellfish allergy is ∼1.3% in the United States, with shrimp most commonly reported. Shellfish is one of the top causes of food-induced anaphylactic reactions, yet there are no reported rates of pediatric shrimp anaphylaxis in the literature. In previously reported adults with shrimp allergy, the rate of anaphylaxis to shrimp was 42%.
To describe the rate of anaphylaxis among children with shrimp allergy, demographics, clinical presentation, and cross-reactive sensitization.
Retrospective chart review of children ≤18 years old who presented with shrimp allergy to Texas Children's Hospital Allergy and Immunology Clinic over 11 years.
Sixty-eight patients were identified with shrimp allergy (61% male, 39% female), with a median age of diagnosis at 5.6 years (range, 0.96-16.6 years). The rate of anaphylaxis was 12%, and mucocutaneous symptoms were most common (skin symptoms, 70%; urticaria, 58%; and angioedema, 58%). No factors were positively associated with anaphylaxis, whereas patients without anaphylaxis had a significantly higher rate of eczema compared with those with anaphylaxis (p = 0.02). African Americans and Asian Americans were disproportionately affected (p < 0.001). There were low rates of cross-sensitization for other crustaceans and for mollusks (57% and 26%, respectively).
The rate of anaphylaxis to shrimp was significantly lower in children with shrimp allergy than in adults, and anaphylactic reactions were negatively associated with eczema. Cross-reactivity to other crustaceans and mollusks does not uniformly occur. Prospective studies with double blinded placebo-controlled food challenges are needed to further characterize patients with shrimp allergy.
Confounding variables play a significant role in many adverse seafood reactions and a clear understanding of these factors is important in properly characterizing reactions associated with potential masqueraders and mimics. Although the medical literature is replete with reviews of seafood hypersensitivity and reports of cross-reactive and newly characterized allergens, there has not been a recent effort to provide an updated overview of the several processes that may lead clinicians to draw incorrect conclusions in evaluating reported reactions to seafood. Ranging from seafood intoxications to other nonallergic or complex seafood reactions, these events can easily be misconstrued as representing a seafood IgE-mediated allergy. Among these are the more familiar topics of cross-reactivity and scombroid intoxication, and those with a still evolving understanding such as ciguatera fish poisoning and Anisakis reactions. This article seeks to provide an accessible but comprehensive summary of the relevant information surrounding these confounders in assessing adverse reactions to seafood. Such knowledge may be instrumental in unraveling complex or otherwise unclear presentations and aid clinicians in accurately evaluating and managing patients with reported seafood reactions.
