Abstract
Shellfish allergy caused by undesirable immunological responses upon ingestion of crustaceans and mollusks is a common cause of food allergy, especially in the Asia-Pacific region. While the prevalence of shellfish allergy is increasing, the mainstay of clinical diagnosis for these patients includes extract-based skin prick test and specific IgE measurement while clinical management consists of food avoidance and as-needed use of adrenaline autoinjector should they develop severe allergic reactions. Such a standard of care is unsatisfactory to both patients and healthcare practitioners. There is a pressing need to introduce more specific diagnostic methods, as well as effective and safe therapies for patients with shellfish allergy. Knowledge gained on the identifications and defining the immuno-molecular features of different shellfish allergens over the past two decades have gradually translated into the design of new diagnostic and treatment options for shellfish allergy. In this review, we will discuss the epidemiology, the molecular identification of shellfish allergens, recent progress in various diagnostic methods, as well as current development in immunotherapeutic approaches including the use of unmodified allergens, hypoallergens, immunoregulatory peptides and DNA vaccines for the prevention and treatment of shellfish allergy. The prospect of a “cure “for shellfish allergy is within reach.
Highlights
Shellfish is one of the most common food allergens, and allergy to shellfish usually persists throughout life
The addition of diagnostic tests such as skin prick tests or specific IgE assays would rule out a substantial proportion of self-reported food allergy and cross-reactivity
Similar to other food allergies, the standard diagnostic approach for shellfish allergy involves a thorough review of clinical history [49] followed by in vivo skin prick test (SPT) and/or in vitro serum specific IgE measurement
Summary
Shellfish is one of the most common food allergens, and allergy to shellfish usually persists throughout life. This is different from allergies to hen’s eggs and cow’s milk to which children often gradually acquire natural tolerance [1]. Food represents the top cause of anaphylaxis at 29.9% in the United States with shellfish being the third most common food eliciting anaphylactic reactions (16.1%) following peanut (23.1%) and tree nuts (21.6%) [3]. Our survey of the local families in Hong Kong with affected children revealed substantial adverse impacts of food allergy on parents’ quality of life, allergy to shellfish was less detrimental when compared to peanut and egg [8]
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