Mollusk allergy in shrimp-allergic patients: Still a complex diagnosis. An Italian real-life cross-sectional multicenter study

Enrico Scala, Damiano Abeni, Arianna Aruanno, Elisa Boni, Ignazio Brusca, Francesca Cappiello, Elisabetta Caprini, Francesca Buzzulini, Gaia Deleonardi, Antongiulio Demonte, Laura Farioli, Fabio Lodi Rizzini, Laura Michelina Losappio, Donatella Macchia, Giuseppina Manzotti, Giorgia Meneguzzi, Marcello Montagni, Eleonora Nucera, Rosa Onida, Elide Anna PastorelloSilvia Peveri, Anna Radice, Federica Rivolta, Angela Rizzi, Mauro Giani, Lorenzo Cecchi, Lorenzo Maria Cecchi, Elena Pinter, Marzia Miglionico, Lorenzo Vantaggio, Valerio Pravettoni, Danilo Villalta, Riccardo Asero

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Introduction: Shellfish allergy is an important cause of food allergies worldwide. Both in vivo and in vitro diagnostics failure nowadays is caused by the poor quality of the extracts associated with the scarce availability of allergenic molecules in the market. It is known that not all patients with shellfish allergies experience adverse reactions to mollusks. It is still unclear how to detect and diagnose these patients correctly.Aim: To investigate the features of shrimp-allergic patients either reactive or tolerant to mollusks, with the currently available diagnostic methods.Methods: Nineteen centers, scattered throughout Italy, participated in the real-life study, enrolling patients allergic to shrimp with or without associated reactions to mollusks. Patients underwent skin tests using commercial extracts or fresh raw and cooked shrimp and mollusks, and IgE reactivity to currently available allergenic extracts and molecules was measured in vitro.Results: Two hundred and forty-seven individuals with a self reported adverse reactions to shrimp participated in the study; of these 47.8% reported an adverse reaction to mollusks ingestion (cephalopod and/or bivalve). Neither of the tests used, in vivo nor in vitro, was able to detect all selected patients. Accordingly, a great heterogeneity of results was observed: in vivo and in vitro tests agreed in 52% and 62% of cases. Skin tests were able to identify the mollusk reactors (p < 0.001), also using fresh cooked or raw food (p < 0.001). The reactivity profile of mollusk reactors was dominated by Pen m 1, over Pen m 2 and Pen m 4 compared to tolerant subjects, but 33% of patients were not detected by any of the available molecules. Overall, a higher frequency of IgE rectivity to shrimp was recorded in northern Italy, while mollusk reactivity was more frequent in the center-south.Conclusion: The current diagnostic methods are inadequate to predict the cross-reactivity between crustaceans and mollusks. The detection of mollusks hypersensitivity should still rely on skin tests with fresh material. The exclusion of mollusks from shrimp allergic patients' diets should occur when clinical history, available diagnostic instruments, and/or tolerance tests support such a decision.
Lingua originaleEnglish
pagine (da-a)100685-100696
Numero di pagine12
RivistaTHE WORLD ALLERGY ORGANIZATION JOURNAL
Volume15
DOI
Stato di pubblicazionePubblicato - 2022

Keywords

  • Anaphylaxis
  • Crustaceans
  • Food allergy
  • Urticaria/angioedema
  • Mollusks
  • Multiplex analysis
  • Tropomyosin
  • IgE diagnosis

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