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

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

World Allergy Organization Journal (Sep 2022)

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

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

Affiliations

Enrico Scala, MD: Clinical and Laboratory Molecular Allergy Unit - IDI-IRCCS | FLMM, Roma, Italy; Corresponding author. Clinical and Laboratory Molecular Allergy Unit- IDI- IRCCS, via Monti di Creta 104, 00138, Rome, Italy. Tel.: +39 348 7998657
Damiano Abeni, MD: Clinical and Laboratory Molecular Allergy Unit - IDI-IRCCS | FLMM, Roma, Italy
Arianna Aruanno, MD: Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
Elisa Boni, MD: Allergologia e autoimmunità LUM AUSL, Bologna, Italy
Ignazio Brusca, MD: Clinical Pathology U.O.C., Buccheri La Ferla F.B.F. Hospital, Palermo, Italy
Francesca Cappiello, MD: Allergy Unit ASST Lecco and Merate, Italy
Elisabetta Caprini, BD: Clinical and Laboratory Molecular Allergy Unit - IDI-IRCCS | FLMM, Roma, Italy
Francesca Buzzulini, MD: SSD di immunologia e Allergologia, PO S. Maria Degli Angeli, Pordenone, Italy
Gaia Deleonardi, MD: Allergologia e autoimmunità LUM AUSL Bologna, Italy
Antongiulio Demonte, MD: UOsD Allergologia, ospedale G. Da Saliceto, Piacenza, Italy
Laura Farioli, MD: Dipartimento di Allergologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
Fabio Lodi Rizzini, MD: SSVD Allergologia Spedali Civili - Università Studi Brescia, Brescia, Italy
Laura Michelina Losappio, MD: Dipartimento di Allergologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
Donatella Macchia, MD: SOS Allergologia e Immunologia Clinica, Ospedale San Giovanni di Dio, Firenze, Italy
Giuseppina Manzotti, MD: Servizio di Allergologia, Casa di Cura Beato Palazzolo, Bergamo, Italy
Giorgia Meneguzzi, MD: Clinical and Laboratory Molecular Allergy Unit - IDI-IRCCS | FLMM, Roma, Italy
Marcello Montagni, MD: UOsD Allergologia, ospedale G. Da Saliceto, Piacenza, Italy
Eleonora Nucera, MD: Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
Rosa Onida, MD: Clinical Pathology U.O.C., Buccheri La Ferla F.B.F. Hospital, Palermo, Italy
Elide Anna Pastorello, MD: Dipartimento di Allergologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
Silvia Peveri, MD: UOsD Allergologia, ospedale G. Da Saliceto, Piacenza, Italy
Anna Radice, MD: SOS Allergologia e Immunologia Clinica, Ospedale San Giovanni di Dio, Firenze, Italy
Federica Rivolta, MD: Immunology and Allergy Department, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Angela Rizzi, MD: Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
Mauro Giani, MD: Clinical and Laboratory Molecular Allergy Unit - IDI-IRCCS | FLMM, Roma, Italy
Lorenzo Cecchi, MD: SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
Elena Pinter, MD: UOC Medicina interna e Immunologia Clinica, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
Marzia Miglionico, MD: Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
Lorenzo Vantaggio, MD: Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
Valerio Pravettoni, MD: Immunology and Allergy Department, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Danilo Villalta, MD: SSD di immunologia e Allergologia, PO S. Maria Degli Angeli, Pordenone, Italy
Riccardo Asero, MD: Ambulatorio di allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy

Journal volume & issue: Vol. 15, no. 9
p. 100685

Abstract

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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.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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