Les mollusques marins

[1] - Taylor SL. Molluscan shellfish allergy. Adv Food Nutr Res 2008;54:139-177

Food allergies affect approximately 3.5-4.0% of the worldwide population. Immediate-type food allergies are mediated by the production of IgE antibodies to specific proteins that occur naturally in allergenic foods. Symptoms are individually variable ranging from mild rashes and hives to life-threatening anaphylactic shock. Seafood allergies are among the most common types of food allergies on a worldwide basis. Allergies to fish and crustacean shellfish are very common. Molluscan shellfish allergies are well known but do not appear to occur as frequently. Molluscan shellfish allergies have been documented to all classes of mollusks including gastropods (e.g., limpet, abalone), bivalves (e.g., clams, oysters, mussels), and cephalopods (e.g., squid, octopus). Tropomyosin, a major muscle protein, is the only well-recognized allergen in molluscan shellfish. The allergens in oyster (Cra g 1), abalone (Hal m 1), and squid (Tod p 1) have been identified as tropomyosin. Cross-reactivity to tropomyosin from other molluscan shellfish species has been observed with sera from patients allergic to oysters, suggesting that individuals with allergies to molluscan shellfish should avoid eating all species of molluscan shellfish. Cross-reactions with the related tropomyosin allergens in crustacean shellfish may also occur but this is less clearly defined. Occupational allergies have also been described in workers exposed to molluscan shellfish products by the respiratory and/or cutaneous routes. With food allergies, one man's food may truly be another man's poison. Individuals with food allergies react adversely to the ingestion of foods and food ingredients that most consumers can safely ingest (Taylor and Hefle, 2001). The allergens that provoke adverse reactions in susceptible individuals are naturally occurring proteins in the specific foods (Bush and Hefle, 1996). Molluscan shellfish, like virtually all foods that contain protein, can provoke allergic reactions in some individuals.

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[2] - Castillo R, Delgado J, Quiralte J, Blanco C, Carrillo T. Food hypersensitivity among adult patients: epidemiological and clinical aspects. Allergol Immunopathol (Madr) 1996;24:93-97

Food hypersensitivity (FH) is lesser frequent among adult patients than in childhood. Foods implicated in hypersensitivity reactions vary with sociocultural and diet habits from a geographic place to other. We studied 142 adult patients sensitized to foods, among 7698 patients visited at our Outpatient Clinic. Hundred and twenty patients referred clinical symptoms after consumption of one or more foods consistently. From the latest, 107 patients (89.2%) were atopics (92 of them sensitizes to dust mites) and 54 (45%) referred atopic familiar background. Most frequent recorded symptoms were: urticaria/angioedema 84 cases (70%), oral syndrome 65 (54%), asthma 48 (37%) and anaphylaxis 33 patients (27.5%). Shellfish sensitization occurred in 50 patients, fresh fruits in 33 and nuts in 29 cases. Shrimp (48 patients), squid (33), kiwi (14), papaya (14), avocado (13) and banana (12 cases) were the most frequent causes of FH. Significant statistical association between foods and inhalants was observed for fresh fruits and latex (p < 0.001), fresh fruits and pollens (p < 0.01), and shellfish and Blatta germanica (p < 0.001). Prevalence of FH among patients at our Area is around 1.6%. Tropical fruits, as other kind of fruits, seem to share common IgE-epitopes to pollens. High prevalence of shellfish and cockroach hypersensitivity could be more easily developed by previous domestic mites sensitization.

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[3] - Crespo JF, Pascual C, Burks AW, Helm RM, Esteban MM. Frequency of food allergy in a pediatric population from Spain. Pediatr Allergy Immunol 1995;6:39-43

We evaluated the prevalence and characteristics of the principal foods implicated in 355 children diagnosed with IgE-mediated food allergy. Diagnosis was established on the basis of positive clinical history for the offending food, positive specific IgE by skin prick test and RAST, and open food challenge. Our results showed the principal foods involved in allergic reactions are: eggs, fish, and cow's milk. These are followed in frequency by fruits (peaches, hazelnuts and walnuts), legumes (lentils, peanuts and chick peas) and other vegetables (mainly sunflower seeds). The legumes demonstrated the highest degree of clinical cross-reactivity. Most patients with food allergy reacted to one or two foods (86.7%). Only 13.3% of patients reacted to 3 or more foods, mostly to legumes and fruits. We found that food allergy begins most frequently in the first (48.8%) and second (20.4%) years of life. Allergy to proteins of cow's milk, egg, and fish begins predominantly before the second year, demonstrating a clear relationship with the introduction of these foods into the child's diet. Allergy to foods of vegetable origin (fruits, legumes and other vegetables) begins predominantly after the second year.

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[4] - Ebisawa M, Ikematsu K, Imai T, Tachimoto H. Food Allergy in Japan. Allergy Clin Immunol Int 2003;15:214-217

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[5] - Moneret-Vautrin DA. Allergie alimentaire aux mollusques. Alim'Inter 2007;12:174-177

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[6] - Azofra J, Lombardero M. Limpet anaphylaxis: cross-reactivity between limpet and house-dust mite Dermatophagoides pteronyssinus. Allergy 2003;58:146-149

BACKGROUND: Limpet is a mollusc that is frequently found along the shores of warm seas. Few allergic reactions to limpet have been described, and cross-reactivity with house-dust mites has not been established . METHODS: We report five patients with anaphylactic reactions due to limpet ingestion. A limpet extract was prepared and skin prick tests (SPT), radioallergosorbent assays (RAST), sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE-immunoblotting were performed. In order to evaluate cross-reactivity, an immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done . RESULTS: All patients were asthmatics sensitized to house-dust mites. In each case, severe bronchospasm was evidenced, and three required mechanical ventilation. Positive SPT with limpet extract was found in the four patients tested. RAST showed specific IgE on each patient's sera. Immunoblotting showed several allergenic fractions with a wide molecular weight range (15-250 kDa). D. pteronyssinus inhibited IgE-binding molecules above 50 kDa in the limpet extract, particularly one molecule of 75 kDa . CONCLUSIONS: We describe five patients with IgE-mediated limpet allergy. Severe bronchospasm was the most important symptom. Cross-reactivity with D. pteronyssinus was demonstrated.

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[7] - Carrillo T, de Castro FR, Cuevas M, Caminero J, Cabrera P. Allergy to limpet. Allergy 1991;46:515-519

Allergy to mollusk has rarely been described. The limpet, belonging to Phylum mollusca, is one of the most frequent mollusks in the Canary Islands, as in all warm maritime regions. We report two cases of atopic patients who developed anaphylactic reactions after ingestion of this mollusk. Type I hypersensitivity to limpet antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, and histamine release test to cooked limpet extract. The controls did not react to any of these tests. Allergic activity was only found with a cooked limpet extract; this suggests that the offending antigen/s may have been released by cooking this food.

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[8] - Carrillo T, Rodriguez de Castro F, Blanco C, Castillo R, Quiralte J, Cuevas M. Anaphylaxis due to limpet ingestion. Ann Allergy 1994;73:504-508

Limpet consumption (raw, grilled, or as part of soups or rice dishes) is common in the Canary Islands. Limpet hypersensitivity in 6 patients with anaphylactic reactions 30-120 min after limpet ingestion was studied. All patients had positive skin prick tests to commercially available aeroallergens (including house dust mites (Dermatophagoides pteronyssinus), cockroach, fungi, pollens, and common foods) and cooked limpet extract (CLE). Weak reactivity to cockroach and raw limpet extract was also observed during skin prick tests. Specific IgE to mites and CLE were found using the in vitro immunocap and RAST methods, respectively. Results suggest that limpets are a potentially dangerous allergen, especially in patients sensitive to the house dust mite.

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[9] - Castillo R, Carrilo T, Blanco C, Quiralte J, Cuevas M. Shellfish hypersensitivity: clinical and immunological characteristics. Allergol Immunopathol (Madr) 1994;22:83-87

Shellfish is one of the most frequent causes of food allergy. We studied 48 patients (25 male and 23 female) with a mean age of 24.2 +/- 1.8 with shellfish hypersensitivity. A clinical questionnaire was carried out and prick tests were performed using a series of aeroallergens and a battery of extracts of squid, shrimp, lobster, crab, mussel and clam. Prick tests were also performed using raw and boiled extracts from fresh squid, octopus and limpet. Total and specific IgE to these allergens were determined. The most frequent causes of symptoms were shrimp (33 cases) and squid (24 cases). The most frequently found symptoms were Urticaria/angioedema (39 patients), asthma (18 patients) and rhinitis (14 patients). Clinical association was found between Cephalopoedae and Lamelibranquiae (p < 0.05 for clam and p < 0.01 for mussel), but not among both groups and Crustaceans. Association between history and Prick was statistically significant for Crustaceae and Cephalopoedae (p < 0.01) but not for Lamalibranquiae. Association between history and CAP was not found for shellfish. Significant differences among prick-tests with raw and boiled extracts were not found. These results suggest that prick test yields better results than CAP does it, in shellfish hypersensitivity, that clinical association among shellfish hypersensitivity can occurs within the same and different Phylum reflecting common epitopes and that squid, octopus and limpet extracts contain a large amount of heat-stable allergens.

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[10] - Juji F, Takashima H, Suko M, Doi M, Takaishi T, Okudaira H, et al. [A case of food-dependent-exercise induced anaphylaxis possibly induced by shellfish (Sulculus Supertexta and Turbo Cornutus)]. Arerugi 1990;39:1515-1522

A 17 years old girl experienced an anaphylactic reaction of urticaria, dyspnea, syncope and hypotension while riding a bicycle 55 minutes after eating shellfish Lapas shellfish which was a-like Sulculus Supertexta (SS). She recovered within several hours after the emergency treatment. Another attack occurred 3 months later while she was running with a dog 30 minutes after eating shellfish (Turbo Cornutus; TC). RAST scores were 4 for Lapas and 2 for TC. RAST inhibition test by ELISA showed a high crose-reaction between keyhole limpet hemocyanin (KLH) and Lapas, and between KLH and TC, while the cross reaction between Lapas and TC was low. Gel chromatography with sephacryl G-200 revealed that both Lapas and TC had several allergens with different molecules which were detected by ELISA. Exercise challenge produced an immediate fall of FEV1 and a significant increase in plasma histamine levels for 45 minutes.

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[11] - Dohi M, Suko M, Sugiyama H, Yamashita N, Tadokoro K, Juji F, et al. Food-dependent, exercise-induced anaphylaxis: a study on 11 Japanese cases. J Allergy Clin Immunol 1991;87:34-40

Eleven patients with food-dependent, exercise-induced anaphylaxis were studied. Seven patients experienced anaphylactic symptoms only after eating certain foods, such as shellfish, wheat, and grape before exercise. In the remaining four patients, no specific food could be identified, but the act of eating itself predisposed to anaphylaxis. Their anaphylactic symptoms were all clearly distinguished from cholinergic urticaria by history. Patients who developed anaphylactic symptoms before 20 years of age (N = 7) were atopic themselves or had atopic first-degree relatives. Six patients had increased serum IgE levels, and IgE antibodies against the causative food allergens were detected by the skin prick test or RAST in four cases. In contrast, patients who developed the symptoms after 30 years of age (N = 4) appeared to have a less atopic background, and IgE levels were within normal range except in one case. Three of four patients in the latter group developed symptoms after ingesting food made of wheat followed by exercise. All patients were sensitive to wheat as determined by the skin prick test. In six of 11 patients, a considerable rise in plasma histamine concentration was observed after exercise challenge with treadmill alone, and food intake followed by exercise induced a further increase in one patient.

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[12] - Maulitz RM, Pratt DS, Schocket AL. Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol 1979;63:433-434

The syndrome of immediate type I food hypersensitivity, mediated by tissue-bound IgE antibody and mast cell histamine release, is well recorded in the medical literature. This case study represents a previously undescribed late food hypersensitivity, induced only by strenuous exercise. Identification of this new syndrome illustrates classical epidemiologic analysis, improves medical advice for the allergic and athletically inclined, and raises new questions in the areas of allergy and immunology.

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[13] - Tanaka R, Ichikawa K, Hamano K. [Clinical characteristics of seafood allergy and classification of 10 seafood allergens by cluster analysis]. [Japanese]. Arerugi 2000;49:479-486

The aim of this study was to investigate the clinical characteristics of children who showed sensitization to any type of seafood and to classify the 10 seafood allergens based on IgE reactivities by a cluster analysis. In children with bronchial asthma (BA) and/or atopic dermatitis (AD), we defined the 'seafood' group as 23 patients having any type of seafood specific IgE antibody (CAP system). We analyzed the clinical features, the serum total IgE and each allergen specific IgE level. In addition, ten seafood allergens were also classified by a cluster analysis. Three patients revealed immediate hypersensitivity to some seafood. The frequency of patients with AD and the total IgE in the seafood group were high and the patients in this group were tend to be sensitized to multiple allergens. Seafood allergens were classified into 4 groups, 1) salmon, sardine, horse mackerel and mackerel, 2) cod and tuna, 3) octopus and squid, and 4) crab and shrimp, by a cluster analysis. These findings corresponded to the biological classification and the classification by the reported common allergens among various types of seafood. Based on our findings, this classification is therefore considered to be useful when selecting allergens to screen for sensitization to seafood.

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[14] - Dohi M, Suko M, Sugiyama H, Yamashita N, Tadokoro K, Juji F, et al. Food-dependent, exercise-induced anaphylaxis: a study on 11 Japanese cases. J Allergy Clin Immunol 1991;87:34-40

Eleven patients with food-dependent, exercise-induced anaphylaxis were studied. Seven patients experienced anaphylactic symptoms only after eating certain foods, such as shellfish, wheat, and grape before exercise. In the remaining four patients, no specific food could be identified, but the act of eating itself predisposed to anaphylaxis. Their anaphylactic symptoms were all clearly distinguished from cholinergic urticaria by history. Patients who developed anaphylactic symptoms before 20 years of age (N = 7) were atopic themselves or had atopic first-degree relatives. Six patients had increased serum IgE levels, and IgE antibodies against the causative food allergens were detected by the skin prick test or RAST in four cases. In contrast, patients who developed the symptoms after 30 years of age (N = 4) appeared to have a less atopic background, and IgE levels were within normal range except in one case. Three of four patients in the latter group developed symptoms after ingesting food made of wheat followed by exercise. All patients were sensitive to wheat as determined by the skin prick test. In six of 11 patients, a considerable rise in plasma histamine concentration was observed after exercise challenge with treadmill alone, and food intake followed by exercise induced a further increase in one patient.

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[15] - Miyake T, Kawamori J, Yoshida T. [A pediatric case of food-dependent exercise-induced anaphylaxis]. Arerugi 1988;37:53-56

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[16] - Caffarelli C, Perrone F, Terzi V. Exercise-induced anaphylaxis related to cuttlefish intake. Eur J Pediatr 1996;155:1025-1026

A 14-year-old girl suffered from exercise-induced anaphylaxis associated with eating cuttlefish. She was advised to avoid the precipitating food 6 h before exercise. No further attack occurred. CONCLUSION: It should always be considered that foods can predispose exercise-induced anaphylaxis. Precipitating food should be identified by challenge test.

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[17] - Taylor SL. Molluscan shellfish allergy. Adv Food Nutr Res 2008;54:139-177

Food allergies affect approximately 3.5-4.0% of the worldwide population. Immediate-type food allergies are mediated by the production of IgE antibodies to specific proteins that occur naturally in allergenic foods. Symptoms are individually variable ranging from mild rashes and hives to life-threatening anaphylactic shock. Seafood allergies are among the most common types of food allergies on a worldwide basis. Allergies to fish and crustacean shellfish are very common. Molluscan shellfish allergies are well known but do not appear to occur as frequently. Molluscan shellfish allergies have been documented to all classes of mollusks including gastropods (e.g., limpet, abalone), bivalves (e.g., clams, oysters, mussels), and cephalopods (e.g., squid, octopus). Tropomyosin, a major muscle protein, is the only well-recognized allergen in molluscan shellfish. The allergens in oyster (Cra g 1), abalone (Hal m 1), and squid (Tod p 1) have been identified as tropomyosin. Cross-reactivity to tropomyosin from other molluscan shellfish species has been observed with sera from patients allergic to oysters, suggesting that individuals with allergies to molluscan shellfish should avoid eating all species of molluscan shellfish. Cross-reactions with the related tropomyosin allergens in crustacean shellfish may also occur but this is less clearly defined. Occupational allergies have also been described in workers exposed to molluscan shellfish products by the respiratory and/or cutaneous routes. With food allergies, one man's food may truly be another man's poison. Individuals with food allergies react adversely to the ingestion of foods and food ingredients that most consumers can safely ingest (Taylor and Hefle, 2001). The allergens that provoke adverse reactions in susceptible individuals are naturally occurring proteins in the specific foods (Bush and Hefle, 1996). Molluscan shellfish, like virtually all foods that contain protein, can provoke allergic reactions in some individuals.

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[18] - Motoyama K, Ishizaki S, Nagashima Y, Shiomi K. Cephalopod tropomyosins: Identification as major allergens and molecular cloning. Food Chem Toxicol 2006;44:1997-2002

Heated extracts prepared from the mantle muscles (for decapods) or leg muscles (for octapods) of nine species of cephalopods were shown to be all reactive with serum IgE in crustacean-allergic patients. No marked difference in the reactivity with IgE was recognized among the cephalopods, suggesting that they are almost equally allergenic. Immunoblotting and inhibition immunoblotting data revealed that the major allergen is tropomyosin in common with the nine species of cephalopods and that the cephalopod tropomyosins are cross-reactive with one another and also with crustacean tropomyosins. Molecular cloning experiments first elucidated the primary structures of tropomyosins from five species of cephalopods. The cephalopod tropomyosins show high sequence identity (more than 92% identity) with one another, being the molecular basis for their cross-reactivity. Although the sequence identity between cephalopod and crustacean topomyosins is only about 63-64%, some of the IgE-binding epitopes proposed for brown shrimp Penaeus aztecus tropomyosin (Pen a 1) are well conserved in the cephalopod tropomyosins, supporting the cross-reactivity between cephalopod and crustacean tropomyosins.

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[19] - Lopata AL, Zinn C, Potter PC. Characteristics of hypersensitivity reactions and identification of a unique 49 kd IgE-binding protein (Hal m1) in abalone (Haliotis midae). J Allergy Clin Immunol 1997;100:642-648

There is a paucity of published data on the clinical presentation and the nature of the allergens involved in hypersensitivity to mollusks. This study reports the clinical and immunologic findings in 38 patients with reported immediate and delayed adverse reactions to abalone (Haliotis midae, Class Gastropoda). METHODS: Patients were recruited as part of a South African seafood allergy survey. Allergic symptoms were assessed by a self-administered questionnaire. A total of 38 patients with abalone sensitivity were recruited. Specific IgE responses to abalone and other mollusks were studied by using RAST and inhibition ELISAs. Skin prick tests and lymphocyte proliferation assays were also performed on several of the subjects. Allergenic components of Haliotis midae were identified with Western blotting. RESULTS: Twenty five of the 38 patients in the study were first seen with immediate symptoms, and 13 had delayed reactions. Seventeen of the sera tested were RAST positive. Skin prick tests responses with abalone extract were positive in all subjects with positive RAST responses (n = 8) and in 6 of 13 subjects with negative RAST responses. Five of the subjects with positive RAST responses had positive results on Western blotting and demonstrated binding to two major allergens with molecular weights of 38 and 49 kd. The 49 kd IgE-binding protein has been designated as Hal-m-1. CONCLUSIONS: Abalone allergens are heat-stable proteins with molecular weights of 38 and 49 kd, later designated as Hal-m-1 according to International Union of Immunological Societies allergen nomenclature regulation. Our studies indicate a clear clinical and immunologic heterogeneity in patients reactive to abalone.

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[20] - Lee BJ, Park HS. Common Whelk ( Buccinum undatum) Allergy: Identification of IgE-binding Components and Effects of Heating and Digestive Enzymes. J Korean Med Sci 2004;19:793-799

In Korea, common whelk (Buccinum undatum) is a popular edible shellfish. The aim of this study was to observe the sensitization rate to common whelk and to characterize its allergens. We carried out skin prick test (SPT) in 1,700 patients with various allergic diseases. Specific IgE were detected by ELISA in the patient sera and ELISA inhibition tests were conducted. IgE-binding components were identified by means of SDS-PAGE and IgE-immunoblotting. The effects of digestive enzymes were evaluated in both raw and thermally treated extracts. SPT to common whelk was positive (>/=2+) in 83 (4.9%) patients studied. Twenty-four (38.7%) out of 62 SPT positive patients had high serum specific IgE to common whelk. ELISA inhibition test showed significant inhibitions by abalone as well as by common whelk. IgE-immunoblotting demonstrated three IgE-binding components (40, 71, 82 kDa), which were digested by simulated intestinal fluid and moderately digested by simulated gastric fluid, and the digestibility of allergens remained unchanged after thermal treatment. In conclusion, IgE-sensitization rate to common whelk was 4.9% in allergy patients. IgE-immunoblotting demonstrated three IgE-binding components, which were degraded by digestive enzymes. Further studies are needed to evaluate the clinical significance of the sensitized patients to common whelk.

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[21] - Ishikawa M, Ishida M, Shimakura K, Nagashima Y, Shiomi K. Purification and IgE-binding epitopes of a major allergen in the gastropod Turbo cornutus. Biosci Biotechnol Biochem 1998;62:1337-1343

The major allergen (Tur c 1) in the muscle of the gastropod, Turbo cornutus, was isolated by Sephacryl S-300, Mono Q HR 5/5 and TSKgel Phenyl-5PW RP column chromatography. ELISA showed Tur c 1 to react strongly with sera from three individuals sensitive to both mollusks and crustaceans. SDS-PAGE showed Tur c 1 to produce a major band corresponding to a molecular mass of 35 kDa under the reduced condition. Its amino acid composition was characterized by the abundance of Glx, followed by Leu, Ala and Lys in decreasing abundance, and the absence of Trp. In addition to these properties, the determined partial amino acid sequence identified Tur c 1 to be a tropomyosin, as in the case of the known mollusk and crustacean allergens. However, the results of competitive ELISA inhibition experiments suggest that Tur c 1 has an IgE-binding epitope in the C-terminal region which is dissimilar to those proposed for Cra g 1 (the oyster Crassostrea gigas allergen) and Pen i 1 (the shrimp Penaeus indicus allergen).

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[22] - Lopata AL, Zinn C, Potter PC. Characteristics of hypersensitivity reactions and identification of a unique 49 kd IgE-binding protein (Hal m1) in abalone (Haliotis midae). J Allergy Clin Immunol 1997;100:642-648

There is a paucity of published data on the clinical presentation and the nature of the allergens involved in hypersensitivity to mollusks. This study reports the clinical and immunologic findings in 38 patients with reported immediate and delayed adverse reactions to abalone (Haliotis midae, Class Gastropoda). METHODS: Patients were recruited as part of a South African seafood allergy survey. Allergic symptoms were assessed by a self-administered questionnaire. A total of 38 patients with abalone sensitivity were recruited. Specific IgE responses to abalone and other mollusks were studied by using RAST and inhibition ELISAs. Skin prick tests and lymphocyte proliferation assays were also performed on several of the subjects. Allergenic components of Haliotis midae were identified with Western blotting. RESULTS: Twenty five of the 38 patients in the study were first seen with immediate symptoms, and 13 had delayed reactions. Seventeen of the sera tested were RAST positive. Skin prick tests responses with abalone extract were positive in all subjects with positive RAST responses (n = 8) and in 6 of 13 subjects with negative RAST responses. Five of the subjects with positive RAST responses had positive results on Western blotting and demonstrated binding to two major allergens with molecular weights of 38 and 49 kd. The 49 kd IgE-binding protein has been designated as Hal-m-1. CONCLUSIONS: Abalone allergens are heat-stable proteins with molecular weights of 38 and 49 kd, later designated as Hal-m-1 according to International Union of Immunological Societies allergen nomenclature regulation. Our studies indicate a clear clinical and immunologic heterogeneity in patients reactive to abalone.

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[23] - Chu KH, Wong SH, Leung PS. Tropomyosin Is the Major Mollusk Allergen: Reverse Transcriptase Polymerase Chain Reaction, Expression and IgE Reactivity. Mar Biotechnol (NY) 2000;2:499-509

The complementary DNAs encoding tropomyosins of the abalone Haliotis diversicolor, the scallop Chlamys nobilis, and the mussel Perna viridis were amplified by reverse transcriptase polymerase chain reaction and thereafter cloned in plasmid vectors for expression. Immunoblot analysis showed that recombinant proteins of abalone, scallop, and mussel tropomyosin were reactive to serum IgE antibodies from subjects allergic to shellfish but not to nonallergic controls. Nucleotide and amino acid sequences of abalone, scallop, and mussel tropomyosins are highly similar (mostly > 55%) to those of crustacean allergens identified as tropomyosins. Absorption experiments showed that recombinant tropomyosins from the 3 mollusks were able to remove serum IgE reactivity against the 38-kDa tropomyosin of the organisms. These results demonstrate that tropomyosin is the major allergen among various common edible mollusks. Yet a comparison between the amino acid sequences of putative epitopes in crustaceans and mollusks suggests that the epitopes in the two groups may be distinct. Parsimony analysis of the nucleotide sequences of tropomyosin from different mollusks suggests that the tropomyosin gene sequence is a useful tool for phylogenetic analysis of this group of animals.

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[24] - Choi JH, Yoon SH, Suh YJ, Suh CH, Nahm DH, Kim YK et al. Measurement of specific IgE to abalone (Haliotis discus hannai) and identification of IgE binding components. J Asthma Allergy Clin Immunol 2003;23:349-357

BACKGROUND: Abalone, which is a member of the shellfish family, can often induce severe allergic reactions in sensitized individuals, but there have been only a few studies ofn its allergenic components. A recent study has identified two major allergens with molecular weights of 38 and 49 kDa in South African abalone. OBJECTIVES: The aim of this study is to evaluate skin test prevalence and IgE sensitization to northern disk abalone (Haliotis discus hannai) which is one of the major abalones in this country, and to identify its allergenic components. METHODS: Skin prick tests were performed with 62 home-made extracts of domestic foods including abalone, turban shell, triton shell, shrimp etc. in 1,738 patients with various allergic diseases. Serum specific IgE antibodies to abalone were determined by ELISA in 81 positive responders on skin prick tests to abalone extract and 40 non-atopic healthy controls. ELISA inhibition tests were performed to evaluate cross-allergenecity between abalone and other sea foods(turban shell, triton shell, shrimp and house dust mite). Allergenic components of Haliotis discus hannai were identified by SDS-PAGE and IgE-immunoblot analysis. RESULTS: The positive response rate(A/H ratio> or=2+) to abalone on skin prick test was 4.7% in patients with various allergic diseases. Serum spcecific IgE to abalone was detected in 23(34.5%) of 67 patients. Serum specific IgE levels to abalone tended to increase according to skin test reactivity without statistical significance(p>0.05). ELISA inhibition tests showed significant dose-dependent inhibitions with addition of turban shell, triton shell and shrimp extracts IgE immunoblot analysis showed ten allergenic components (33, 37, 40, 60, 63, 71, 76, 86, 92, 111 kDa), of which seven allergens (40, 60, 63, 71, 76, 86, 92 kd) were bound to IgE in more than 50% of the sera tested. CONCLUSION: The sensitization rate to abalone was 4.7% in allergy patients. Serum specific IgE to abalone was detected by ELISA, and 7 major allergens within abalone were identified. Further studies will be needed to elucidate their clinical significances.

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[25] - Ishikawa M, Shimakura K, Nagashima Y, Shiomi K. Isolation and properties of allergenic proteins in the oyster Crassostrea gigas. Fisheries Sci 1998;63:610-614

Two allergens, designated as Cra gs 1 and 2, were isolated from oysters, Crassostrea gigas, by gel permeation chromatography on a Sephacryl S-300 column, ion exchange FPLC on a MonoQ HR 5/5 column or reverse phase HPLC on a TSKgel Phenyl 5PW-RP column. Although the allergens were separated from each other by ion exchange FPLC, they showed the same behaviour in gel permeation chromatography and reverse phase HPLC. Cra gs 1 and 2 were both 86 kDa glycoproteins with a carbohydrate content of approx. 5%, and were composed of 35 kDa subunits. They had high concn. of glutamic acid/glutamine, aspartic acid/asparagine, alanine and leucine, but were devoid of proline or tryptophan. Their reactivities against sera from sea food allergy patients were equivalent. Mol. masses and amino acid compositions suggest that the 2 Cra gs allergens are tropomyosin of C. gigas.

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[26] - Ishikawa M, Ishida M, Shimakura K, Nagashima Y, Shiomi K. Tropomyosin, the major oyster Crassostrea gigas allergen and its IgE-binding epitopes. J Food Sci 1998;63:44-47

The objectives of the study were to verify that the oyster (Crassostrea gigas) major allergen Cra g 1 is tropomyosin and to characterize its IgE-binding epitopes.] Cra g 1 isolated from oyster was digested with lysylendopeptidase [EC 3.4.21.50]. 21 peptide fragments were isolated from the digest by reverse-phase HPLC and some of them were sequenced. Cra g 1 was identified as tropomyosin. In competitive ELISA inhibition analyses of lysylendopeptidase fragments, a peptide (K21) showed max. inhibition of the binding of IgE antibodies in sensitive human serum to Cra g 1. On further tryptic hydrolysis of K21, 2 peptides exhibited high inhibitory ability equivalent to K21. Results suggested that Cra g 1 had an IgE-binding epitope in the segment 92-105 (IQLLEEDMERSEER) which was dissimilar to those of the major allergen (tropomyosin) from the shrimp Penaeus indicus.

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[27] - Leung PSC, Chu KH. cDNA cloning and molecular identification of the major oyster allergen from the Pacific oyster Crassostrea gigas. Clin Exp Allergy 2001;31:1287-1294

BACKGROUND: Shellfish is one of the most common food allergens. Despite the recent cloning and molecular identification of the major heat stable crustacean allergens in shrimp, lobster and crab, there have been no similar studies on molluscs to which a significant portion of populations allergic to shellfish are also hypersensitive. Recent biochemical evidence suggests that tropomyosin is also an allergen in molluscs, but data on the molecular cloning, nucleotide sequencing, expression and IgE binding to mollusc tropomyosin are lacking . OBJECTIVE: This study was undertaken to clone, identify and determine the primary structure of a major IgE-reactive mollusc allergen in oyster at the DNA and protein level . METHODS: We constructed an expression cDNA library from the Pacific oyster Crassostrea gigas. This library was screened for IgE binding clones using sera from 15 subjects with a well-documented history of type I hypersensitivity reactions to oysters. An IgE reactive clone was selected and sub-cloned into plasmids for nucleotide sequence determination and expression in E. coli . RESULTS: We identified a 1.3-kb cDNA designated as Cra g 1.03. Expression of Cra g 1.03 in plasmid vector pGEX produced a 59-kDa recombinant fusion protein reactive to the IgE antibodies from patients with oyster allergies but not non-allergic controls. Cra g 1.03 has an open reading frame of 233 amino acids and demonstrates marked similarity in amino acid composition and peptide sequence with mollusc and crustacean tropomyosins. Absorption of oyster allergic sera with Cra g 1.03 totally removed IgE reactivity to oyster extract. Moreover, absorption of allergic sera with recombinant shrimp tropomyosin (Met e 1), lobster tropomyosin (Pan s 1) and crab tropomyosin (Cha f 1) removed most of the IgE reactivity to Cra g 1.03 . CONCLUSION: Cra g 1.03 is the first oyster allergen identified at the molecular level. Nucleotide and amino acid comparison shows that this protein is the oyster tropomyosin.

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[28] - Chu KH, Wong SH, Leung PS. Tropomyosin Is the Major Mollusk Allergen: Reverse Transcriptase Polymerase Chain Reaction, Expression and IgE Reactivity. Mar Biotechnol (NY) 2000;2:499-509

The complementary DNAs encoding tropomyosins of the abalone Haliotis diversicolor, the scallop Chlamys nobilis, and the mussel Perna viridis were amplified by reverse transcriptase polymerase chain reaction and thereafter cloned in plasmid vectors for expression. Immunoblot analysis showed that recombinant proteins of abalone, scallop, and mussel tropomyosin were reactive to serum IgE antibodies from subjects allergic to shellfish but not to nonallergic controls. Nucleotide and amino acid sequences of abalone, scallop, and mussel tropomyosins are highly similar (mostly > 55%) to those of crustacean allergens identified as tropomyosins. Absorption experiments showed that recombinant tropomyosins from the 3 mollusks were able to remove serum IgE reactivity against the 38-kDa tropomyosin of the organisms. These results demonstrate that tropomyosin is the major allergen among various common edible mollusks. Yet a comparison between the amino acid sequences of putative epitopes in crustaceans and mollusks suggests that the epitopes in the two groups may be distinct. Parsimony analysis of the nucleotide sequences of tropomyosin from different mollusks suggests that the tropomyosin gene sequence is a useful tool for phylogenetic analysis of this group of animals.

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[29] - Song J, Li L, Liu Z, Li Q, Ran P. Sequence analysis and expression of a cDNA clone encoding tropomyosin in Sinonovacula constricta. Mol Biol Rep 2009;36:315-321

Shellfish can cause severe anaphylactic reactions. Tropomyosin has been assumed partly responsible for the cross-reactivity among shellfish and other invertebrates. In this study, cDNA of Sinonovacula constricta was amplified by RT-PCR and 3'-RACE from total RNA. The obtained tropomyosin cDNA included an open reading frame coding for 284 amino acids. The deduced amino acid sequence of the corresponding protein shared high identity with other allergenic tropomyosins. Expression of the recombinant tropomyosin was carried out in Escherichia coli BL21(DE3) using vector PET28a and the purification of the recombinant protein was performed via affinity chromatography. IgE reactivity of recombinant tropomyosin was investigated by immunoblot and the sensized precentage was 36% which indicated that tropomyosin was the minor allergens in S. constricta. Moreover, the character of the purified protein was analyzed by MALDI-TOF-MS

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[30] - Jiménez M, Pineda F, Sanchez I, Orozco I, Senent C. Allergy due to Ensis macha. Allergy 2005;60:1090-1091

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[31] - Leung PS, Chu KH. Molecular and immunological characterization of shellfish allergens. Front Biosci 1998;3:306-312

Shellfish (crustaceans and mollusks) have long been known as a common cause of allergic reactions to food. Like other food allergies, the allergic reactions to shellfish involve IgE-mediated Type I hypersensitivity. Biochemical and molecular studies have documented the major shrimp allergen is the muscle protein tropomyosin. Subsequent molecular cloning studies on lobsters and crabs have characterized this protein as the common allergen in crustaceans. There has also been strong immunological evidence that tropomyosin is a cross-reactive allergen among crustaceans and mollusks. This is further confirmed by recent studies on the identification of allergens in squid and abalone. The advances in the characterization of shellfish allergens will not only enhance our understanding on the physiological basis of shellfish allergy but also lay the groundwork for the development of diagnostic and therapeutic design in food allergies.

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[32] - Miyazawa H, Fukamachi H, Inagaki Y, Reese G, Daul CB, Lehrer SB, et al. Identification of the first major allergen of a squid (Todarodes pacificus). J Allergy Clin Immunol 1996;98:948-953

In Japan, squid is an important seafood, and some patients with food allergies are sensitive to squid. There has been no report, however, describing the major allergens of squid. OBJECTIVE: To characterize squid allergens, we isolated a major allergen from the Pacific flying squid (Todarodes pacificus) and compared it with a major allergen from a shrimp (Penaeus orientalis). METHODS: The major squid and shrimp allergens were isolated by column chromatography on diethylaminoethyl-Sepharose (Pharmacia, Uppsala, Sweden), hydroxylapatite, and Sephacryl S-300 (Pharmacia). The IgE reactivity of the isolated allergens was assessed by immunoblotting. The cross-reactivity between the squid and shrimp allergens was examined by use of mouse polyclonal and monoclonal antibodies to the major allergens. Amino acid sequence analyses of the isolated allergens were done. RESULTS: The isolated squid allergen is a 38 kd, heat-stable protein. IgE antibody binding to the purified squid allergen was demonstrated by immunoblotting. Cross-reactivity between major squid and shrimp allergens was demonstrated with sera from patients allergic to squid or shrimp or with allergen-specific monoclonal antibodies. The amino acid sequence analysis of the major squid allergen showed a marked homology with tropomyosin from blood fluke planorbid (Biomphalaria glabrata), which is a common vector snail of Schistosoma mansoni. CONCLUSION: This 38 kd protein is a major allergen of the squid, Todarodes pacificus, and is believed to be squid muscle protein tropomyosin. We named it Tod p 1 according to International Union of Immunological Societies allergen nomenclature regulation.

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[33] - Ishikawa M, Suzuki F, Ishida M, Nagashima Y, Shiomi K. Identification of tropomyosin as a major allergen in Octopus vulgaris and elucidation of its IgE-binding epitopes. Fisheries Sci 2001;67:934-942

ABSTRACT: The major allergen (named Oct v 1) in the muscle of the octopus Octopus vulgaris was purified by gel filtration on Sephacryl S-300, anion-exchange fast protein liquid chromatography on Mono Q and reverse-phase high-pressure liquid chromatography on TSKgel Octadecyl-4PW. In addition to the molecular mass, amino acid composition and cross-reactivity with Tur c 1 (turban shell Turbo cornutus allergen), the determined partial amino acid sequence clearly demonstrated that Oct v 1 is tropomyosin, similar to the known molluscan and crustacean allergens. Using peptide fragments isolated from the lysylendopeptidase digest of Oct v 1, competitive enzyme-linked immunosorbant assay inhibition experiments showed that IgE-binding epitopes of Oct v 1 are contained in two peptides (77ˆ112 and 148ˆ160) in the central region and one peptide (269ˆ281) in the C-terminal region. In the peptide 77ˆ112, the same sequence as the IgE-binding epitope proposed for Cra g 1 (oyster Crassostrea gigas allergen) is recognized at 92-105. Moreover, the peptide 148-160 partly overlaps with the IgE-binding epitopes suggested for Pen i 1 (shrimp Penaeus indicus allergen) and Pen a 1 (shrimp Penaeus aztecus allergen), and the peptide 269ˆ281 with those for Tur c 1 and Pen a 1.

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[34] - Motoyama K, Ishizaki S, Nagashima Y, Shiomi K. Cephalopod tropomyosins: Identification as major allergens and molecular cloning. Food Chem Toxicol 2006;44:1997-2002

Heated extracts prepared from the mantle muscles (for decapods) or leg muscles (for octapods) of nine species of cephalopods were shown to be all reactive with serum IgE in crustacean-allergic patients. No marked difference in the reactivity with IgE was recognized among the cephalopods, suggesting that they are almost equally allergenic. Immunoblotting and inhibition immunoblotting data revealed that the major allergen is tropomyosin in common with the nine species of cephalopods and that the cephalopod tropomyosins are cross-reactive with one another and also with crustacean tropomyosins. Molecular cloning experiments first elucidated the primary structures of tropomyosins from five species of cephalopods. The cephalopod tropomyosins show high sequence identity (more than 92% identity) with one another, being the molecular basis for their cross-reactivity. Although the sequence identity between cephalopod and crustacean topomyosins is only about 63-64%, some of the IgE-binding epitopes proposed for brown shrimp Penaeus aztecus tropomyosin (Pen a 1) are well conserved in the cephalopod tropomyosins, supporting the cross-reactivity between cephalopod and crustacean tropomyosins.

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[35] - Jeong KY, Hong CS, Yong TS. Allergenic tropomyosins and their cross-reactivities. Protein Pept Lett 2006;13:835-845

The ingestion or inhalation of some proteins may lead to adverse immune reactions. Allergens may trigger allergic reactions in genetically predisposed individuals when they are absorbed through the skin or make contact with mucous membranes. An allergic disease often deteriorates the quality of life and may sometimes be life-threatening due to anaphylactic shock. A number of allergens have been characterized from various multicellular organisms to date. It is thought to be reasonable to pay a special attention to the substance which is highly cross-reactive and which causes adverse responses in the molecules that are not sensitized but similar to the sensitized allergen. Tropomyosin has been described as an important food allergen in shrimp, lobster, crab, oysters, squid, and other invertebrates. Allergic reactions to shellfish and mollusks are often cross-reactive, which may be explained by the highly conserved amino acid sequences of tropomyosins among invertebrates, but vertebrate tropomyosins are not known to be allergenic. Several tropomyosins from domestic arthropods have been reported to be allergenic. Recently, it was suggested that an infection of helminthic parasites might lead to sensitization to tropomyosin and elicit allergic reactions to other invertebrates. Much effort has been made to characterize these allergenic tropomyosins from various sources. We will discuss the physicochemical characteristics and the potential application of tropomyosin for the diagnosis and therapeutics of allergic disorders.

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[36] - Caiado J, Lundberg M, Öman H, Pedro E, Pereira-Santos MC, Pereira Barbosa MA. Isolated snail allergy without house dust mites sensitization: case-report. Allergy 2007;62(suppl. 83):218-219

Background: Snail consumption is frequent in the Mediterranean area. It has been recognized as a food allergy with a significant association with known respiratory house dust mite (HDM) sensitization. This fact is usually due to cross-sensitization to the major allergen, tropomyiosin, present in HDM, seafood, snail and cockroach. Snail allergy can have some different clinic presentations namely asthma, urticaria, angioedema, anaphylaxis or even death. There have been very few case-reports of isolated snail allergy, in the absence of HDM sensitization. Case report: The authors report a 49-year-old man, who was admitted to the Immunoallergology Department in 2006 with bilateral eyelid oedema, itchy lip and throat and dysphonia, thirty minutes after snail ingestion, denying either urticaria or dyspnoea. He had no history of previous respiratory symptoms related to HDM allergy. The patient was submitted to skin prick tests (SPT) with HDM and other aeroallergens, namely cockroach, which were negative. SPT with snail extract (Helix aspersa- Bial Aristegui˙) and prick-to-prick with cooked and raw snail were positive and negative to all other food allergens, namely seafood. Specific IgE (Unicap-Phadia˙) to HDM and tropomyosin were negative (< 0.35 kUA/l) and positive to snail- Helix aspersa (0.89 kUA/l ˆ class II). Total IgE: 66.0 kU/l. Immunoblotting of serum sample of the patient was performed in Sweden (manufactured by MIAB- Phadia˙) and it was identified one, and probably two new bands, 55 and 95 kDa, respectively, which were not paralleled by similar bands on control sample, i.e. they were specific for the patient. The absence of HDM sensitization was confirmed in Sweden with determination of native protein of Dermatophagoides pteronyssinus (n Der p1) and tropomyosin which were negative. Discussion: The peculiarity of this case-report is based on the fact that snail allergy without cross-sensitization with HDM is very uncommon. Some authors have described some bands of this species of snail (Helix aspersa), but in this patient there was identified one (55 kDa) and probably two (95 KDa) new bands, not referred in the literature until now. They are, probably, minor allergens possibly responsible for snail allergy in this patient.

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[37] - San Miguel-Moncín MM, Pineda F, Llamas E, Amat P, García R, García-Rubio I, et al. Octopus hypersensitivity. Allergy 2007;62(suppl. 83):330

Background: Shellfish have been recognized as potent allergens both in food allergy and occupational allergy. Of these, shrimp has received the most attention, but hypersensitivity to cephalopods has been rarely reported. A case report of octopus allergy without hypersensitivity to other cephalodods is described, being allergens involved studied. Methods: A 52-years old woman attended our Allergy Department. During last three years she had suffered several episodes of labial angioedema after octopus ingestion. Recently, she had been attended in the emergency room because of an episode of labial, lingual and facial angioedema with difficult to breath and wheezing treated with epinephrine which appeared immediately after ingesting octopus. After this last episode she had eaten in several occasions squid, cuttlefish, shrimp, crab, Norway lobster and velvet crabs without any adverse reaction. Skin prick tests (SPT) with panels of inhalants including dust mites, food allergens including anisakis, crustaceans and molluscs, and prick-by-prick with raw and cooked octopus, squid and cuttlefish were performed. In vitro immunoassays were carried out in order to asses the pattern of IgE reactivity. Results: SPT with panels of inhalants, food allergens, crustaceans and molluscs were negative. Prick-by-prick with raw and cooked squid and cuttlefish were also negative. Prick-by-prick with both raw and cooked octopus showed an immediate positive wheal (7x7 mm). Determination of specific IgE by enzyme allergosorbent test (EAST) (Hycor) to octopus gave 6,48 UI/mL, while was negative to squid, cuttlefish and shrimp. SDS-PAGE immunoblotting of squid, cuttlefish and octopus extracts showed a strong IgE-binding band of about 16-18 kDa. Not any IgE-binding band appeared with squid and cuttlefish extracts. Conclusions: A case report of hypersensitivity to octopus without allergy to other molluscs and crustaceans is described. To our knowledge, this is the first report of an allergen of about 16-18 kDa is involved in octopus allergy.

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[38] - Leung PS, Chow WK, Duffey S, Kwan HS, Gershwin ME, Chu KH. IgE reactivity against a cross-reactive allergen in crustacea and mollusca: evidence for tropomyosin as the common allergen. J Allergy Clin Immunol 1996;98:954-961

Although cross-reactivity between mollusks and other crustaceans in shrimp-sensitive subjects has been reported, the mechanism of this allergenic cross-reactivity has not been studied in detail. OBJECTIVE: To investigate this cross-reactivity in vitro, we have taken advantage of a complementary DNA that expresses tropomyosin, the immunodominant shrimp allergen. METHODS: Serum IgE from nine patients with known anaphylaxis to shrimp and five normal volunteers were analyzed by immunoblotting against 13 distinct crustaceans and mollusks. As additional antigens, muscle preparations were isolated from grasshopper, cockroach, fruit fly, chicken, and mouse. RESULTS: Sera from all patients, but not control subjects, reacted specifically with a 38 kd protein in all crustaceans and mollusks studied. In addition, 8 of 9 sera from patients, but from none of the normal control subjects, recognized proteins of various other molecular weights among the mollusk extracts studied. The 38 kd protein was identified as tropomyosin and was shown to share immunodominant epitopes among all species of crustaceans and mollusks tested by specific absorption studies. Moreover, sera from all nine subjects with shrimp allergy demonstrated IgE reactivities against grasshopper, cockroach, and fruit fly but not chicken or murine muscle. CONCLUSION: The allergic epitopes on tropomyosin are conserved among invertebrates including not only shellfish but also insects. This latter observation suggests that persons sensitive to shrimp should undergo further study for potential cross-reactive inhalant or ingested insect sensitivity.

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[39] - Jiménez M, Pineda F, Sanchez I, Orozco I, Senent C. Allergy due to Ensis macha. Allergy 2005;60:1090-1091

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[40] - Lin RY, Shen HD, Han SH. Identification and characterization of a 30 kd major allergen from Parapenaeus fissurus. J Allergy Clin Immunol 1993;92:837-845

The allergenic components of the shrimp (Parapenaeus fissurus) were identified by immunoblotting with sera from 10 allergic patients. Six components, ranging in molecular weight from about 86 to 39 kd, showed IgE-binding activity and were identified as allergens of the shrimp. The component with a molecular weight of about 39 kd showed the highest frequency of IgE binding (70%) and was considered to be one of its major allergens. Two monoclonal antibodies against this 39 kd component were generated, and their antigenic cross-reactivity with five different kinds of seafood, shrimp, crab, cuttlefish, oyster, and pomfret was analyzed Monoclonal antibody 1-6-10B reacted with the 39 kd component from shrimp only, but monoclonal antibody 2-7-1E also reacted with the 39 kd component from crab. By extraction with 0.5% sodium dodecylsulfate and ethanol precipitation, a highly purified shrimp 39 kd component was obtained. In two-dimensional gel electrophoresis six isoforms of this purified 39 kd component, with isoelectric point values from 5.1 to 5.6, were identified No marked difference was observed when the amino acid composition of this purified 39 kd allergen was compared with those of serum albumin from different animals. They all contain a high proportion of acidic amino acids. There was also a 62% to 83% sequence homology among three different pairs of peptide fragments of purified 39 kd components of shrimp and crab. In conclusion, a 39 kd major allergen from the shrimp has been identified and characterized in the present study. According to the suggestions of the International Union of Immunological Societies, this allergen is designated as Par f I.

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[41] - Koshte VL, Kagen SL, Aalberse RC. Cross-reactivity of IgE antibodies to caddis fly with arthropoda and mollusca. J Allergy Clin Immunol 1989;84:174-183

We investigated the possibility that subjects with IgE antibodies to an inhalant insect allergen, such as caddis fly, might also have antibodies to cross-reacting carbohydrate determinants (CCDs). IgE antibodies to cross-reacting allergens in caddis flies, mussels, oysters, shrimps, crabs, honeybee, and yellow jacket venoms were determined by RAST, RAST inhibition, and immunoblot studies with sera from three different sources: (1) sera of patients with well-defined inhalant atopy to caddis fly, (2) sera with IgE anti-CCD antibodies from subjects without known exposure to caddis fly, and (3) hyperimmune antisera with IgG anti-CCD antibodies raised as a result of immunization of rabbits with grass-pollen extract, buckwheat glycoprotein, or with honeybee venom. Sera from groups 2 and 3 reacted with Sepharose-coupled caddis fly extract in a RAST-type assay and elicited virtually identical patterns on immunoblots of caddis fly extract separated on sodium dodecyl sulfate-polyacrylamide gel electrophoresis, whereas the sera from group 1 atopic patients did not react with CCD-rich material. However, indications for other types of cross-reacting antibodies were detected. The IgE antibodies of one of the patients studied (who was allergic not only to caddis fly but also to shellfish) were found to detect a cross-reacting homologous protein in extracts of mussel, oyster, shrimp, crab, honeybee, and yellow jacket venom. Preliminary results suggest that this cross-reacting 13 kd protein, the most prominent caddis fly allergen, is an invertebrate hemoglobin (erythrocruorin)-like molecule. These studies suggest the possibility that patients sensitized by exposure to caddis fly antigens could develop allergic reactions during their first exposure to shellfish or to their first bee sting

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[42] - Morikawa A, Kato M, Tokuyama K, Kuroume T, Minoshima M, Iwata S. Anaphylaxis to grand keyhole limpet (abalone-like shellfish) and abalone. Ann Allergy 1990;65:415-417

We report five patients who developed moderate to severe anaphylactic reactions induced by the ingestion of grand keyhole limpet (GKL) and abalone. Specific IgE-mediated hypersensitivity to these shellfish was demonstrated by history, prick skin test, and RAST. RAST inhibition technique revealed the cross-antigenicity between GKL, abalone, and keyhole limpet hemocyanin.

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[43] - Juji F, Takashima H, Suko M, Doi M, Takaishi T, Okudaira H, et al. [A case of food-dependent-exercise induced anaphylaxis possibly induced by shellfish (Sulculus Supertexta and Turbo Cornutus)]. Arerugi 1990;39:1515-1522

A 17 years old girl experienced an anaphylactic reaction of urticaria, dyspnea, syncope and hypotension while riding a bicycle 55 minutes after eating shellfish Lapas shellfish which was a-like Sulculus Supertexta (SS). She recovered within several hours after the emergency treatment. Another attack occurred 3 months later while she was running with a dog 30 minutes after eating shellfish (Turbo Cornutus; TC). RAST scores were 4 for Lapas and 2 for TC. RAST inhibition test by ELISA showed a high crose-reaction between keyhole limpet hemocyanin (KLH) and Lapas, and between KLH and TC, while the cross reaction between Lapas and TC was low. Gel chromatography with sephacryl G-200 revealed that both Lapas and TC had several allergens with different molecules which were detected by ELISA. Exercise challenge produced an immediate fall of FEV1 and a significant increase in plasma histamine levels for 45 minutes.

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[44] - Maeda S, Morikawa A, Kato M, Motegi Y, Shigeta M, Tokuyama K, et al. [11 cases of anaphylaxis caused by grand keyhole limpet (abalone like shellfish)]. Arerugi 1991;40:1415-1420

We reported 11 cases of patients who developed moderate to severe anaphylactic reactions induced by the ingestion of grand keyhole limpet (GKL) and abalone. Specific IgE-mediated hypersensitivity to these shellfish was demonstrated by history, skin prick test, RAST and immunoblotting. The RAST inhibition technique revealed cross antigenicity between GKL, abalone and keyhole limpet hemocyanin. By immunoblotting analysis, the major antigens of GKL are shown in the MW range of about 38 Kd and 80 Kd.

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[45] - San Miguel-Moncin M, Pineda F, Amat P, Lluch- Perez M, Malet A, Garcia-Rubio I, et al. Identification on an octopus allergen. Allergy 2008;63(suppl. 88):587

Background: Nowadays the relevance of identificating new food allergens is pointed out. Proteomic methods have been used to identify proteins that may have an special role in food science. Hypersensitivity to shellfish is quite common, and people who are sensitive can react to different types of shellfish. A case-report of octopus hypersensitivity is presented, being the allergen involved studied by proteomic methods. Methods: A 52-years old woman attended our Allergy Department. During last three years she suffered several episodes of labial angioedema after octopus ingestion. Recently, she attended an emergency unit because of labial, lingual and facial angioedema with difficult to breath and wheezing treated with epinephrine which appeared immediately after ingesting octopus. After that she had eaten several times squid, cuttlefish, shrimp, crab, Norway lobster and velvet crabs without any adverse reaction. Skin prick tests (SPT) with panels of inhalant and food allergens, and in vitro immunoassays were carried out. Results: SPT with panels of inhalants including dust mites, food allergens including anisakis, crustaceans and molluscs were negative. Prick-by-prick with raw and cooked squid and cuttlefish were also negative. Prick-by-prick with both raw and cooked octopus showed an immediate positive wheal (7_7 mm). Determination of specific IgE by enzyme allergosorbent test (EAST) (Hycor) to octopus gave 6.48 UI/ mL, while was negative to squid, cuttlefish and shrimp. SDS-PAGE immunoblotting of squid, cuttlefish and octopus extracts showed a strong IgE-binding band of 15 kDa in octopus, whereas no IgE-binding band appeared with squid and cuttlefish extracts. To identify the IgE-binding band protein found, proteomic methods were carried out throughout peptide mass ŒŒfingerprinting‚‚ and MS-MS spectra approach. Using mass spectrometry analysis of protein spots and once was identified using NCBI database, we found that this protein could correspond to a fragment of the actine. Conclusions: A case report of hypersensitivity to octopus without allergy to other molluscs and crustaceans is described. To our knowledge, this is the first report of an allergen of about 15 kDa identified as a fragment of actine is involved in octopus allergy.

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[46] - Lourenço Martins LM, Peltre G, Fialho da Costa Faro CJ, Vieira Pires EM, Fernando da Cruz Inacio F. The Helix aspersa (Brown Garden Snail) Allergen Repertoire. Int Arch Allergy Immunol 2005;136:7-15

BACKGROUND: Ingestion of snails can induce strong asthmatic or anaphylactic responses, mainly in house-dust-mite-sensitized patients. The aim of this study was to identify the Helix aspersa (Hel a), Theba pisana (The p) and Otala lactea (Ota l) allergens and the extent of their cross-reactivity with the Dermatophagoides pteronyssinus (Der p) mite. PATIENTS AND METHODS: In 60 atopic patients, skin prick tests (SPT) to snail and D. pteronyssinus, total and specific IgE, specific IgE immunoblots, RAST and immunoblot inhibition assays were performed . RESULTS: Mean total IgE was >1,000 kU/l. Mean specific IgE (class 6 for Der p and class 2 for Hel a) SPT were positive in 44 patients for snail and in 56 for mite. Isoelectric focusing (IEF) and SDS-PAGE followed by immunoblotting of H. aspersa extract enabled the identification of 27 and 20 allergens, respectively. Myosin heavy chains from snails (molecular weight >208 kDa) disclosed two major allergens. Hel a and Der p RAST were strongly inhibited by their homologous extracts, with Hel a RAST being inhibited by the Der p extract to a much greater extent (72.6%) than the inverse (5.6%). A complete inhibition of the immunoblots by their homologous extract was obtained. However, Hel a extract did not inhibit Der p IEF separated recognition. On the other hand, mite extract extensively inhibited snail immunoblots from both IEF and SDS-PAGE separations. Immune detection on chicken, pig, rabbit, cow and horse myosins did not reveal any IgE cross recognition with snail . CONCLUSIONS: In most cases of snail allergy, mite appeared to be the sensitizing agent. Nevertheless, snails may also be able to induce sensitization by themselves. This hypothesis is supported by the finding of specific IgE to Hel a in 2 patients who did not show specific IgE to Der p, and one of them was suffering from asthma after snail ingestion.

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[47] - Azofra J, Lombardero M. Limpet anaphylaxis: cross-reactivity between limpet and house-dust mite Dermatophagoides pteronyssinus. Allergy 2003;58:146-149

BACKGROUND: Limpet is a mollusc that is frequently found along the shores of warm seas. Few allergic reactions to limpet have been described, and cross-reactivity with house-dust mites has not been established . METHODS: We report five patients with anaphylactic reactions due to limpet ingestion. A limpet extract was prepared and skin prick tests (SPT), radioallergosorbent assays (RAST), sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE-immunoblotting were performed. In order to evaluate cross-reactivity, an immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done . RESULTS: All patients were asthmatics sensitized to house-dust mites. In each case, severe bronchospasm was evidenced, and three required mechanical ventilation. Positive SPT with limpet extract was found in the four patients tested. RAST showed specific IgE on each patient's sera. Immunoblotting showed several allergenic fractions with a wide molecular weight range (15-250 kDa). D. pteronyssinus inhibited IgE-binding molecules above 50 kDa in the limpet extract, particularly one molecule of 75 kDa . CONCLUSIONS: We describe five patients with IgE-mediated limpet allergy. Severe bronchospasm was the most important symptom. Cross-reactivity with D. pteronyssinus was demonstrated.

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[48] - de la Cuesta CG, Garcia BE, Cordoba H, Dieguez I, Oehling A. Food allergy to Helix terrestre (snail). Allergol Immunopathol (Madr) 1989;17:337-339

Among the rare foods capable of producing food allergies is the snail (Helix terrestre). The snail is a delicacy eaten in Spain, France and Portugal. This study presents the findings of an allergic study of 10 patients with this infrequent food allergy during the past 10 years. The shock organ in the majority (80%) of these patients was the bronchial tree. Six of them did not have any digestive or skin symptoms which are usually seen in cases of food allergy. All patients manifested the symptomatology after ingestion of Helix terrestre. Two also had reactions after eating Patella vulgata (limpet). The snail and the limpet are within the phylogenetic line of molluscs, i.e. of gastropods. All patients tolerated the ingestion of cephalopods and bivalves which belong to two other phylogenetic lines. Skin tests to seafoods (squids, prawns, lobsters and clams) were negative for all patients. This suggests that the sensitizing antigen is probably a protein found only in gastropod molluscs. Skin tests along with the histamine release test were valid diagnostic methods for this food allergy. The limited bibliography on this subject is probably due to the fact that the consumption of snails as well as limpets is limited to specific geographical areas.

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[49] - Carrillo T, Rodriguez de Castro F, Blanco C, Castillo R, Quiralte J, Cuevas M. Anaphylaxis due to limpet ingestion. Ann Allergy 1994;73:504-508

Limpet consumption (raw, grilled, or as part of soups or rice dishes) is common in the Canary Islands. Limpet hypersensitivity in 6 patients with anaphylactic reactions 30-120 min after limpet ingestion was studied. All patients had positive skin prick tests to commercially available aeroallergens (including house dust mites (Dermatophagoides pteronyssinus), cockroach, fungi, pollens, and common foods) and cooked limpet extract (CLE). Weak reactivity to cockroach and raw limpet extract was also observed during skin prick tests. Specific IgE to mites and CLE were found using the in vitro immunocap and RAST methods, respectively. Results suggest that limpets are a potentially dangerous allergen, especially in patients sensitive to the house dust mite.

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[50] - Azofra J, Lombardero M. Limpet anaphylaxis: cross-reactivity between limpet and house-dust mite Dermatophagoides pteronyssinus. Allergy 2003;58:146-149

BACKGROUND: Limpet is a mollusc that is frequently found along the shores of warm seas. Few allergic reactions to limpet have been described, and cross-reactivity with house-dust mites has not been established . METHODS: We report five patients with anaphylactic reactions due to limpet ingestion. A limpet extract was prepared and skin prick tests (SPT), radioallergosorbent assays (RAST), sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE-immunoblotting were performed. In order to evaluate cross-reactivity, an immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done . RESULTS: All patients were asthmatics sensitized to house-dust mites. In each case, severe bronchospasm was evidenced, and three required mechanical ventilation. Positive SPT with limpet extract was found in the four patients tested. RAST showed specific IgE on each patient's sera. Immunoblotting showed several allergenic fractions with a wide molecular weight range (15-250 kDa). D. pteronyssinus inhibited IgE-binding molecules above 50 kDa in the limpet extract, particularly one molecule of 75 kDa . CONCLUSIONS: We describe five patients with IgE-mediated limpet allergy. Severe bronchospasm was the most important symptom. Cross-reactivity with D. pteronyssinus was demonstrated.

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[51] - Maeda S, Morikawa A, Kato M, Motegi Y, Shigeta M, Tokuyama K, et al. [11 cases of anaphylaxis caused by grand keyhole limpet (abalone like shellfish)]. Arerugi 1991;40:1415-1420

We reported 11 cases of patients who developed moderate to severe anaphylactic reactions induced by the ingestion of grand keyhole limpet (GKL) and abalone. Specific IgE-mediated hypersensitivity to these shellfish was demonstrated by history, skin prick test, RAST and immunoblotting. The RAST inhibition technique revealed cross antigenicity between GKL, abalone and keyhole limpet hemocyanin. By immunoblotting analysis, the major antigens of GKL are shown in the MW range of about 38 Kd and 80 Kd.

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[52] - Carrillo T, de Castro FR, Cuevas M, Caminero J, Cabrera P. Allergy to limpet. Allergy 1991;46:515-519

Allergy to mollusk has rarely been described. The limpet, belonging to Phylum mollusca, is one of the most frequent mollusks in the Canary Islands, as in all warm maritime regions. We report two cases of atopic patients who developed anaphylactic reactions after ingestion of this mollusk. Type I hypersensitivity to limpet antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, and histamine release test to cooked limpet extract. The controls did not react to any of these tests. Allergic activity was only found with a cooked limpet extract; this suggests that the offending antigen/s may have been released by cooking this food.

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[53] - Carrillo T, Rodriguez de Castro F, Blanco C, Castillo R, Quiralte J, Cuevas M. Anaphylaxis due to limpet ingestion. Ann Allergy 1994;73:504-508

Limpet consumption (raw, grilled, or as part of soups or rice dishes) is common in the Canary Islands. Limpet hypersensitivity in 6 patients with anaphylactic reactions 30-120 min after limpet ingestion was studied. All patients had positive skin prick tests to commercially available aeroallergens (including house dust mites (Dermatophagoides pteronyssinus), cockroach, fungi, pollens, and common foods) and cooked limpet extract (CLE). Weak reactivity to cockroach and raw limpet extract was also observed during skin prick tests. Specific IgE to mites and CLE were found using the in vitro immunocap and RAST methods, respectively. Results suggest that limpets are a potentially dangerous allergen, especially in patients sensitive to the house dust mite.

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[54] - Azofra J, Lombardero M. Limpet anaphylaxis: cross-reactivity between limpet and house-dust mite Dermatophagoides pteronyssinus. Allergy 2003;58:146-149

BACKGROUND: Limpet is a mollusc that is frequently found along the shores of warm seas. Few allergic reactions to limpet have been described, and cross-reactivity with house-dust mites has not been established . METHODS: We report five patients with anaphylactic reactions due to limpet ingestion. A limpet extract was prepared and skin prick tests (SPT), radioallergosorbent assays (RAST), sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE-immunoblotting were performed. In order to evaluate cross-reactivity, an immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done . RESULTS: All patients were asthmatics sensitized to house-dust mites. In each case, severe bronchospasm was evidenced, and three required mechanical ventilation. Positive SPT with limpet extract was found in the four patients tested. RAST showed specific IgE on each patient's sera. Immunoblotting showed several allergenic fractions with a wide molecular weight range (15-250 kDa). D. pteronyssinus inhibited IgE-binding molecules above 50 kDa in the limpet extract, particularly one molecule of 75 kDa . CONCLUSIONS: We describe five patients with IgE-mediated limpet allergy. Severe bronchospasm was the most important symptom. Cross-reactivity with D. pteronyssinus was demonstrated.

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[55] - Joral A, Navarro JA, Villas F, Garmendia J, Villarreal O. Limpet anaphylaxis. Allergy 1997;52(suppl. 37):117

Limpet (Patella vulgata) is a gasteropod mollusc, which is seldom consumed in our country. Due to this, the observation of adverse reactions is exceptional. We present two patients who experienced immediate anaphylaxis after the intake of limpets. Both of them had a concomitant house dust mite (HDM) hypersensitivity. Cross reactivity has already been described between HDM and other molluscs and crustaceans. Case1 : female 26y Rhinoconjunctivitis and mild asthma to HDM and anaphylaxis to limpet Skin tests+ for HDM and Limpet Case1 : male 20y Rhinoconjunctivitis to HDM and anaphylaxis to limpet Skin tests+ for HDM and Limpet The clinical picture of the adverse reaction to limpets, the atopic background and the results of skin tests suggest an IgE mechanism. Other groups have previously described limpet specific IgE in similar cases, although no cross reactivity was demonstrated between HDM and limpets

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[56] - Morikawa A, Kato M, Tokuyama K, Kuroume T, Minoshima M, Iwata S. Anaphylaxis to grand keyhole limpet (abalone-like shellfish) and abalone. Ann Allergy 1990;65:415-417

We report five patients who developed moderate to severe anaphylactic reactions induced by the ingestion of grand keyhole limpet (GKL) and abalone. Specific IgE-mediated hypersensitivity to these shellfish was demonstrated by history, prick skin test, and RAST. RAST inhibition technique revealed the cross-antigenicity between GKL, abalone, and keyhole limpet hemocyanin.

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[57] - Maeda S, Morikawa A, Kato M, Motegi Y, Shigeta M, Tokuyama K, et al. [11 cases of anaphylaxis caused by grand keyhole limpet (abalone like shellfish)]. Arerugi 1991;40:1415-1420

We reported 11 cases of patients who developed moderate to severe anaphylactic reactions induced by the ingestion of grand keyhole limpet (GKL) and abalone. Specific IgE-mediated hypersensitivity to these shellfish was demonstrated by history, skin prick test, RAST and immunoblotting. The RAST inhibition technique revealed cross antigenicity between GKL, abalone and keyhole limpet hemocyanin. By immunoblotting analysis, the major antigens of GKL are shown in the MW range of about 38 Kd and 80 Kd.

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[58] - Azofra J, Lombardero M. Limpet anaphylaxis: cross-reactivity between limpet and house-dust mite Dermatophagoides pteronyssinus. Allergy 2003;58:146-149

BACKGROUND: Limpet is a mollusc that is frequently found along the shores of warm seas. Few allergic reactions to limpet have been described, and cross-reactivity with house-dust mites has not been established . METHODS: We report five patients with anaphylactic reactions due to limpet ingestion. A limpet extract was prepared and skin prick tests (SPT), radioallergosorbent assays (RAST), sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE-immunoblotting were performed. In order to evaluate cross-reactivity, an immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done . RESULTS: All patients were asthmatics sensitized to house-dust mites. In each case, severe bronchospasm was evidenced, and three required mechanical ventilation. Positive SPT with limpet extract was found in the four patients tested. RAST showed specific IgE on each patient's sera. Immunoblotting showed several allergenic fractions with a wide molecular weight range (15-250 kDa). D. pteronyssinus inhibited IgE-binding molecules above 50 kDa in the limpet extract, particularly one molecule of 75 kDa . CONCLUSIONS: We describe five patients with IgE-mediated limpet allergy. Severe bronchospasm was the most important symptom. Cross-reactivity with D. pteronyssinus was demonstrated.

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[59] - Castillo R, Carrilo T, Blanco C, Quiralte J, Cuevas M. Shellfish hypersensitivity: clinical and immunological characteristics. Allergol Immunopathol (Madr) 1994;22:83-87

Shellfish is one of the most frequent causes of food allergy. We studied 48 patients (25 male and 23 female) with a mean age of 24.2 +/- 1.8 with shellfish hypersensitivity. A clinical questionnaire was carried out and prick tests were performed using a series of aeroallergens and a battery of extracts of squid, shrimp, lobster, crab, mussel and clam. Prick tests were also performed using raw and boiled extracts from fresh squid, octopus and limpet. Total and specific IgE to these allergens were determined. The most frequent causes of symptoms were shrimp (33 cases) and squid (24 cases). The most frequently found symptoms were Urticaria/angioedema (39 patients), asthma (18 patients) and rhinitis (14 patients). Clinical association was found between Cephalopoedae and Lamelibranquiae (p < 0.05 for clam and p < 0.01 for mussel), but not among both groups and Crustaceans. Association between history and Prick was statistically significant for Crustaceae and Cephalopoedae (p < 0.01) but not for Lamalibranquiae. Association between history and CAP was not found for shellfish. Significant differences among prick-tests with raw and boiled extracts were not found. These results suggest that prick test yields better results than CAP does it, in shellfish hypersensitivity, that clinical association among shellfish hypersensitivity can occurs within the same and different Phylum reflecting common epitopes and that squid, octopus and limpet extracts contain a large amount of heat-stable allergens.

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[60] - Morikawa A, Kato M, Tokuyama K, Kuroume T, Minoshima M, Iwata S. Anaphylaxis to grand keyhole limpet (abalone-like shellfish) and abalone. Ann Allergy 1990;65:415-417

We report five patients who developed moderate to severe anaphylactic reactions induced by the ingestion of grand keyhole limpet (GKL) and abalone. Specific IgE-mediated hypersensitivity to these shellfish was demonstrated by history, prick skin test, and RAST. RAST inhibition technique revealed the cross-antigenicity between GKL, abalone, and keyhole limpet hemocyanin.

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[61] - Ishikawa M, Ishida M, Shimakura K, Nagashima Y, Shiomi K. Purification and IgE-binding epitopes of a major allergen in the gastropod Turbo cornutus. Biosci Biotechnol Biochem 1998;62:1337-1343

The major allergen (Tur c 1) in the muscle of the gastropod, Turbo cornutus, was isolated by Sephacryl S-300, Mono Q HR 5/5 and TSKgel Phenyl-5PW RP column chromatography. ELISA showed Tur c 1 to react strongly with sera from three individuals sensitive to both mollusks and crustaceans. SDS-PAGE showed Tur c 1 to produce a major band corresponding to a molecular mass of 35 kDa under the reduced condition. Its amino acid composition was characterized by the abundance of Glx, followed by Leu, Ala and Lys in decreasing abundance, and the absence of Trp. In addition to these properties, the determined partial amino acid sequence identified Tur c 1 to be a tropomyosin, as in the case of the known mollusk and crustacean allergens. However, the results of competitive ELISA inhibition experiments suggest that Tur c 1 has an IgE-binding epitope in the C-terminal region which is dissimilar to those proposed for Cra g 1 (the oyster Crassostrea gigas allergen) and Pen i 1 (the shrimp Penaeus indicus allergen).

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[62] - Stewart AG, Ewan PW. The incidence, aetiology and management of anaphylaxis presenting to an accident and emergency department. Quart J Med 1996;89:859-864

We retrospectively studied anaphylaxis in an A&E department from computerized records. In 1993 (Study A), of 55,000 patients seen in casualty, nine had severe anaphylaxis (ANA) with loss of consciousness (LOC) or fainting (about 1: 6000). Fifteen had generalized allergic reactions (GR) without LOC or fainting, but including dyspnoea due to laryngeal oedema or asthma, angioedema and/or urticaria. Thus there were 24 (about 1:2300) generalized reactions involving hypotension and/or respiratory difficulty. A further case diagnosed as hyperventilation syndrome was probably a wasp sting GR. Six cases of urticaria and/or angioedema were also identified. Of the nine with ANA, a possible cause was identified in eight (3 stings; 2 drugs; 3 foods). There was delay in arrival in A&E: hypotension was noted in three and had resolved spontaneously in six. Only 3/9 were related with adrenaline: i.v. hydrocortisone and chlorpheniramine was the mainstay of treatment. No investigation was recommended nor advice given on future management. Four patients were later referred to our allergy clinic by their GPs. In study B (aug-Oct 1994), nine cases of ANA were identified (1:1500), eight due to bee or wasp stings. The increased incidence was probably related to more detailed history-taking. Only three were treated with adrenaline. The use of adrenaline for future anaphylaxis was discussed with six patients, and five were referred to our allergy clinic. A reaction to the same allergen had occurred previously in 24%. Improved awareness of anaphylaxis and its management is necessary.

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[63] - Lee BJ, Park HS. Common Whelk ( Buccinum undatum) Allergy: Identification of IgE-binding Components and Effects of Heating and Digestive Enzymes. J Korean Med Sci 2004;19:793-799

In Korea, common whelk (Buccinum undatum) is a popular edible shellfish. The aim of this study was to observe the sensitization rate to common whelk and to characterize its allergens. We carried out skin prick test (SPT) in 1,700 patients with various allergic diseases. Specific IgE were detected by ELISA in the patient sera and ELISA inhibition tests were conducted. IgE-binding components were identified by means of SDS-PAGE and IgE-immunoblotting. The effects of digestive enzymes were evaluated in both raw and thermally treated extracts. SPT to common whelk was positive (>/=2+) in 83 (4.9%) patients studied. Twenty-four (38.7%) out of 62 SPT positive patients had high serum specific IgE to common whelk. ELISA inhibition test showed significant inhibitions by abalone as well as by common whelk. IgE-immunoblotting demonstrated three IgE-binding components (40, 71, 82 kDa), which were digested by simulated intestinal fluid and moderately digested by simulated gastric fluid, and the digestibility of allergens remained unchanged after thermal treatment. In conclusion, IgE-sensitization rate to common whelk was 4.9% in allergy patients. IgE-immunoblotting demonstrated three IgE-binding components, which were degraded by digestive enzymes. Further studies are needed to evaluate the clinical significance of the sensitized patients to common whelk.

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[64] - Juji F, Takashima H, Suko M, Doi M, Takaishi T, Okudaira H, et al. [A case of food-dependent-exercise induced anaphylaxis possibly induced by shellfish (Sulculus Supertexta and Turbo Cornutus)]. Arerugi 1990;39:1515-1522

A 17 years old girl experienced an anaphylactic reaction of urticaria, dyspnea, syncope and hypotension while riding a bicycle 55 minutes after eating shellfish Lapas shellfish which was a-like Sulculus Supertexta (SS). She recovered within several hours after the emergency treatment. Another attack occurred 3 months later while she was running with a dog 30 minutes after eating shellfish (Turbo Cornutus; TC). RAST scores were 4 for Lapas and 2 for TC. RAST inhibition test by ELISA showed a high crose-reaction between keyhole limpet hemocyanin (KLH) and Lapas, and between KLH and TC, while the cross reaction between Lapas and TC was low. Gel chromatography with sephacryl G-200 revealed that both Lapas and TC had several allergens with different molecules which were detected by ELISA. Exercise challenge produced an immediate fall of FEV1 and a significant increase in plasma histamine levels for 45 minutes.

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[65] - Dohi M, Suko M, Sugiyama H, Yamashita N, Tadokoro K, Juji F, et al. Food-dependent, exercise-induced anaphylaxis: a study on 11 Japanese cases. J Allergy Clin Immunol 1991;87:34-40

Eleven patients with food-dependent, exercise-induced anaphylaxis were studied. Seven patients experienced anaphylactic symptoms only after eating certain foods, such as shellfish, wheat, and grape before exercise. In the remaining four patients, no specific food could be identified, but the act of eating itself predisposed to anaphylaxis. Their anaphylactic symptoms were all clearly distinguished from cholinergic urticaria by history. Patients who developed anaphylactic symptoms before 20 years of age (N = 7) were atopic themselves or had atopic first-degree relatives. Six patients had increased serum IgE levels, and IgE antibodies against the causative food allergens were detected by the skin prick test or RAST in four cases. In contrast, patients who developed the symptoms after 30 years of age (N = 4) appeared to have a less atopic background, and IgE levels were within normal range except in one case. Three of four patients in the latter group developed symptoms after ingesting food made of wheat followed by exercise. All patients were sensitive to wheat as determined by the skin prick test. In six of 11 patients, a considerable rise in plasma histamine concentration was observed after exercise challenge with treadmill alone, and food intake followed by exercise induced a further increase in one patient.

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[66] - Lopata AL, Zinn C, Potter PC. Characteristics of hypersensitivity reactions and identification of a unique 49 kd IgE-binding protein (Hal m1) in abalone (Haliotis midae). J Allergy Clin Immunol 1997;100:642-648

There is a paucity of published data on the clinical presentation and the nature of the allergens involved in hypersensitivity to mollusks. This study reports the clinical and immunologic findings in 38 patients with reported immediate and delayed adverse reactions to abalone (Haliotis midae, Class Gastropoda). METHODS: Patients were recruited as part of a South African seafood allergy survey. Allergic symptoms were assessed by a self-administered questionnaire. A total of 38 patients with abalone sensitivity were recruited. Specific IgE responses to abalone and other mollusks were studied by using RAST and inhibition ELISAs. Skin prick tests and lymphocyte proliferation assays were also performed on several of the subjects. Allergenic components of Haliotis midae were identified with Western blotting. RESULTS: Twenty five of the 38 patients in the study were first seen with immediate symptoms, and 13 had delayed reactions. Seventeen of the sera tested were RAST positive. Skin prick tests responses with abalone extract were positive in all subjects with positive RAST responses (n = 8) and in 6 of 13 subjects with negative RAST responses. Five of the subjects with positive RAST responses had positive results on Western blotting and demonstrated binding to two major allergens with molecular weights of 38 and 49 kd. The 49 kd IgE-binding protein has been designated as Hal-m-1. CONCLUSIONS: Abalone allergens are heat-stable proteins with molecular weights of 38 and 49 kd, later designated as Hal-m-1 according to International Union of Immunological Societies allergen nomenclature regulation. Our studies indicate a clear clinical and immunologic heterogeneity in patients reactive to abalone.

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[67] - Castillo R, Delgado J, Quiralte J, Blanco C, Carrillo T. Food hypersensitivity among adult patients: epidemiological and clinical aspects. Allergol Immunopathol (Madr) 1996;24:93-97

Food hypersensitivity (FH) is lesser frequent among adult patients than in childhood. Foods implicated in hypersensitivity reactions vary with sociocultural and diet habits from a geographic place to other. We studied 142 adult patients sensitized to foods, among 7698 patients visited at our Outpatient Clinic. Hundred and twenty patients referred clinical symptoms after consumption of one or more foods consistently. From the latest, 107 patients (89.2%) were atopics (92 of them sensitizes to dust mites) and 54 (45%) referred atopic familiar background. Most frequent recorded symptoms were: urticaria/angioedema 84 cases (70%), oral syndrome 65 (54%), asthma 48 (37%) and anaphylaxis 33 patients (27.5%). Shellfish sensitization occurred in 50 patients, fresh fruits in 33 and nuts in 29 cases. Shrimp (48 patients), squid (33), kiwi (14), papaya (14), avocado (13) and banana (12 cases) were the most frequent causes of FH. Significant statistical association between foods and inhalants was observed for fresh fruits and latex (p < 0.001), fresh fruits and pollens (p < 0.01), and shellfish and Blatta germanica (p < 0.001). Prevalence of FH among patients at our Area is around 1.6%. Tropical fruits, as other kind of fruits, seem to share common IgE-epitopes to pollens. High prevalence of shellfish and cockroach hypersensitivity could be more easily developed by previous domestic mites sensitization.

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[68] - Rancé F, Grandmottet X, Grandjean H. Prevalence and main characteristics of schoolchildren diagnosed with food allergies in France. Clin Exp Allergy 2005;35:167-172

Summary Background A cross-sectional, descriptive, questionnaire-based survey was conducted in Toulouse schools to determine the prevalence of food allergies among schoolchildren. Objectives The first goal of the survey was to estimate the prevalence of food allergies. The second goal was to determine the main characteristics of the allergies. Methods The questionnaires (3500) were distributed in 150 classes in eight schools. The return rate was 77.6% (2716). Results Of the 192 (7.0%) questionnaires with a 'Yes' response (report of a food allergy), 182 were retained as reporting true food allergies (6.7%). The cumulative and point prevalences were 6.7% [95% confidence interval (CI) 5.8-7.6] and 4.7% [95% CI 3.9-5.5], respectively. The point prevalences were 4.0% for the children aged 2-5 years, 6.8% for the children aged 6-10 years, and 3.4% for the children aged 11-14 years. The main foods reported as causing adverse reactions were cow milk (n=29, 11.9%), eggs (n=23, 9.4%), kiwis (n=22, 9.0%), peanuts (n=20, 8.2%), fish (n=19, 7.8%), tree nuts (n=19, 7.8%), and shrimp (n=13, 5.3%). The average age at which the allergies were detected was 3.4+/-2.8 years (with a range of 0.1-12 years). The clinical signs of the food allergies were cutaneous (n=153, 62.7%), digestive (n=74, 30.3%), respiratory (n=17, 6.9%), and anaphylactic shock (n=12, 4.9%). Conclusion While well aware of the biases inherent in this type of study, we estimated the cumulative and point prevalences of food allergies in a population of schoolage children in Toulouse at 6.7% and 4.7%, respectively. Cow milk, eggs, and peanuts were the main foods reported as causing allergies. Exotic fruits, shellfish, and tree nuts appeared to be relatively new allergens.

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[69] - Woods RK, Abramson M, Bailey M, Walters EH. International prevalences of reported food allergies and intolerances. Comparisons arising from the European Community Respiratory Health Survey (ECRHS) 1991-1994. Eur J Clin Nutr 2001;55:298-304

OBJECTIVE: The aim of this study was to report the prevalence, type and reported symptoms associated with food intolerance. DESIGN: A cross-sectional epidemiological study involving 15 countries using standardized methodology. Participants answered a detailed interviewer-administered questionnaire and took part in blood, lung function and skin prick tests to common aeroallergens. SETTING: Randomly selected adults who took part in the second phase of the European Community Respiratory Health Survey (ECRHS). SUBJECTS: The subjects were 17280 adults aged 20-44 y. RESULTS: Twelve percent of respondents reported food allergy/intolerance (range 4.6% in Spain to 19.1% in Australia). Atopic females who had wheezed in the past 12 months, ever had asthma or were currently taking oral asthma medications were significantly more likely to report food allergy/intolerance. Participants from Scandinavia or Germany were significantly more likely than those from Spain to report food allergy/intolerance. Respondents who reported breathlessness as a food-related symptom were more likely to have wheezed in the past 12 months, to have asthma, use oral asthma medications, be atopic, have bronchial hyperreactivity, be older and reside in Scandinavia. CONCLUSION: Self-reported food allergy/intolerance differed significantly across multiple countries. The reasons for these differences were not explored in this study, but are likely to be largely due to cultural differences.

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[70] - Maulitz RM, Pratt DS, Schocket AL. Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol 1979;63:433-434

The syndrome of immediate type I food hypersensitivity, mediated by tissue-bound IgE antibody and mast cell histamine release, is well recorded in the medical literature. This case study represents a previously undescribed late food hypersensitivity, induced only by strenuous exercise. Identification of this new syndrome illustrates classical epidemiologic analysis, improves medical advice for the allergic and athletically inclined, and raises new questions in the areas of allergy and immunology.

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[71] - Gonzalez Galan I, Garcia Menaya JM, Jimenez Ferrera G, Gonzalez Mateos G. Anaphylactic shock to oysters and white fish with generalized urticaria to prawns and white fish. Allergol Immunopathol (Madr) 2002;30:300-303

Because seafood consumption is moderate-to-high in Spain, allergic reactions to seafood such as fish, crustacea and mollusc are fairly frequent. The clinical features of these reactions depend on the implicated species and whether the reaction is provoked by ingestion, handling or vapor inhalation. Because different species have common antigenic structures, cross-sensitization is frequent, especially between crustaceans and molluscs. Contamination of fish by nematodes (Anisakis) may produce severe reactions.We report the case of a female patient with no personal or family history of allergy who experienced two episodes of anaphylactic shock: the first occurred immediately after eating oysters and the second after ingestion of white fish. The patient also developed generalized urticaria provoked by crustacean (prawns) and white fish. The results of skin prick tests were negative for fish, shellfish, crustacean and oysters while in vitro tests were positive for oyster, prawns, Anisakis, Ascaris and Echinococcus, although stool samples and gastric endoscopy were negative.

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[72] - Castillo R, Delgado J, Quiralte J, Blanco C, Carrillo T. Food hypersensitivity among adult patients: epidemiological and clinical aspects. Allergol Immunopathol (Madr) 1996;24:93-97

Food hypersensitivity (FH) is lesser frequent among adult patients than in childhood. Foods implicated in hypersensitivity reactions vary with sociocultural and diet habits from a geographic place to other. We studied 142 adult patients sensitized to foods, among 7698 patients visited at our Outpatient Clinic. Hundred and twenty patients referred clinical symptoms after consumption of one or more foods consistently. From the latest, 107 patients (89.2%) were atopics (92 of them sensitizes to dust mites) and 54 (45%) referred atopic familiar background. Most frequent recorded symptoms were: urticaria/angioedema 84 cases (70%), oral syndrome 65 (54%), asthma 48 (37%) and anaphylaxis 33 patients (27.5%). Shellfish sensitization occurred in 50 patients, fresh fruits in 33 and nuts in 29 cases. Shrimp (48 patients), squid (33), kiwi (14), papaya (14), avocado (13) and banana (12 cases) were the most frequent causes of FH. Significant statistical association between foods and inhalants was observed for fresh fruits and latex (p < 0.001), fresh fruits and pollens (p < 0.01), and shellfish and Blatta germanica (p < 0.001). Prevalence of FH among patients at our Area is around 1.6%. Tropical fruits, as other kind of fruits, seem to share common IgE-epitopes to pollens. High prevalence of shellfish and cockroach hypersensitivity could be more easily developed by previous domestic mites sensitization.

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[73] - Jiménez M, Pineda F, Sanchez I, Orozco I, Senent C. Allergy due to Ensis macha. Allergy 2005;60:1090-1091

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[74] - Parker SL, Leznoff A, Sussman GL, Tarlo SM, Krondl M. Characteristics of patients with food-related complaints. J Allergy Clin Immunol 1990;86:503-511

Forty-five patients with classic food-allergic symptoms and/or subjective food-related complaints not traditionally associated with food allergy underwent evaluation. On the basis of a comprehensive clinical history, skin testing, and placebo-controlled, double-blind food challenges, patients were assigned to one of two groups: patients with reactions highly suggestive of IgE-mediated food hypersensitivity (group A, N = 22) and patients with atypical adverse food reactions that could not be confirmed by double-blind food challenge (group B, N = 23). Most patients in both groups were female, 77.3% and 91.3% of patients in group A and B, respectively. In group B, onset of symptoms occurred at an older age than in group A, 28.9 years +/- 17.2 versus 17.1 +/- 12.1 (p = 0.0015), respectively, and involved more foods, 25.6 +/- 22.1 versus 5.2 +/- 5.5 (p = 0.0002). Foods causing most prominent symptoms among patients in group A included legumes, tree nuts, crustaceans, and fish. In group B, milk, white sugar, wheat, egg, smoked/cured meat, and yeast were among the most troublesome foods. All but one patient in group A gave a positive skin test response to food; only four patients in group B had a positive response. We conclude that a subset of patients with food-related complaints can be accurately predicted to have a negative double-blind challenge with suspected foods on the basis of information obtained by history and skin testing.

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[75] - Tomikawa M, Suzuki N, Urisu A, Tsuburai T, Ito S, Shibata R, et al. [Characteristics of shrimp allergy from childhood to adulthood in Japan]. Arerugi 2006;55:1536-1542

The profiles and clinical symptoms of 99 shrimp allergy patients and the correlation of shrimp-specific IgE to crustaceans-specific IgE, mollusks-specific IgE and shellfish-specific IgE was investigated. Their onset started during either childhood or young adulthood. Symptoms appeared within an hour after ingestion of shrimp in 87.9% cases. The most common symptoms were skin symptoms, followed by oral allergic syndrome (OAS) like symptoms, respiratory symptoms. Anaphylaxis were observed in 61 cases including 2 anaphylactic shock cases. Among 99 shrimp allergy cases, 44 cases (64.7%) showed positive reaction to crabs out of 68 cases experiencing crab ingestion. Only 11 cases (17.5%) reacted against squid out of 63 cases with the experience in squid ingestion. Crab-specific IgE and squid-specific IgE were strongly correlated with shrimp-specific IgE.

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[76] - Zuberbier T, Edenharter G, Worm M, Ehlers I, Reimann S, Hantke T, et al. Prevalence of adverse reactions to food in Germany – a population study. Allergy 2004;59:338-345

OBJECTIVE: A population study was performed to identify the prevalence of all kinds of adverse reactions to food . METHODS: In a representative cross-sectional survey performed in 1999 and 2000 in Berlin, 13 300 inhabitants of all ages were addressed by questionnaire. This questionnaire was answered by 4093 persons. All respondents mentioning any sign of food intolerance or the existence of allergic diseases (n = 2298) were followed up by telephone and, in case food intolerance could not be ruled out by patient history, were invited to attend to the clinic for personal investigation including double-blind, placebo-controlled food challenge tests (DBPCFC) . RESULTS: The self-reported lifetime prevalence of any adverse reaction to food in the Berlin population (mean age 41 years) was 34.9%. Eight hundred and fourteen individuals were personally investigated according to the guidelines. The point prevalence of adverse reactions to food confirmed by DBPCFC tests in the Berlin population as a mean of all age groups was 3.6% (95% confidence interval [3.0-4.2%]) and 3.7% in the adult population (18-79 years, 95% confidence interval [3.1-4.4.%]). Two and a half percent were IgE-mediated and 1.1% non-IgE-mediated, females were more frequently affected (60.6%). Based on a statistical comparison with available data of adults from the nationwide German Health Survey from 1998, adverse reactions to food in the adult population of Germany (age 18-79) were calculated with 2.6% [2.1-3.2%]) . CONCLUSIONS: The study gives for the first time information about the point prevalence of both immunological and nonimmunological adverse reactions to food and underlines the relevance of this issue in public health. The data also show that an individualized stepwise approach including provocation tests is mandatory to confirm the diagnosis.

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[77] - Rancé F, Grandmottet X, Grandjean H. Prevalence and main characteristics of schoolchildren diagnosed with food allergies in France. Clin Exp Allergy 2005;35:167-172

Summary Background A cross-sectional, descriptive, questionnaire-based survey was conducted in Toulouse schools to determine the prevalence of food allergies among schoolchildren. Objectives The first goal of the survey was to estimate the prevalence of food allergies. The second goal was to determine the main characteristics of the allergies. Methods The questionnaires (3500) were distributed in 150 classes in eight schools. The return rate was 77.6% (2716). Results Of the 192 (7.0%) questionnaires with a 'Yes' response (report of a food allergy), 182 were retained as reporting true food allergies (6.7%). The cumulative and point prevalences were 6.7% [95% confidence interval (CI) 5.8-7.6] and 4.7% [95% CI 3.9-5.5], respectively. The point prevalences were 4.0% for the children aged 2-5 years, 6.8% for the children aged 6-10 years, and 3.4% for the children aged 11-14 years. The main foods reported as causing adverse reactions were cow milk (n=29, 11.9%), eggs (n=23, 9.4%), kiwis (n=22, 9.0%), peanuts (n=20, 8.2%), fish (n=19, 7.8%), tree nuts (n=19, 7.8%), and shrimp (n=13, 5.3%). The average age at which the allergies were detected was 3.4+/-2.8 years (with a range of 0.1-12 years). The clinical signs of the food allergies were cutaneous (n=153, 62.7%), digestive (n=74, 30.3%), respiratory (n=17, 6.9%), and anaphylactic shock (n=12, 4.9%). Conclusion While well aware of the biases inherent in this type of study, we estimated the cumulative and point prevalences of food allergies in a population of schoolage children in Toulouse at 6.7% and 4.7%, respectively. Cow milk, eggs, and peanuts were the main foods reported as causing allergies. Exotic fruits, shellfish, and tree nuts appeared to be relatively new allergens.

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[78] - Castillo R, Delgado J, Quiralte J, Blanco C, Carrillo T. Food hypersensitivity among adult patients: epidemiological and clinical aspects. Allergol Immunopathol (Madr) 1996;24:93-97

Food hypersensitivity (FH) is lesser frequent among adult patients than in childhood. Foods implicated in hypersensitivity reactions vary with sociocultural and diet habits from a geographic place to other. We studied 142 adult patients sensitized to foods, among 7698 patients visited at our Outpatient Clinic. Hundred and twenty patients referred clinical symptoms after consumption of one or more foods consistently. From the latest, 107 patients (89.2%) were atopics (92 of them sensitizes to dust mites) and 54 (45%) referred atopic familiar background. Most frequent recorded symptoms were: urticaria/angioedema 84 cases (70%), oral syndrome 65 (54%), asthma 48 (37%) and anaphylaxis 33 patients (27.5%). Shellfish sensitization occurred in 50 patients, fresh fruits in 33 and nuts in 29 cases. Shrimp (48 patients), squid (33), kiwi (14), papaya (14), avocado (13) and banana (12 cases) were the most frequent causes of FH. Significant statistical association between foods and inhalants was observed for fresh fruits and latex (p < 0.001), fresh fruits and pollens (p < 0.01), and shellfish and Blatta germanica (p < 0.001). Prevalence of FH among patients at our Area is around 1.6%. Tropical fruits, as other kind of fruits, seem to share common IgE-epitopes to pollens. High prevalence of shellfish and cockroach hypersensitivity could be more easily developed by previous domestic mites sensitization.

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[79] - Nettis E, Pannofino A, Dambra P, Loria MP, Di Maggio G, Damiani E, et al. IgE-mediated urticaria/angioedema after ingestion of mussels. Acta Derm Venereol 2001;81:62

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[80] - Novembre E, Cianferoni A, Bernardini R, Mugnaini L, Caffarelli C, Cavagni G, et al. Anaphylaxis in children: clinical and allergologic features. Pediatrics 1998;101(4):e8

Despite the importance of anaphylaxis, little information is available on its clinical features. OBJECTIVE: To evaluate the clinical and allergologic features of anaphylaxis in children referred to the allergology and immunology unit of A. Meyer Children's Hospital (Florence, Italy) from 1994 to 1996. RESULTS: Ninety-five episodes of anaphylaxis occurred in 76 children (50 boys and 26 girls). Sixty-six children (87%) had only one episode of anaphylaxis, while 10 (13%) had two or more episodes. Sixty-two (82%) of the 76 patients had a personal history of atopic symptoms, although 14 (18%) did not. Sixty (79%) of the 76 children studied had at least one positive skin prick test to one or more of the common inhalant and/or food allergens. Children with venom-induced anaphylaxis usually had negative skin tests to the allergens tested. A younger age and eczema were more frequent among children with food-dependent anaphylaxis, whereas an older age together with urticaria-angioedema were common among those with exercise-induced anaphylaxis. The mean latent period (+/-SD) of the anaphylaxis episodes was 15.4 +/- 27.5 minutes. Skin and respiratory manifestations had an earlier onset and were more common than the gastrointestinal and cardiovascular ones. The most frequent clinical manifestation in children with food anaphylaxis was gastrointestinal symptoms, whereas cardiovascular symptoms were rare. The most probable causative agents in the 95 episodes described were foods (57%), drugs (11%), hymenoptera venom (12%), exercise (9%), additives (1%), specific immunotherapy (1%), latex (1%), and vaccines (2%), but in 6 cases (6%) the agent was never determined. Among the foods, seafood and milk were the most frequently involved. As for location, 57% of the anaphylactic events occurred in the home (54/95), 12% outdoors (11/95); 5% in restaurants (5/95); 3% in the doctor's office (3/95); 3% in hospitals (3/95); 3% on football fields (3/95); 2% on the beach (2/95); 1% in the gym (1/95); 1% at school (1/95); and 1% in the operating room (1/95). In the remaining 12% of cases (11/95) the site remained unknown. Sixty-two percent of the patients (59/95) were treated in an emergency room or hospital, while 32% (30/95) were not (this information is lacking in 6% of the cases [6/95]). Patients were treated with corticosteroids in 72% of the cases (68/95), with antihistamines in 20% (19/95), with epinephrine in 18% (17/95), with beta2-agonists in 5% (5/95), and with oxygen in 4% (4/95). CONCLUSIONS: In our area, foods, particularly seafood and milk, seem to be the most important etiologic factors triggering anaphylaxis. Food-induced anaphylaxis often occurs in younger children with a severe food allergy, whereas exercise-induced anaphylaxis occurs more often in older children with a history of urticaria-angioedema. The venom-induced variant usually presents itself in nonatopic subjects. Given the fact that most of the children had only one anaphylactic reaction, prevention is almost impossible. Epinephrine, although it is the first-choice treatment of anaphylaxis, often goes unused, even in hospitals and doctors' offices.

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[81] - Pastorello EA, Rivolta F, Bianchi M, Mauro M, Pravettoni V. Incidence of anaphylaxis in the emergency department of a general hospital in Milan. J Chromatogr B Biomed Appl 2001;756:11-17

OBJECTIVE: To evaluate incidence and causes of anaphylactic reactions in the emergency room (E.R.) of a general hospital in Milan during a 2-year period. Methods: We retrospectively studied the computerized records of patients discharged from an E.R. with a diagnosis of anaphylactic reaction. Anaphylaxis was established on the presence of at least two cutaneous, respiratory, gastrointestinal or cardiovascular system symptoms. Results: During 1997 and 1998, out of 38 685 patients referred to the E.R., 13 had severe anaphylaxis with loss of consciousness (LOC) and 127 had anaphylactic symptoms, without LOC. Of the 13 patients with LOC, a possible cause was identified in 12 (five foods, six drugs, one hair dye). In the other 127 patients anaphylaxis was related to foods in 49 cases (38.5%), drugs in 44 (34.6%), unknown causes in 29 (22.8%), hymenoptera stings in two (1.5%), and other causes in three (2.3%). Conclusion: The incidence of anaphylactic reactions was 0.4% and mainly affected females and atopic subjects. Foods, particularly fruits and vegetables, appeared to be the most important cause; other important causes were non steroidal antiinflammatory drugs and beta-lactam antibiotics.

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[82] - Cianferoni A, Novembre E, Mugnaini L, Lombardi E, Bernardini R, Pucci N, et al. Clinical features of acute anaphylaxis in patients admitted to a university hospital: an 11-year retrospective review (1985-1996). Ann Allergy Asthma Immunol 2001;87:27-32

BACKGROUND: Although anaphylaxis is considered a life-threatening event, there is a lack of information on the clinical characteristics at presentation, both in adults and in children. OBJECTIVE: To describe in a nonselected population the clinical characteristics and the treatments of acute anaphylaxis triggered by different agents. METHODS: This is a retrospective review of the clinical features of 113 episodes of acute anaphylaxis resulting in admission to a university hospital. Initially, the 107 patients visited the emergency room and were then admitted to the hospital. RESULTS: Most anaphylactic events (63%) occurred at home. The most frequent symptoms involved the respiratory system (78%) and the skin (90%). Drugs, especially nonsteroidal anti-inflammatory drugs and antibiotics, were the most frequent cause of anaphylaxis in adults (49%). Patients with drug-induced anaphylaxis were older and more often had cardiovascular symptoms (hypotension and tachycardia) (P = 0.0064). Hymenoptera venom was the second most frequent cause of anaphylaxis (29%). Most of the patients with hymenoptera venom anaphylaxis were male (80%) and more frequently they had no history of atopy (P = 0.012). In food-induced anaphylaxis, the cardiovascular system was less likely to be involved (P < 0.05) (39%). Seafood seems to be frequently involved in food-induced anaphylaxis in our area. Specific immunotherapy-induced anaphylaxis occurred more often in younger patients (P = 0.032). Epinephrine seems to be underused in Italy (only 15% of patients received it), especially for respiratory symptoms. CONCLUSIONS: Anaphylaxis triggered by different agents may have different clinical presentations and may occur in different types of patients. In Italy, the inadequate use of epinephrine for anaphylaxis treatment needs to be publicized to both physicians and the general population.

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[83] - Carrillo T, Castillo R, Caminero J, Cuevas M, Rodriguez JC, Acosta O, et al. Squid hypersensitivity: a clinical and immunologic study. Ann Allergy 1992;68:483-487

Hypersensitivity to mollusk has rarely been described in the literature. Among the mollusks, the cephalopods are a group of great importance as a food source. We report seven patients who had had symptoms highly suggestive of IgE-mediated reactions after ingesting squid or inhaling vapors from cooking squid. All had previously suffered from persistent rhinitis or asthma for years. In addition, six of the seven patients had had symptoms after ingesting shrimp. Skin prick tests were strongly positive for boiled squid extract and for various commercial crustacean extracts. Specific IgE antibodies against boiled extract and several crustacean extracts were demonstrated in all patients by RAST and reverse enzyme immunoassay. Cross reactivity between squid and shrimp and other crustaceans was demonstrated by reverse immunoassay inhibition studies. Cross reactivity could not be demonstrated between squid and octopus, which are both cephalopods, nor between squid and other mollusks

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[84] - Castillo R, Carrilo T, Blanco C, Quiralte J, Cuevas M. Shellfish hypersensitivity: clinical and immunological characteristics. Allergol Immunopathol (Madr) 1994;22:83-87

Shellfish is one of the most frequent causes of food allergy. We studied 48 patients (25 male and 23 female) with a mean age of 24.2 +/- 1.8 with shellfish hypersensitivity. A clinical questionnaire was carried out and prick tests were performed using a series of aeroallergens and a battery of extracts of squid, shrimp, lobster, crab, mussel and clam. Prick tests were also performed using raw and boiled extracts from fresh squid, octopus and limpet. Total and specific IgE to these allergens were determined. The most frequent causes of symptoms were shrimp (33 cases) and squid (24 cases). The most frequently found symptoms were Urticaria/angioedema (39 patients), asthma (18 patients) and rhinitis (14 patients). Clinical association was found between Cephalopoedae and Lamelibranquiae (p < 0.05 for clam and p < 0.01 for mussel), but not among both groups and Crustaceans. Association between history and Prick was statistically significant for Crustaceae and Cephalopoedae (p < 0.01) but not for Lamalibranquiae. Association between history and CAP was not found for shellfish. Significant differences among prick-tests with raw and boiled extracts were not found. These results suggest that prick test yields better results than CAP does it, in shellfish hypersensitivity, that clinical association among shellfish hypersensitivity can occurs within the same and different Phylum reflecting common epitopes and that squid, octopus and limpet extracts contain a large amount of heat-stable allergens.

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[85] - Miyazawa H, Fukamachi H, Inagaki Y, Reese G, Daul CB, Lehrer SB, et al. Identification of the first major allergen of a squid (Todarodes pacificus). J Allergy Clin Immunol 1996;98:948-953

In Japan, squid is an important seafood, and some patients with food allergies are sensitive to squid. There has been no report, however, describing the major allergens of squid. OBJECTIVE: To characterize squid allergens, we isolated a major allergen from the Pacific flying squid (Todarodes pacificus) and compared it with a major allergen from a shrimp (Penaeus orientalis). METHODS: The major squid and shrimp allergens were isolated by column chromatography on diethylaminoethyl-Sepharose (Pharmacia, Uppsala, Sweden), hydroxylapatite, and Sephacryl S-300 (Pharmacia). The IgE reactivity of the isolated allergens was assessed by immunoblotting. The cross-reactivity between the squid and shrimp allergens was examined by use of mouse polyclonal and monoclonal antibodies to the major allergens. Amino acid sequence analyses of the isolated allergens were done. RESULTS: The isolated squid allergen is a 38 kd, heat-stable protein. IgE antibody binding to the purified squid allergen was demonstrated by immunoblotting. Cross-reactivity between major squid and shrimp allergens was demonstrated with sera from patients allergic to squid or shrimp or with allergen-specific monoclonal antibodies. The amino acid sequence analysis of the major squid allergen showed a marked homology with tropomyosin from blood fluke planorbid (Biomphalaria glabrata), which is a common vector snail of Schistosoma mansoni. CONCLUSION: This 38 kd protein is a major allergen of the squid, Todarodes pacificus, and is believed to be squid muscle protein tropomyosin. We named it Tod p 1 according to International Union of Immunological Societies allergen nomenclature regulation.

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[86] - Tomikawa M, Suzuki N, Urisu A, Tsuburai T, Ito S, Shibata R, et al. [Characteristics of shrimp allergy from childhood to adulthood in Japan]. Arerugi 2006;55:1536-1542

The profiles and clinical symptoms of 99 shrimp allergy patients and the correlation of shrimp-specific IgE to crustaceans-specific IgE, mollusks-specific IgE and shellfish-specific IgE was investigated. Their onset started during either childhood or young adulthood. Symptoms appeared within an hour after ingestion of shrimp in 87.9% cases. The most common symptoms were skin symptoms, followed by oral allergic syndrome (OAS) like symptoms, respiratory symptoms. Anaphylaxis were observed in 61 cases including 2 anaphylactic shock cases. Among 99 shrimp allergy cases, 44 cases (64.7%) showed positive reaction to crabs out of 68 cases experiencing crab ingestion. Only 11 cases (17.5%) reacted against squid out of 63 cases with the experience in squid ingestion. Crab-specific IgE and squid-specific IgE were strongly correlated with shrimp-specific IgE.

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[87] - Fæste CK, Wiker HG, Løvik M, Egaas E. Hidden shellfish allergen in a fish cake. Allergy 2003;58:1204-1205

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[88] - Pétrus M, Nyunga M, Causse E, Chung E, Cossarizza G. Allergie au calamar et aux acariens chez l'enfant. Arch Pediatr 1999;6:1075-1076

Anaphylactic reactions after consumption of squid by patients sensitized to house dust mites have been reported several times. CASE REPORT: A child allergic to dust mites developed an angioneurotic edema after eating squid. An immunoallergological assessment, including the prick test, labial test and IgE RAST revealed an allergy associated to both dust mites and squid. CONCLUSIONS: In light of the potential seriousness of anaphylactic reactions, parents of children allergic to dust mites and these children should be made aware of the increased risk of allergies to squid that they may face.

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[89] - Falcão H, Lunet N, Lopes C, Barros H. Food hypersensitivity in Portuguese adults. Eur J Clin Nutr 2004;58:1621-1625

OBJECTIVE: To describe the frequency and epidemiological features of self-reported food hypersensitivity in Portuguese adults. DESIGN: Cross-sectional. SETTING: Participants were selected by random digit dialing among residents of Porto. SUBJECTS: In total, 659 individuals over 39 y were asked to recall the occurrence of food hypersensitivity, and to describe the most serious episode. The adoption of eviction diets and previous medical diagnosis of food allergy were recorded, and recent dietary intake was evaluated using a validated food frequency questionnaire. RESULTS: Self-reported food allergy was more frequent in women than men (7.3 vs 1.9%, P<0.01) and decreased with age. Age- and sex-standardized (European population > or =40 y) prevalence of food hypersensitivity was 4.8% (95% CI 3.4-6.9%). Most subjects (67.6%) referred allergy to a single food, fresh fruits being the more frequently incriminated (25%). Approximately 90% that reported food allergy declared the adoption of eviction diets, although 53% in fact ingested the incriminated foods during the previous year. CONCLUSIONS: The adult prevalence of food hypersensitivity in Porto is one of the lowest observed worldwide, probably reflecting specificities of the genetic make-up and dietary patterns of our population.

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[90] - Tanaka R, Ichikawa K, Hamano K. [Clinical characteristics of seafood allergy and classification of 10 seafood allergens by cluster analysis]. [Japanese]. Arerugi 2000;49:479-486

The aim of this study was to investigate the clinical characteristics of children who showed sensitization to any type of seafood and to classify the 10 seafood allergens based on IgE reactivities by a cluster analysis. In children with bronchial asthma (BA) and/or atopic dermatitis (AD), we defined the 'seafood' group as 23 patients having any type of seafood specific IgE antibody (CAP system). We analyzed the clinical features, the serum total IgE and each allergen specific IgE level. In addition, ten seafood allergens were also classified by a cluster analysis. Three patients revealed immediate hypersensitivity to some seafood. The frequency of patients with AD and the total IgE in the seafood group were high and the patients in this group were tend to be sensitized to multiple allergens. Seafood allergens were classified into 4 groups, 1) salmon, sardine, horse mackerel and mackerel, 2) cod and tuna, 3) octopus and squid, and 4) crab and shrimp, by a cluster analysis. These findings corresponded to the biological classification and the classification by the reported common allergens among various types of seafood. Based on our findings, this classification is therefore considered to be useful when selecting allergens to screen for sensitization to seafood.

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[91] - Dohi M, Suko M, Sugiyama H, Yamashita N, Tadokoro K, Juji F, et al. Food-dependent, exercise-induced anaphylaxis: a study on 11 Japanese cases. J Allergy Clin Immunol 1991;87:34-40

Eleven patients with food-dependent, exercise-induced anaphylaxis were studied. Seven patients experienced anaphylactic symptoms only after eating certain foods, such as shellfish, wheat, and grape before exercise. In the remaining four patients, no specific food could be identified, but the act of eating itself predisposed to anaphylaxis. Their anaphylactic symptoms were all clearly distinguished from cholinergic urticaria by history. Patients who developed anaphylactic symptoms before 20 years of age (N = 7) were atopic themselves or had atopic first-degree relatives. Six patients had increased serum IgE levels, and IgE antibodies against the causative food allergens were detected by the skin prick test or RAST in four cases. In contrast, patients who developed the symptoms after 30 years of age (N = 4) appeared to have a less atopic background, and IgE levels were within normal range except in one case. Three of four patients in the latter group developed symptoms after ingesting food made of wheat followed by exercise. All patients were sensitive to wheat as determined by the skin prick test. In six of 11 patients, a considerable rise in plasma histamine concentration was observed after exercise challenge with treadmill alone, and food intake followed by exercise induced a further increase in one patient.

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[92] - Miyake T, Kawamori J, Yoshida T. [A pediatric case of food-dependent exercise-induced anaphylaxis]. Arerugi 1988;37:53-56

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[93] - Carrillo T, Castillo R, Caminero J, Cuevas M, Rodriguez JC, Acosta O, et al. Squid hypersensitivity: a clinical and immunologic study. Ann Allergy 1992;68:483-487

Hypersensitivity to mollusk has rarely been described in the literature. Among the mollusks, the cephalopods are a group of great importance as a food source. We report seven patients who had had symptoms highly suggestive of IgE-mediated reactions after ingesting squid or inhaling vapors from cooking squid. All had previously suffered from persistent rhinitis or asthma for years. In addition, six of the seven patients had had symptoms after ingesting shrimp. Skin prick tests were strongly positive for boiled squid extract and for various commercial crustacean extracts. Specific IgE antibodies against boiled extract and several crustacean extracts were demonstrated in all patients by RAST and reverse enzyme immunoassay. Cross reactivity between squid and shrimp and other crustaceans was demonstrated by reverse immunoassay inhibition studies. Cross reactivity could not be demonstrated between squid and octopus, which are both cephalopods, nor between squid and other mollusks

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[94] - San Miguel-Moncín MM, Pineda F, Llamas E, Amat P, García R, García-Rubio I, et al. Octopus hypersensitivity. Allergy 2007;62(suppl. 83):330

Background: Shellfish have been recognized as potent allergens both in food allergy and occupational allergy. Of these, shrimp has received the most attention, but hypersensitivity to cephalopods has been rarely reported. A case report of octopus allergy without hypersensitivity to other cephalodods is described, being allergens involved studied. Methods: A 52-years old woman attended our Allergy Department. During last three years she had suffered several episodes of labial angioedema after octopus ingestion. Recently, she had been attended in the emergency room because of an episode of labial, lingual and facial angioedema with difficult to breath and wheezing treated with epinephrine which appeared immediately after ingesting octopus. After this last episode she had eaten in several occasions squid, cuttlefish, shrimp, crab, Norway lobster and velvet crabs without any adverse reaction. Skin prick tests (SPT) with panels of inhalants including dust mites, food allergens including anisakis, crustaceans and molluscs, and prick-by-prick with raw and cooked octopus, squid and cuttlefish were performed. In vitro immunoassays were carried out in order to asses the pattern of IgE reactivity. Results: SPT with panels of inhalants, food allergens, crustaceans and molluscs were negative. Prick-by-prick with raw and cooked squid and cuttlefish were also negative. Prick-by-prick with both raw and cooked octopus showed an immediate positive wheal (7x7 mm). Determination of specific IgE by enzyme allergosorbent test (EAST) (Hycor) to octopus gave 6,48 UI/mL, while was negative to squid, cuttlefish and shrimp. SDS-PAGE immunoblotting of squid, cuttlefish and octopus extracts showed a strong IgE-binding band of about 16-18 kDa. Not any IgE-binding band appeared with squid and cuttlefish extracts. Conclusions: A case report of hypersensitivity to octopus without allergy to other molluscs and crustaceans is described. To our knowledge, this is the first report of an allergen of about 16-18 kDa is involved in octopus allergy.

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[95] - Ebisawa M, Ikematsu K, Imai T, Tachimoto H. Food Allergy in Japan. Allergy Clin Immunol Int 2003;15:214-217

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[96] - Ishikawa M, Suzuki F, Ishida M, Nagashima Y, Shiomi K. Identification of tropomyosin as a major allergen in Octopus vulgaris and elucidation of its IgE-binding epitopes. Fisheries Sci 2001;67:934-942

ABSTRACT: The major allergen (named Oct v 1) in the muscle of the octopus Octopus vulgaris was purified by gel filtration on Sephacryl S-300, anion-exchange fast protein liquid chromatography on Mono Q and reverse-phase high-pressure liquid chromatography on TSKgel Octadecyl-4PW. In addition to the molecular mass, amino acid composition and cross-reactivity with Tur c 1 (turban shell Turbo cornutus allergen), the determined partial amino acid sequence clearly demonstrated that Oct v 1 is tropomyosin, similar to the known molluscan and crustacean allergens. Using peptide fragments isolated from the lysylendopeptidase digest of Oct v 1, competitive enzyme-linked immunosorbant assay inhibition experiments showed that IgE-binding epitopes of Oct v 1 are contained in two peptides (77ˆ112 and 148ˆ160) in the central region and one peptide (269ˆ281) in the C-terminal region. In the peptide 77ˆ112, the same sequence as the IgE-binding epitope proposed for Cra g 1 (oyster Crassostrea gigas allergen) is recognized at 92-105. Moreover, the peptide 148-160 partly overlaps with the IgE-binding epitopes suggested for Pen i 1 (shrimp Penaeus indicus allergen) and Pen a 1 (shrimp Penaeus aztecus allergen), and the peptide 269ˆ281 with those for Tur c 1 and Pen a 1.

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[97] - Ebisawa M, Ikematsu K, Imai T, Tachimoto H. Food Allergy in Japan. Allergy Clin Immunol Int 2003;15:214-217

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[98] - Caffarelli C, Perrone F, Terzi V. Exercise-induced anaphylaxis related to cuttlefish intake. Eur J Pediatr 1996;155:1025-1026

A 14-year-old girl suffered from exercise-induced anaphylaxis associated with eating cuttlefish. She was advised to avoid the precipitating food 6 h before exercise. No further attack occurred. CONCLUSION: It should always be considered that foods can predispose exercise-induced anaphylaxis. Precipitating food should be identified by challenge test.

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[99] - Shibasaki M, Ehara T, Takita H. Late anaphylactic reaction to cuttlefish. Ann Allergy 1989;63:421-422

A 10-year-old girl exhibited a late-onset systemic anaphylactic reaction, three and one-half hours after ingestion of cuttlefish. The late reaction was not preceded by an early-phase reaction but occurred seven days after an immediate anaphylactic reaction to this allergen. The patient had a high level of specific IgE antibody against cuttlefish.

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[100] - Wu YY. Spectrum of Skin Test Reactivities to Shellfish in Allergic Patients. AAAAI 59th Annual Meeting, Denver, 7-12 March, 2003, Poster n°745

RATIONALE: Shellfish is the most common food allergen amongst adult patients in Hong Kong, and accounts for a significant proportion of severe anaphylactic reactions seen in the emergency department. The pattern of cross-reactivity between different shellfish species in the local population is unknown. This study aims to determine the clinical presentation and skin test reactivity of patients allergic to shellfish in Hong Kong. METHODS: Patients attending the allergy clinic at Queen Mary Hospital from April 2001 to August 2002 for suspected shellfish allergy were recruited. Skin prick tests to eight shellfish and house dust mites were performed. RESULTS: 64 (22 M, 42 F) consecutive patients were recruited. The average age was 32 (range 14 months-70 years). 16 patients reported history of severe anaphylaxis requiring hospitalization. The most frequent positive skin test was to crab (60%), followed by lobster (50.77%), shrimp (41.54%), oyster (36.92%), chiton (35.38%), abalone (26.15%), scallop (21.54%) and clam (18.46%). There were 189 positive shellfish skin tests, with an average of 2.95 positive tests per subject. 6 (9.38%) subjects had no positive skin tests, and 4 (6.25%) subjects had eight positive skin tests. Overall, 76% of subjects had more than one positive skin test to shellfish. 55 (84.62%) subjects also had positive skin tests to house dust mites. CONCLUSIONS: There is a high degree of cross-reactivity between different species of shellfish. Patients with a history of shellfish allergy should therefore be cautious with all types of shellfish.

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[101] - Wu AYY, Chik SCC, Williams GA, Leung PSC. Cross-reactivity between different species of marine molluscs. EAACI 22th Congress, Paris, 7-11 June, 2003, Poster n°717

Background: Shellfish is the most common allergenic food in adults in Hong Kong. The major shellfish allergen tropomyosin is well-documented to be responsible for the cross-reactivity between different species. We have seen a number of patients with severe anaphylaxis after consuming a shellfish commonly used by local restaurants. Further investigation revealed that these shellfish are likely to be chitons, a Polyplacophoran mollusc. The aim of this study is to determine the prevalence of IgE against molluscs amongst shellfish allergic individuals. Methods: Serum samples from 112 shellfish allergic individuals were screened for IgE reactivity against abalone, Cellana grata, Colisella dorsuosa, and the chiton Acanthopleura japonica by ELISA. Positive sera were then subjected to IgE immunoblot analysis. Cross-inhibition studies were carried out by pre-incubating sera with recombinant abalone allergen followed by IgE immunoblotting. Results: 34 sera were reactive to C. grata, 27 to C. dorsuosa, 35 to A. japonica and 15 to abalone. Overall, 51 (45.5%) sera were reactive to at least one species, with 22 sera being reactive to one species only, 8 sera to two species, 11 sera to three species and 10 sera to all four species. Of the sera that were only reactive to one species, 10 of those were reactive to A. japonica, 3 to abalone, 8 to C. grata and 1 to C. dorsuosa. IgE immunoblot against all four species were performed with 12 serum samples. 7 of those were reactive to a 38kD band in one or more species, which was inhibited by recombinant tropomyosin. However, 5 serum samples that were only reactive to A. japonica showed a strong 180kD band and the 38kD band was absent. This 180kD band was not inhibited by recombinant tropomyosin. Conclusion: IgE reactivity against molluscs is very common in patients with shellfish allergy. There is extensive cross-reactivity between the different species of gastropods, due to the major allergen tropomyosin. However, the chiton A. japonica has a unique 180kD non-tropomyosin allergen that is absent in the three gastropods. It appears that this allergen can provoke very severe allergic reactions. Since this shellfish is usually hidden in Chinese restaurant food without labeling, it can be a serious problem for allergic individuals. The identity of this high molecular weight allergen is currently under investigation.

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[102] - Carrillo T, Castillo R, Caminero J, Cuevas M, Rodriguez JC, Acosta O, et al. Squid hypersensitivity: a clinical and immunologic study. Ann Allergy 1992;68:483-487

Hypersensitivity to mollusk has rarely been described in the literature. Among the mollusks, the cephalopods are a group of great importance as a food source. We report seven patients who had had symptoms highly suggestive of IgE-mediated reactions after ingesting squid or inhaling vapors from cooking squid. All had previously suffered from persistent rhinitis or asthma for years. In addition, six of the seven patients had had symptoms after ingesting shrimp. Skin prick tests were strongly positive for boiled squid extract and for various commercial crustacean extracts. Specific IgE antibodies against boiled extract and several crustacean extracts were demonstrated in all patients by RAST and reverse enzyme immunoassay. Cross reactivity between squid and shrimp and other crustaceans was demonstrated by reverse immunoassay inhibition studies. Cross reactivity could not be demonstrated between squid and octopus, which are both cephalopods, nor between squid and other mollusks

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[103] - Shibasaki M, Ehara T, Takita H. Late anaphylactic reaction to cuttlefish. Ann Allergy 1989;63:421-422

A 10-year-old girl exhibited a late-onset systemic anaphylactic reaction, three and one-half hours after ingestion of cuttlefish. The late reaction was not preceded by an early-phase reaction but occurred seven days after an immediate anaphylactic reaction to this allergen. The patient had a high level of specific IgE antibody against cuttlefish.

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[104] - Lee BJ, Park HS. Common Whelk ( Buccinum undatum) Allergy: Identification of IgE-binding Components and Effects of Heating and Digestive Enzymes. J Korean Med Sci 2004;19:793-799

In Korea, common whelk (Buccinum undatum) is a popular edible shellfish. The aim of this study was to observe the sensitization rate to common whelk and to characterize its allergens. We carried out skin prick test (SPT) in 1,700 patients with various allergic diseases. Specific IgE were detected by ELISA in the patient sera and ELISA inhibition tests were conducted. IgE-binding components were identified by means of SDS-PAGE and IgE-immunoblotting. The effects of digestive enzymes were evaluated in both raw and thermally treated extracts. SPT to common whelk was positive (>/=2+) in 83 (4.9%) patients studied. Twenty-four (38.7%) out of 62 SPT positive patients had high serum specific IgE to common whelk. ELISA inhibition test showed significant inhibitions by abalone as well as by common whelk. IgE-immunoblotting demonstrated three IgE-binding components (40, 71, 82 kDa), which were digested by simulated intestinal fluid and moderately digested by simulated gastric fluid, and the digestibility of allergens remained unchanged after thermal treatment. In conclusion, IgE-sensitization rate to common whelk was 4.9% in allergy patients. IgE-immunoblotting demonstrated three IgE-binding components, which were degraded by digestive enzymes. Further studies are needed to evaluate the clinical significance of the sensitized patients to common whelk.

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[105] - Azofra J, Lombardero M. Limpet anaphylaxis: cross-reactivity between limpet and house-dust mite Dermatophagoides pteronyssinus. Allergy 2003;58:146-149

BACKGROUND: Limpet is a mollusc that is frequently found along the shores of warm seas. Few allergic reactions to limpet have been described, and cross-reactivity with house-dust mites has not been established . METHODS: We report five patients with anaphylactic reactions due to limpet ingestion. A limpet extract was prepared and skin prick tests (SPT), radioallergosorbent assays (RAST), sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE-immunoblotting were performed. In order to evaluate cross-reactivity, an immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done . RESULTS: All patients were asthmatics sensitized to house-dust mites. In each case, severe bronchospasm was evidenced, and three required mechanical ventilation. Positive SPT with limpet extract was found in the four patients tested. RAST showed specific IgE on each patient's sera. Immunoblotting showed several allergenic fractions with a wide molecular weight range (15-250 kDa). D. pteronyssinus inhibited IgE-binding molecules above 50 kDa in the limpet extract, particularly one molecule of 75 kDa . CONCLUSIONS: We describe five patients with IgE-mediated limpet allergy. Severe bronchospasm was the most important symptom. Cross-reactivity with D. pteronyssinus was demonstrated.

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[106] - Carrillo T, de Castro FR, Cuevas M, Caminero J, Cabrera P. Allergy to limpet. Allergy 1991;46:515-519

Allergy to mollusk has rarely been described. The limpet, belonging to Phylum mollusca, is one of the most frequent mollusks in the Canary Islands, as in all warm maritime regions. We report two cases of atopic patients who developed anaphylactic reactions after ingestion of this mollusk. Type I hypersensitivity to limpet antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, and histamine release test to cooked limpet extract. The controls did not react to any of these tests. Allergic activity was only found with a cooked limpet extract; this suggests that the offending antigen/s may have been released by cooking this food.

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[107] - Martín-García C, Carnés J, Blanco R, Martínez-Alonso JC, Callejo-Melgosa A, Frades A, et al. Selective Hypersensitivity to Boiled Razor Shell. J Investig Allergol Clin Immunol 2007;17:271-273

Many types of seafood require cooking before ingestion and it has been demonstrated that this cooking process may affect the antigenicity and allergenicity of the food. We describe a case of anaphylaxis caused by selective sensitization to razor shell, a mollusc. In vivo and in vitro studies confirmed sensitization to boiled razor shell. Analysis of the nature of the allergen yielded results that were consistent with the findings of other authors and suggested that allergens involved in seafood allergy are commonly high molecular weight proteins that, in most cases, are heat stable.

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[108] - San Miguel-Moncín MM, Pineda F, Llamas E, Amat P, García R, García-Rubio I, et al. Octopus hypersensitivity. Allergy 2007;62(suppl. 83):330

Background: Shellfish have been recognized as potent allergens both in food allergy and occupational allergy. Of these, shrimp has received the most attention, but hypersensitivity to cephalopods has been rarely reported. A case report of octopus allergy without hypersensitivity to other cephalodods is described, being allergens involved studied. Methods: A 52-years old woman attended our Allergy Department. During last three years she had suffered several episodes of labial angioedema after octopus ingestion. Recently, she had been attended in the emergency room because of an episode of labial, lingual and facial angioedema with difficult to breath and wheezing treated with epinephrine which appeared immediately after ingesting octopus. After this last episode she had eaten in several occasions squid, cuttlefish, shrimp, crab, Norway lobster and velvet crabs without any adverse reaction. Skin prick tests (SPT) with panels of inhalants including dust mites, food allergens including anisakis, crustaceans and molluscs, and prick-by-prick with raw and cooked octopus, squid and cuttlefish were performed. In vitro immunoassays were carried out in order to asses the pattern of IgE reactivity. Results: SPT with panels of inhalants, food allergens, crustaceans and molluscs were negative. Prick-by-prick with raw and cooked squid and cuttlefish were also negative. Prick-by-prick with both raw and cooked octopus showed an immediate positive wheal (7x7 mm). Determination of specific IgE by enzyme allergosorbent test (EAST) (Hycor) to octopus gave 6,48 UI/mL, while was negative to squid, cuttlefish and shrimp. SDS-PAGE immunoblotting of squid, cuttlefish and octopus extracts showed a strong IgE-binding band of about 16-18 kDa. Not any IgE-binding band appeared with squid and cuttlefish extracts. Conclusions: A case report of hypersensitivity to octopus without allergy to other molluscs and crustaceans is described. To our knowledge, this is the first report of an allergen of about 16-18 kDa is involved in octopus allergy.

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[109] - Rodriguez del Rio P, Sanchez-Lopez J, HouchaimI A, Gonzalez-Gutierrez M, Pastor Vargas C, Fernandez-Rivas M. Allergy to Venus antiqua clam. Allergy 2008;63(suppl. 88):427

Background: Allergy to seafood is a well known and frequent food allergy, being shrimp allergy the most frequent one. We present the case of a patient with isolated allergy to King of Broderip (Venus antiqua). As far as we know, this is the first case of isolated allergy to clam in the medical literature. Case report: A 68 year-old man with a previous history of chronic bronchitis and high blood pressure who presented, 15- 30 min after the intake of canned clams, King of Broderip (Venus antiqua), palpebral oedema, scalp and palmo-plantar pruritus with shortness of breath that required antihistamines and corticosteroids. Skin prick tests (SPT) with commercial extracts of clam, shrimp, mussel, oyster and squid were negative. Prick-prick tests with fresh mussel, razor, cockle and Pullet carpet shell (Tapes pullastra, another variety of clam) were negative, but positive (7x5 mm) for King of Broderip (Venus antiqua). Total IgE was 245 kU/L, specific IgE to clam, crab, shrimp and mussel were negative (CAP Phadia). Oral challenges performed with canned mussel, razor and Pullet carpet shell were negative. An oral challenge was carried out with King of Broderip clam and 30 min after the last portion the patient developed a generalised urticaria, facial oedema and bronchospasm with normal blood pressure, that required inhaled salbutamol, intravenous corticosteroids, antihistamines and intramuscular epinephrine. The patient tolerated the ingestion of canned cockle from the same factory that manufactured the canned King of Broderip with a similar ingredient list. Conclusion: We present the case of a patient with a selective allergy to the clam King of Broderip (Venus antiqua), that tolerated other molluscs including the closely related clam Pullet carpet shell (Tapes pullastra).

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[110] - Fernandez-Caldas E, Puerta L, Caraballo L, Lockey RF. Mite allergens. Clin Allergy Immunol 2004;18:251-270

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[111] - Rico Diaz A, Pita S, Martin J, Pertega S, Ferreiro M. Study of variables associated to shellfood sensitivity. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°1043

Background: Shellfish is one of the most frequent food allergy causes in adults and also a typical plate of our gastronomy. Objective: The investigation of risk factors to shellfish sensitivity by comparison of different variables associated to a group of shellfish sensitized patients in relation to a control group of our sanitary area. Method: 104 outpatients out of 11921 who consulted our Allergic Service in a seven year period, were shellfish sensitized (SSG) . 108 consecutive outpatients came to our Allergy Service for different reasons and formed part of a group control (CG) which was applied the same clinical history protocol, skin prick test to a battery of aeroallergens, invertebrates (aedes comunis, culex pipiens, blatella germanica, orientalis, pleriplaneta americana, anisakis simplex), and seafood: shellfish (octopus vulgaris, todarodes pacificus, helix aspersa, ruditapes spp, mytilus edulis, pandalus borealis, penaeus indicus, palinurus vulgaris, micropipus puber, pollicipes) and a mix of white and blue fish. The IgE (CAP-FEIA) was determined. Statistic analysis were made: descriptive statistic of the variable included in the study, X2, Fisher and OR estimation with 95% of CI. Results: Out of the 104 outpatients with hypersensitivity to shellfood, 61,8 % were male and 39,8 % were female. .A 98,1 % were atopic ( sensitive to at least one aeroallergen); P: 0,000; OR: 51;95 %, CI:11,5-314,8) and the 98 % had mite hypersensitivity (p: 0,000; OR: 61,4; 95 % CI:(14,4-261,7); and 83,3% had cocroach sensitivity (p ,000; OR: 72,1 CI 95%(28,3-183,8). In relation to the 108 CG outpatients, 38,2 % were male, 60,2 % were female, 50 % were atopic and a 45,3 % were mite sensitized, and 6,5% cocroach sensitized. A 22,2 % of this group were sensitive to shellfish and the 100 % were atopic (p: 0,000). Conclusion: The shellfish sensitized profile of the patient of the sample in our sanitary area is an atopic mite allergic young boy. Atopia and mite and cocroach allergy are two variables strongly associated to IgE mediated shellfish sensitivity.

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[112] - Ferrer A, Huertas J, Carnés J, Casanovas M, Fernández-Caldas E. Seafood Extracts: Raw or Boiled for the Diagnosis of Allergic Patients ? J Allergy Clin Immunol 2005;115(2 suppl.):S92

RATIONALE: Seafood is an important component of the human diet The aim of this study was to evaluate what kind of extract (boiled or raw) is more effective to diagnose seafood allergy METHODS: Raw (A) and boiled (B) extracts from 2 types of lobsters, prawns, squid, octopus, mussels and clams were manufactured. Extracts B were prepared after the raw materials were boiled for 30 minutes. Extract A and B were homogenized, separately, and extracted for 4 hours. Afterwards, the content was centrifuged, dialyzed, filtered, frozen and freezedried Antigenic profile of extract A and B were compared by SDS-PAGE and the protein content determined. Fifty-six seafood allergic patients were included in the study. They were allergic to at least one of the seafood tested All of them were skin prick tested with all A and B extracts RESULTS: Important antigenic differences were detected in the antigenic profile of both types of extracts by SDS-PAGE. However, the protein content remained similar. In vivo results showed that extracts B induced statistically significant larger wheal sizes than extracts A in all cases except for clams, where extract Aand B induced similar wheal sizes This could be explained because clams can be ingested either boiled, or raw. In vitro experiments by direct ELISA confirmed the in vivo results CONCLUSIONS: The use of boiled extracts seems to be more effective to detect seafood allergy. The antigenic profile of B extracts is considerably modified after boiling

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[113] - Azofra J, Lombardero M. Limpet anaphylaxis: cross-reactivity between limpet and house-dust mite Dermatophagoides pteronyssinus. Allergy 2003;58:146-149

BACKGROUND: Limpet is a mollusc that is frequently found along the shores of warm seas. Few allergic reactions to limpet have been described, and cross-reactivity with house-dust mites has not been established . METHODS: We report five patients with anaphylactic reactions due to limpet ingestion. A limpet extract was prepared and skin prick tests (SPT), radioallergosorbent assays (RAST), sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE-immunoblotting were performed. In order to evaluate cross-reactivity, an immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done . RESULTS: All patients were asthmatics sensitized to house-dust mites. In each case, severe bronchospasm was evidenced, and three required mechanical ventilation. Positive SPT with limpet extract was found in the four patients tested. RAST showed specific IgE on each patient's sera. Immunoblotting showed several allergenic fractions with a wide molecular weight range (15-250 kDa). D. pteronyssinus inhibited IgE-binding molecules above 50 kDa in the limpet extract, particularly one molecule of 75 kDa . CONCLUSIONS: We describe five patients with IgE-mediated limpet allergy. Severe bronchospasm was the most important symptom. Cross-reactivity with D. pteronyssinus was demonstrated.

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[114] - van Ree R, Antonicelli L, Akkerdaas JH, Pajno GB, Barberio G, Corbetta L, et al. Asthma after consumption of snails in house-dust-mite-allergic patients: a case of IgE cross-reactivity. Allergy 1996;51:387-393

A group of 28 patients from Italy was studied who had asthma after consumption of snail. All patients also had asthma and/or rhinitis caused by house-dust mite. RAST analyses confirmed the combined sensitization to snail and mite. In a few sera, IgE antibodies reactive with other foods of invertebrate origin (mussel and shrimp) were detected. RAST inhibition showed that most IgE antibodies against snail were cross-reactive with house-dust mite. In contrast, the mite RAST was not significantly inhibited by snail. This indicates that house-dust mite was the sensitizing agent. Immunoblot analyses revealed multiple bands in snail extract recognized by IgE. In contrast to what has been described for cross-reactivity between shrimp and mite, tropomyosin played only a minor role as a cross-reactive allergen in these patients. The observations in this study indicate that snail consumption can cause severe asthmatic symptoms in house-dust-mite-allergic patients. It might, therefore, be advisable to screen mite-allergic asthma patients for allergy to snail and other invertebrate animal foods.

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[115] - Peroni DG, Piacentini GL, Bodini A, Boner AL. Snail anaphylaxis during house dust mite immunotherapy. Pediatr Allergy Immunol 2000;11:260-261

This study reports a 12-year-old girl who developed an anaphylactic reaction following snail ingestion during house dust mite (HDM) immunotherapy treatment. Radioallergosorbent (RAST) inhibition showed cross-reactivity between the two allergens, leading to consideration of HDM as the sensitizing agent. Children undergoing HDM immunotherapy treatment should be aware of the potential risks of hypersensitivity reactions to invertebrate foods.

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[116] - Piedade S, Gaspar A, Rosa S, Santa-Marta C, Paiva M, Matos V, et al. Seafood allergy and house dust mite sensitisation: what is the truth ? Allergy 2008;63(suppl. 88):10

Background: Seafood allergy is a usual food allergy often associated with severe lifethreatening systemic reactions. Nevertheless, the true prevalence of this clinical entity remains uncertain, namely in patients sensitised to house dust mites (HDM). Purpose: To determine the prevalence of seafood allergy in a specialized Immunoallergy outpatient clinic, and to evaluate the importance of HDM sensitisation as a risk factor. Methods: In 1067 patients, with >=6 years of age, consecutively observed in our Immunoallergy department during the period of 1 year, a normalized questionnaire and skin prick tests (SPT) with common aeroallergens were applied. All patients with symptoms related with seafood ingestion were studied with SPT (commercial extracts and fresh food) and specific IgE (sIgE) to the implicated food(s), HDM (Dermatophagoides pteronyssinus and Dermatophagoides farinae) and cockroach (Blattella germanica); food challenges were performed when needed. Results: During the one year period, 110 patients referred adverse reaction after seafood ingestion (10.3%), being the food allergy confirmed in 56 (5.2%). The prevalence of seafood allergy in HDM sensitised patients was significantly higher, 8.2% vs. 1.5% (OR55.9, CI95%52.5-14.4; P< 0.0001). The seafood allergic patients had a mean age of 27±15 years (ranged from 6 to 62 years), 34% with =<15 years of age. The male/female ratio was 0.8 : 1. The mean age of the onset of symptoms was 19±15 years (range from 6 months to 56 years). Symptoms occurred after the first ingestion of the seafood in 24% of the patients. Clinical manifestations were: anaphylaxis - 27 patients (2 required mechanical ventilation), mucocutaneous - 21 and respiratory - 8. They also had symptoms with inhalation in 25% of cases. The foods associated were: crustaceous - 51 patients, molluscs - 37 (gastropods - 20, bivalves - 15, cephalopods - 19). In 13 patients the SPT were positive only with the fresh food. The sIgE to the implicated food was positive in 60% of seafood allergic patients. Conclusion: Seafood allergy is an important problem in our population. HDM sensitisation proved to be a risk factor for the development of this food allergy, probably in the context of a cross-reactivity phenomenon. Anaphylaxis was the clinical presentation of the disease in half of patients. We emphasize the importance of performing SPT with fresh food in order to increase the diagnostic sensitivity.

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[117] - Carrillo T, de Castro FR, Cuevas M, Caminero J, Cabrera P. Allergy to limpet. Allergy 1991;46:515-519

Allergy to mollusk has rarely been described. The limpet, belonging to Phylum mollusca, is one of the most frequent mollusks in the Canary Islands, as in all warm maritime regions. We report two cases of atopic patients who developed anaphylactic reactions after ingestion of this mollusk. Type I hypersensitivity to limpet antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, and histamine release test to cooked limpet extract. The controls did not react to any of these tests. Allergic activity was only found with a cooked limpet extract; this suggests that the offending antigen/s may have been released by cooking this food.

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[118] - Joral A, Navarro JA, Villas F, Garmendia J, Villarreal O. Limpet anaphylaxis. Allergy 1997;52(suppl. 37):117

Limpet (Patella vulgata) is a gasteropod mollusc, which is seldom consumed in our country. Due to this, the observation of adverse reactions is exceptional. We present two patients who experienced immediate anaphylaxis after the intake of limpets. Both of them had a concomitant house dust mite (HDM) hypersensitivity. Cross reactivity has already been described between HDM and other molluscs and crustaceans. Case1 : female 26y Rhinoconjunctivitis and mild asthma to HDM and anaphylaxis to limpet Skin tests+ for HDM and Limpet Case1 : male 20y Rhinoconjunctivitis to HDM and anaphylaxis to limpet Skin tests+ for HDM and Limpet The clinical picture of the adverse reaction to limpets, the atopic background and the results of skin tests suggest an IgE mechanism. Other groups have previously described limpet specific IgE in similar cases, although no cross reactivity was demonstrated between HDM and limpets

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[119] - Sun B, Wu A, Zhong N. Asthma after consumption of seafood in housedust- mite-allergic patients: cross-reactivity of shrimp, abalone and Derp1. Ann Allergy Asthma Immunol 2005;94:182

Background: The prevalence of allergic disease in most human population is steadily increasing. Seafood allergy is a serious food allergy, although hypersensitive reactions caused by seafood has long been know, biochemical and Immunological studies on seafood allergies had only begun lately. Shrimp and abalone are the most frequently reported causes early asthmatic response. OBJECTIVE: To investigate cross-reactivity of shrimp, abalone and Derp1. METHODS: Shrimp and abalone extracts were prepare from raw seafood. Sera from 17 patients from HongKong were studied who had asthma after consumption of seafood. IgE ELISA analyses comfirmed the combined sensitization to shrimp, abalone and Derp1. Specific-IgE ELISA assays were accomplished for shrimp and abalone extracts inhibited by Derp1 and Derp1 ELISA and Immunoblot assays inhibited by shrimp and abalone extracts. RESULTS: ELISA inhibition showed that most IgE antibodies against shrimp and abalone were cross-reactive with Derp1 and the same time, Derp1 ELISA was inhibition by shrimp and abalone extract. The ELISA inhibition percent (%)of shrimp extract (GM:53.28%) and abalone extract(GM:36.75%) by Derp1 were significantly higher than Derp1 by shrimp extract(GM:26.64%) and abalone extract (GM:17.59%). (P<0.01). Furthermore, and there was a significant correlation of ELISA inhibition percent between shrimp extract, abalone extract and Derp1 inhibited by each other; SDS-PAGE and immunoblot of shrimp and abalone is the 38 and 49kD allergen respectively. CONCLUSION: This indicates that Derp1 was the sensitive agent. Shrimp, abalone and Derp1 demonstrate significant cross-reactivity. These findings confirm that the primary crossreactive allergen of shrimp and abalone is the 38 and 49kD allergen respectively.

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[120] - Peroni DG, Piacentini GL, Bodini A, Boner AL. Snail anaphylaxis during house dust mite immunotherapy. Pediatr Allergy Immunol 2000;11:260-261

This study reports a 12-year-old girl who developed an anaphylactic reaction following snail ingestion during house dust mite (HDM) immunotherapy treatment. Radioallergosorbent (RAST) inhibition showed cross-reactivity between the two allergens, leading to consideration of HDM as the sensitizing agent. Children undergoing HDM immunotherapy treatment should be aware of the potential risks of hypersensitivity reactions to invertebrate foods.

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[121] - Reese G, Ayuso R, Lehrer SB. Tropomyosin: an invertebrate pan-allergen. Int Arch Allergy Immunol 1999;119:247-258

Among food allergens, crustaceans, such as shrimp, crab, crawfish and lobster, are a frequent cause of adverse food reactions in allergic individuals. The major allergen has been identified as the muscle protein tropomyosin. This molecule belongs to a family of highly conserved proteins with multiple isoforms found in both muscle and nonmuscle cells of all species of vertebrates and invertebrates. Its native structure consists of two parallel alpha-helical tropomyosin molecules that are wound around each other forming a coiled-coil dimer. Allergenic tropomyosins are found in invertebrates such as crustaceans (shrimp, lobster, crab, crawfish), arachnids (house dust mites), insects (cockroaches), and mollusks (e.g. squid), whereas vertebrate tropomyosins are nonallergenic. Studies of cross-reactivities among crustaceans and the high degree of sequence identity among them suggest that tropomyosin is probably the common major allergen in crustaceans. Furthermore, immunological relationships between crustaceans, cockroaches and housedust mites have been established and may suggest tropomyosin as an important cross-sensitizing pan allergen. [References: 57]

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[122] - Asero R. Lack of de novo Sensitization to Tropomyosin in a Group of Mite-Allergic Patients Treated by House Dust Mite-Specific Immunotherapy. Int Arch Allergy Immunol 2005;137:62-65

BACKGROUND: There is some evidence that specific immunotherapy may induce de novo sensitization to proteins contained in the allergen extract. This raises the possibility that the novel sensitization to cross-reacting allergens may cause food allergies . OBJECTIVE: The aim of this study was to assess whether injection of mite-specific immunotherapy (SIT) may induce sensitization to shrimp tropomyosin . METHODS: Seventy mite-allergic subjects who did not show any shrimp sensitization at baseline were followed up for at least 3 years. Thirty-one of them underwent a 3-year SIT course, 39 served as controls. At the follow-up visit, SPTs with both fresh shrimp and commercial extract were performed, and patients underwent an open oral challenge with shrimp . RESULTS: Neither patient nor control had become sensitized to shrimp allergens at the end of the study period. Both patients and controls reported the regular intake of crustaceans and/or molluscs . CONCLUSION: Injection SIT with house dust mite extracts does not seem to induce de novo tropomyosin sensitization in mite-allergic patients

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[123] - Lehrer SB, Ayuso R, Reese G. Current Understanding of Food Allergens. Ann N Y Acad Sci 2002;964:69-85

Food allergies are IgE-mediated immunological reactions; this distinguishes them from other adverse reactions to foods. Most (>90%) of the recognized food allergies are generally thought to be caused by eight foods or food groups. A number of factors can affect food allergy development, including diet and culture, route of exposure, processing, cooking, and digestion. In addition, it is thought that the properties of certain food proteins render them more likely to be allergenic than other proteins. Most food allergens are major proteins, polyvalent molecules with at least two or more IgE-binding sites, and are recognized as foreign molecules (hence immunogenic). A number of major food allergens have been recently characterized, and amino acid sequences determined. Tropomyosin is the only major allergen of shrimp. A number of IgE-binding epitopes have been identified in this molecule, though they may vary from one shrimp-allergic individual to another. Single amino acid substitutions within epitopes based on that of homologous, nonreactive tropomyosins can substantially enhance or abolish IgE antibody binding. Using the accumulated knowledge of food allergen protein structure, the allergenicity of novel proteins to which there has been no prior human exposure has been assessed. This has been based primarily on the lability or resistance of a protein to enzymatic degradation. Clearly, further criteria must be developed to refine this process. In this regard, the development of animal models that have been sufficiently validated as surrogates of human IgE antibody responses is needed for more precise assessment of the allergenic potential of proteins

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[124] - Taylor SL. Molluscan shellfish allergy. Adv Food Nutr Res 2008;54:139-177

Food allergies affect approximately 3.5-4.0% of the worldwide population. Immediate-type food allergies are mediated by the production of IgE antibodies to specific proteins that occur naturally in allergenic foods. Symptoms are individually variable ranging from mild rashes and hives to life-threatening anaphylactic shock. Seafood allergies are among the most common types of food allergies on a worldwide basis. Allergies to fish and crustacean shellfish are very common. Molluscan shellfish allergies are well known but do not appear to occur as frequently. Molluscan shellfish allergies have been documented to all classes of mollusks including gastropods (e.g., limpet, abalone), bivalves (e.g., clams, oysters, mussels), and cephalopods (e.g., squid, octopus). Tropomyosin, a major muscle protein, is the only well-recognized allergen in molluscan shellfish. The allergens in oyster (Cra g 1), abalone (Hal m 1), and squid (Tod p 1) have been identified as tropomyosin. Cross-reactivity to tropomyosin from other molluscan shellfish species has been observed with sera from patients allergic to oysters, suggesting that individuals with allergies to molluscan shellfish should avoid eating all species of molluscan shellfish. Cross-reactions with the related tropomyosin allergens in crustacean shellfish may also occur but this is less clearly defined. Occupational allergies have also been described in workers exposed to molluscan shellfish products by the respiratory and/or cutaneous routes. With food allergies, one man's food may truly be another man's poison. Individuals with food allergies react adversely to the ingestion of foods and food ingredients that most consumers can safely ingest (Taylor and Hefle, 2001). The allergens that provoke adverse reactions in susceptible individuals are naturally occurring proteins in the specific foods (Bush and Hefle, 1996). Molluscan shellfish, like virtually all foods that contain protein, can provoke allergic reactions in some individuals.

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[125] - Lehrer SB, McCants ML. Reactivity to IgE antibodies with crustacea and oyster allergens: evidence for common antigenic structures. J Allergy Clin Immunol 1987;80:133-139

IgE-antibody reactivity to oysters and crustacea of sera from six oyster-sensitive, seven oyster- and crustacea-sensitive, and 12 crustacea-sensitive subjects was investigated. All six subjects with a history of only oyster sensitivity had minimal RAST reactivity (ratios 2 to 5) to extracts of raw or boiled oysters. Three of the seven oyster- and crustacea-sensitive subjects and six of the 12 crustacea-sensitive, oyster-tolerant or unexposed subjects had elevated RAST ratios to oyster (14 to 41). Generally, elevated oyster RAST correlated with skin prick test reactivity to oyster but not with total serum IgE levels. The oyster RAST values of the 19 crustacea-sensitive subjects (with or without oyster sensitivity) correlated with crustacea RAST reactivity (crab RAST, most significant; shrimp RAST, least significant). Rabbit antisera to crustacea extracts detected precipitating antigens present in extracts of raw or boiled oysters. Significant inhibition of the oyster RAST was obtained with oyster or crustacea extracts. These studies suggest that in the diagnosis of oyster sensitivity the RAST may not be useful and that oyster and crustacea contain common antigenic structures.

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[126] - Reder MW, Wild LG, El-Dahr JM, Villacis J, Demerell D, Soteres D, et al. IgE Antibody Activity of Shrimp Allergic Subjects to Inhalant and Food Allergens. J Allergy Clin Immunol 2005;115(2 suppl.):S92

RATIONALE: Shrimp is an important allergenic seafood. The major shrimp allergen is the muscle protein tropomyosin. Since tropomyosin is present in other inhaled and ingested allergens, it was of interest to determine potential sensitivity of shrimp allergic subjects to these other allergens METHODS: Shrimp allergic subjects were recruited by advertisement 58 subjects (25 male, 33 female) ages 18-63, with definitive histories of shrimp allergy, as determined by questionnaire, were selected. Subjects were skin prick tested (ST) with aeroallergen and shellfish food extracts from Hollister-Stier; positive ST was determined by wheal with flare. IgE antibody responses to shrimp were measured by CAP-RAST RESULTS: 37/58 subjects were ST positive to at least 1 shrimp extract (64%). 41 (71%) were positive to either crab, lobster, crawfish, or oyster, 51 (88%) to either cockroach or DM, 19 (33%) to tree pollens, and 14 (24%) to grass pollens. Of the 37 subjects ST positive for shrimp, 35 (96%) were positive to crab, lobster, or crawfish. 36 (97%) reacted to either cockroach or DM. Of the 58 original subjects, 28 (48%) had undetectable IgE to shrimp (class 0) on CAP-RAST analysis. Of the 37 shrimp ST positive subjects, only 10 (27%) had undetectable IgE to shrimp CONCLUSIONS: Shrimp allergic subjects show significant reactivity to other shellfish, the greatest was to lobster, the least to oysters. Significant reactivity was observed to cockroach and DM extracts which is probably due in part to cross reactivity of invertebrate tropomyosin allergens. Better understanding of this should help improve diagnosis and therapy of food allergy

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[127] - Motoyama K, Ishizaki S, Nagashima Y, Shiomi K. Cephalopod tropomyosins: Identification as major allergens and molecular cloning. Food Chem Toxicol 2006;44:1997-2002

Heated extracts prepared from the mantle muscles (for decapods) or leg muscles (for octapods) of nine species of cephalopods were shown to be all reactive with serum IgE in crustacean-allergic patients. No marked difference in the reactivity with IgE was recognized among the cephalopods, suggesting that they are almost equally allergenic. Immunoblotting and inhibition immunoblotting data revealed that the major allergen is tropomyosin in common with the nine species of cephalopods and that the cephalopod tropomyosins are cross-reactive with one another and also with crustacean tropomyosins. Molecular cloning experiments first elucidated the primary structures of tropomyosins from five species of cephalopods. The cephalopod tropomyosins show high sequence identity (more than 92% identity) with one another, being the molecular basis for their cross-reactivity. Although the sequence identity between cephalopod and crustacean topomyosins is only about 63-64%, some of the IgE-binding epitopes proposed for brown shrimp Penaeus aztecus tropomyosin (Pen a 1) are well conserved in the cephalopod tropomyosins, supporting the cross-reactivity between cephalopod and crustacean tropomyosins.

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[128] - Motoyama K, Ishizaki S, Nagashima Y, Shiomi K. Cephalopod tropomyosins: Identification as major allergens and molecular cloning. Food Chem Toxicol 2006;44:1997-2002

Heated extracts prepared from the mantle muscles (for decapods) or leg muscles (for octapods) of nine species of cephalopods were shown to be all reactive with serum IgE in crustacean-allergic patients. No marked difference in the reactivity with IgE was recognized among the cephalopods, suggesting that they are almost equally allergenic. Immunoblotting and inhibition immunoblotting data revealed that the major allergen is tropomyosin in common with the nine species of cephalopods and that the cephalopod tropomyosins are cross-reactive with one another and also with crustacean tropomyosins. Molecular cloning experiments first elucidated the primary structures of tropomyosins from five species of cephalopods. The cephalopod tropomyosins show high sequence identity (more than 92% identity) with one another, being the molecular basis for their cross-reactivity. Although the sequence identity between cephalopod and crustacean topomyosins is only about 63-64%, some of the IgE-binding epitopes proposed for brown shrimp Penaeus aztecus tropomyosin (Pen a 1) are well conserved in the cephalopod tropomyosins, supporting the cross-reactivity between cephalopod and crustacean tropomyosins.

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[129] - Wu AY, Williams GA. Clinical Characteristics and Pattern of Skin Test Reactivities in Shellfish Allergy Patients in Hong Kong. Allergy Asthma Proc 2004;25:237-242

Allergens from crustaceans and mollusks exhibit extensive cross-reactivity in vitro. However, the degree and pattern of crossreactivity between different shellfish species in vivo is still unclear. The objective of this study was to determine the clinical characteristics of shellfish allergic patients in Hong Kong and the pattern of skin test reactivities to the different species. This cohort study involves patients attending the allergy clinic of a large teaching hospital for suspected shellfish allergy. Each subject underwent skin-prick tests to eight species of shellfish and house-dust mites. Eighty-four consecutive patients were tested. Twenty-eight patients reported a history of severe anaphylaxis. Fourteen patients had no positive shellfish skin test and were excluded. There were 183 positive shellfish skin tests, with an average of 2.61 positive tests per subject. Ninety percent of subjects also had positive skin tests to house-dust mites. Overall, 65.7% of subjects had more than one positive skin test to shellfish. There were strong statistical associations between species belonging to the same order but also between some mollusks and crustaceans. We found a high degree of skin test cross-reactivity between different species of shellfish and between shellfish and house-dust mites. Therefore, patients with a history of shellfish allergy should be cautious with all types of shellfish.

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[130] - Marinho S, Morais-Almeida M, Gaspar A, Santa-Marta C, Pires G, Rosado Pinto J. Allergy to barnacle - clinical cases. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°1042

Allergy to barnacle (phylum Arthropoda, subphylum Crustacea) is a condition of which there aren't, until now, any cases described in the indexed literature. Barnacles are crustaceans regularly consumed in our country. We describe 5 cases of IgE mediated allergy to barnacles. Case 1: 3-year-old male, with asthma, allergic rhinitis, AEDS and egg allergy; sensitized to mites and egg. Generalized urticaria and facial angioedema after the first ingestion of barnacle at 2 years of age; subsequent facial angioedema after contact; no symptoms related to other crustaceans or molluscs. Positive skin prick tests (SPT) to raw and cooked barnacle. Case 2: 6 year old female, with allergic rhinitis and AEDS, sensitized to mites. Generalized urticaria and facial angioedema after the first ingestion of barnacle at 2 years of age; subsequent urticaria and facial angioedema after contact; no symptoms related to other foods. Positive SPT to cooked barnacle. Case 3: 9-year-old male, with asthma, allergic rhinitis and AEDS, sensitized to mites and cockroaches. Oral allergy syndrome (OAS), periorbitary angioedema and rhinoconjunctivitis after the first ingestion of barnacle at 7 years of age; similar episodes after the ingestion of snail, squid and cuttlefish at 8 years of age (prior ingestion with no symptoms); no symptoms upon the ingestion of other crustaceans or bivalves. Positive SPT to raw and cooked barnacle, snail, squid, cuttlefish, shrimp and clam. Case 4: 20-year-old female with asthma, allergic rhinitis and kiwi fruit allergy; sensitized to tree's pollens and kiwi fruit. Two episodes of laryngeal edema after the ingestion of barnacle and shrimp at 18 years of age (prior ingestion with no symptoms); no symptoms with other foods. Positive SPT to cooked barnacle and shrimp. Case 5: 29-year-old male, with allergic rhinitis, sensitized to mites, cockroaches and flowers' pollens. OAS after the ingestion of barnacle and shrimp since 10 years of age; generalized urticaria and face and hands angioedema after the ingestion of shrimp and crab since 20 years of age; periorbitary angioedema after the ingestion of snail at 29 years; no symptoms related to other molluscs. Positive SPT to raw and cooked barnacle and shrimp. We conclude that the food habits of a population strongly influence the patterns of food allergy; in our patients, also sensitized to mites, cross-reactivity phenomena appear to be most probable, as it was demonstrated for other crustaceans.

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[131] - Carrillo T, Castillo R, Caminero J, Cuevas M, Rodriguez JC, Acosta O, et al. Squid hypersensitivity: a clinical and immunologic study. Ann Allergy 1992;68:483-487

Hypersensitivity to mollusk has rarely been described in the literature. Among the mollusks, the cephalopods are a group of great importance as a food source. We report seven patients who had had symptoms highly suggestive of IgE-mediated reactions after ingesting squid or inhaling vapors from cooking squid. All had previously suffered from persistent rhinitis or asthma for years. In addition, six of the seven patients had had symptoms after ingesting shrimp. Skin prick tests were strongly positive for boiled squid extract and for various commercial crustacean extracts. Specific IgE antibodies against boiled extract and several crustacean extracts were demonstrated in all patients by RAST and reverse enzyme immunoassay. Cross reactivity between squid and shrimp and other crustaceans was demonstrated by reverse immunoassay inhibition studies. Cross reactivity could not be demonstrated between squid and octopus, which are both cephalopods, nor between squid and other mollusks

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[132] - Zhang Y, Matsuo H, Morita E. Cross-reactivity among shrimp, crab and scallops in a patient with a seafood allergy. J Dermatol 2006;33:174-177

Shrimp is known to be the most common causative agent in seafood allergy. Patients with shrimp allergy often exhibit allergic symptoms to a variety of seafoods such as crabs and clams. We experienced a 14-year-old girl with shrimp allergy who developed oral swelling and pain accompanied with an uncomfortable feeling after ingestion of scallops followed by intensive exercise. Laboratory investigation showed that she had serum immunoglobulin (Ig)E molecules reacting with several kinds of crustaceans and mollusks, including shrimp, crab and scallops. Immunoblotting revealed that her serum IgE reacted with the 38 kDa bands for shrimp, crab and scallops, suggesting that tropomyosin was the major allergen. Dot-blot inhibition analysis showed a cross-reactivity among shrimp, crab and scallops. We conclude that the cross-reactivity of IgE in this patient resulted from the high homology of tropomyosins.

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[133] - Leung PS, Chow WK, Duffey S, Kwan HS, Gershwin ME, Chu KH. IgE reactivity against a cross-reactive allergen in crustacea and mollusca: evidence for tropomyosin as the common allergen. J Allergy Clin Immunol 1996;98:954-961

Although cross-reactivity between mollusks and other crustaceans in shrimp-sensitive subjects has been reported, the mechanism of this allergenic cross-reactivity has not been studied in detail. OBJECTIVE: To investigate this cross-reactivity in vitro, we have taken advantage of a complementary DNA that expresses tropomyosin, the immunodominant shrimp allergen. METHODS: Serum IgE from nine patients with known anaphylaxis to shrimp and five normal volunteers were analyzed by immunoblotting against 13 distinct crustaceans and mollusks. As additional antigens, muscle preparations were isolated from grasshopper, cockroach, fruit fly, chicken, and mouse. RESULTS: Sera from all patients, but not control subjects, reacted specifically with a 38 kd protein in all crustaceans and mollusks studied. In addition, 8 of 9 sera from patients, but from none of the normal control subjects, recognized proteins of various other molecular weights among the mollusk extracts studied. The 38 kd protein was identified as tropomyosin and was shown to share immunodominant epitopes among all species of crustaceans and mollusks tested by specific absorption studies. Moreover, sera from all nine subjects with shrimp allergy demonstrated IgE reactivities against grasshopper, cockroach, and fruit fly but not chicken or murine muscle. CONCLUSION: The allergic epitopes on tropomyosin are conserved among invertebrates including not only shellfish but also insects. This latter observation suggests that persons sensitive to shrimp should undergo further study for potential cross-reactive inhalant or ingested insect sensitivity.

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[134] - Lopata AL, Zinn C, Potter PC. Characteristics of hypersensitivity reactions and identification of a unique 49 kd IgE-binding protein (Hal m1) in abalone (Haliotis midae). J Allergy Clin Immunol 1997;100:642-648

There is a paucity of published data on the clinical presentation and the nature of the allergens involved in hypersensitivity to mollusks. This study reports the clinical and immunologic findings in 38 patients with reported immediate and delayed adverse reactions to abalone (Haliotis midae, Class Gastropoda). METHODS: Patients were recruited as part of a South African seafood allergy survey. Allergic symptoms were assessed by a self-administered questionnaire. A total of 38 patients with abalone sensitivity were recruited. Specific IgE responses to abalone and other mollusks were studied by using RAST and inhibition ELISAs. Skin prick tests and lymphocyte proliferation assays were also performed on several of the subjects. Allergenic components of Haliotis midae were identified with Western blotting. RESULTS: Twenty five of the 38 patients in the study were first seen with immediate symptoms, and 13 had delayed reactions. Seventeen of the sera tested were RAST positive. Skin prick tests responses with abalone extract were positive in all subjects with positive RAST responses (n = 8) and in 6 of 13 subjects with negative RAST responses. Five of the subjects with positive RAST responses had positive results on Western blotting and demonstrated binding to two major allergens with molecular weights of 38 and 49 kd. The 49 kd IgE-binding protein has been designated as Hal-m-1. CONCLUSIONS: Abalone allergens are heat-stable proteins with molecular weights of 38 and 49 kd, later designated as Hal-m-1 according to International Union of Immunological Societies allergen nomenclature regulation. Our studies indicate a clear clinical and immunologic heterogeneity in patients reactive to abalone.

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[135] - Motoyama K, Ishizaki S, Nagashima Y, Shiomi K. Cephalopod tropomyosins: Identification as major allergens and molecular cloning. Food Chem Toxicol 2006;44:1997-2002

Heated extracts prepared from the mantle muscles (for decapods) or leg muscles (for octapods) of nine species of cephalopods were shown to be all reactive with serum IgE in crustacean-allergic patients. No marked difference in the reactivity with IgE was recognized among the cephalopods, suggesting that they are almost equally allergenic. Immunoblotting and inhibition immunoblotting data revealed that the major allergen is tropomyosin in common with the nine species of cephalopods and that the cephalopod tropomyosins are cross-reactive with one another and also with crustacean tropomyosins. Molecular cloning experiments first elucidated the primary structures of tropomyosins from five species of cephalopods. The cephalopod tropomyosins show high sequence identity (more than 92% identity) with one another, being the molecular basis for their cross-reactivity. Although the sequence identity between cephalopod and crustacean topomyosins is only about 63-64%, some of the IgE-binding epitopes proposed for brown shrimp Penaeus aztecus tropomyosin (Pen a 1) are well conserved in the cephalopod tropomyosins, supporting the cross-reactivity between cephalopod and crustacean tropomyosins.

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[136] - Lee BJ, Park HS. Common Whelk ( Buccinum undatum) Allergy: Identification of IgE-binding Components and Effects of Heating and Digestive Enzymes. J Korean Med Sci 2004;19:793-799

In Korea, common whelk (Buccinum undatum) is a popular edible shellfish. The aim of this study was to observe the sensitization rate to common whelk and to characterize its allergens. We carried out skin prick test (SPT) in 1,700 patients with various allergic diseases. Specific IgE were detected by ELISA in the patient sera and ELISA inhibition tests were conducted. IgE-binding components were identified by means of SDS-PAGE and IgE-immunoblotting. The effects of digestive enzymes were evaluated in both raw and thermally treated extracts. SPT to common whelk was positive (>/=2+) in 83 (4.9%) patients studied. Twenty-four (38.7%) out of 62 SPT positive patients had high serum specific IgE to common whelk. ELISA inhibition test showed significant inhibitions by abalone as well as by common whelk. IgE-immunoblotting demonstrated three IgE-binding components (40, 71, 82 kDa), which were digested by simulated intestinal fluid and moderately digested by simulated gastric fluid, and the digestibility of allergens remained unchanged after thermal treatment. In conclusion, IgE-sensitization rate to common whelk was 4.9% in allergy patients. IgE-immunoblotting demonstrated three IgE-binding components, which were degraded by digestive enzymes. Further studies are needed to evaluate the clinical significance of the sensitized patients to common whelk.

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[137] - Leung PS, Chow WK, Duffey S, Kwan HS, Gershwin ME, Chu KH. IgE reactivity against a cross-reactive allergen in crustacea and mollusca: evidence for tropomyosin as the common allergen. J Allergy Clin Immunol 1996;98:954-961

Although cross-reactivity between mollusks and other crustaceans in shrimp-sensitive subjects has been reported, the mechanism of this allergenic cross-reactivity has not been studied in detail. OBJECTIVE: To investigate this cross-reactivity in vitro, we have taken advantage of a complementary DNA that expresses tropomyosin, the immunodominant shrimp allergen. METHODS: Serum IgE from nine patients with known anaphylaxis to shrimp and five normal volunteers were analyzed by immunoblotting against 13 distinct crustaceans and mollusks. As additional antigens, muscle preparations were isolated from grasshopper, cockroach, fruit fly, chicken, and mouse. RESULTS: Sera from all patients, but not control subjects, reacted specifically with a 38 kd protein in all crustaceans and mollusks studied. In addition, 8 of 9 sera from patients, but from none of the normal control subjects, recognized proteins of various other molecular weights among the mollusk extracts studied. The 38 kd protein was identified as tropomyosin and was shown to share immunodominant epitopes among all species of crustaceans and mollusks tested by specific absorption studies. Moreover, sera from all nine subjects with shrimp allergy demonstrated IgE reactivities against grasshopper, cockroach, and fruit fly but not chicken or murine muscle. CONCLUSION: The allergic epitopes on tropomyosin are conserved among invertebrates including not only shellfish but also insects. This latter observation suggests that persons sensitive to shrimp should undergo further study for potential cross-reactive inhalant or ingested insect sensitivity.

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[138] - Castillo R, Carrilo T, Blanco C, Quiralte J, Cuevas M. Shellfish hypersensitivity: clinical and immunological characteristics. Allergol Immunopathol (Madr) 1994;22:83-87

Shellfish is one of the most frequent causes of food allergy. We studied 48 patients (25 male and 23 female) with a mean age of 24.2 +/- 1.8 with shellfish hypersensitivity. A clinical questionnaire was carried out and prick tests were performed using a series of aeroallergens and a battery of extracts of squid, shrimp, lobster, crab, mussel and clam. Prick tests were also performed using raw and boiled extracts from fresh squid, octopus and limpet. Total and specific IgE to these allergens were determined. The most frequent causes of symptoms were shrimp (33 cases) and squid (24 cases). The most frequently found symptoms were Urticaria/angioedema (39 patients), asthma (18 patients) and rhinitis (14 patients). Clinical association was found between Cephalopoedae and Lamelibranquiae (p < 0.05 for clam and p < 0.01 for mussel), but not among both groups and Crustaceans. Association between history and Prick was statistically significant for Crustaceae and Cephalopoedae (p < 0.01) but not for Lamalibranquiae. Association between history and CAP was not found for shellfish. Significant differences among prick-tests with raw and boiled extracts were not found. These results suggest that prick test yields better results than CAP does it, in shellfish hypersensitivity, that clinical association among shellfish hypersensitivity can occurs within the same and different Phylum reflecting common epitopes and that squid, octopus and limpet extracts contain a large amount of heat-stable allergens.

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[139] - Sanchez-Garcia S, Gamez C, Lopez E, Ibañez MD, Escudero C, Madero MF et al. Allergy To Shrimp: A Double Blind, Placebo-controlled, Food Challenge Study And Allergens Implicated In Spain. J Allergy Clin Immunol 2009;123:S23

RATIONALE: Our study aimed to investigate clinical characteristics and allergens recognized by patients with suspected shrimp allergy. METHODS: We studied 35 patients with suspected allergic reactions to shrimp, mostly urticaria. In all patients double-blind placebo controlled oral challenge (DBPCOC) was performed. Prick-by-prick tests and serum specific IgE (CAP system) with mites, anisakis, mosquito, cockroach, shrimp, clam, snail, mussel, scallop, cockle, squid, octopus and cuttlefish were performed as well as IgE to rPen a1 (tropomyosin). All patient‚s sera were tested individually by IgE immunodetection after SDS-PAGE with shrimp crude extract. Seven patients sensitized to mites and with good tolerance to shrimp were included as controls. RESULTS: 20 (57%) patients were considered allergic (14 1 DBPCOC and 6 anaphylaxis). Specific IgE was positive to all of extracts tested by CAP, except in 2 patients. 17 were sensitized to mites. All but 2 had specific IgE to tropomyosin, in 1 only detected by immunoblotting. In patients with negative DBPCOC, 5 had specific IgE to other seafood and 10 to mites. In the control group all CAP determinations were negative except in one patient who had specific IgE to shrimp and other patient a 37 kDa IgE-binding band. Immunoblots demonstrated several IgE bindingbands. The main bands were of 37 and 20 kDa in 12 allergic patients. These bands were also detected in 3 patients with negative DBPCOC. CONCLUSIONS: This study shows the need to perform food challenges for a correct diagnosis. Tropomyosin seems the major allergen in shrimp allergic patients in Spain, although, other allergens may be implicated.

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[140] - Castillo R, Delgado J, Quiralte J, Blanco C, Carrillo T. Food hypersensitivity among adult patients: epidemiological and clinical aspects. Allergol Immunopathol (Madr) 1996;24:93-97

Food hypersensitivity (FH) is lesser frequent among adult patients than in childhood. Foods implicated in hypersensitivity reactions vary with sociocultural and diet habits from a geographic place to other. We studied 142 adult patients sensitized to foods, among 7698 patients visited at our Outpatient Clinic. Hundred and twenty patients referred clinical symptoms after consumption of one or more foods consistently. From the latest, 107 patients (89.2%) were atopics (92 of them sensitizes to dust mites) and 54 (45%) referred atopic familiar background. Most frequent recorded symptoms were: urticaria/angioedema 84 cases (70%), oral syndrome 65 (54%), asthma 48 (37%) and anaphylaxis 33 patients (27.5%). Shellfish sensitization occurred in 50 patients, fresh fruits in 33 and nuts in 29 cases. Shrimp (48 patients), squid (33), kiwi (14), papaya (14), avocado (13) and banana (12 cases) were the most frequent causes of FH. Significant statistical association between foods and inhalants was observed for fresh fruits and latex (p < 0.001), fresh fruits and pollens (p < 0.01), and shellfish and Blatta germanica (p < 0.001). Prevalence of FH among patients at our Area is around 1.6%. Tropical fruits, as other kind of fruits, seem to share common IgE-epitopes to pollens. High prevalence of shellfish and cockroach hypersensitivity could be more easily developed by previous domestic mites sensitization.

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[141] - Wu AY, Williams GA. Clinical Characteristics and Pattern of Skin Test Reactivities in Shellfish Allergy Patients in Hong Kong. Allergy Asthma Proc 2004;25:237-242

Allergens from crustaceans and mollusks exhibit extensive cross-reactivity in vitro. However, the degree and pattern of crossreactivity between different shellfish species in vivo is still unclear. The objective of this study was to determine the clinical characteristics of shellfish allergic patients in Hong Kong and the pattern of skin test reactivities to the different species. This cohort study involves patients attending the allergy clinic of a large teaching hospital for suspected shellfish allergy. Each subject underwent skin-prick tests to eight species of shellfish and house-dust mites. Eighty-four consecutive patients were tested. Twenty-eight patients reported a history of severe anaphylaxis. Fourteen patients had no positive shellfish skin test and were excluded. There were 183 positive shellfish skin tests, with an average of 2.61 positive tests per subject. Ninety percent of subjects also had positive skin tests to house-dust mites. Overall, 65.7% of subjects had more than one positive skin test to shellfish. There were strong statistical associations between species belonging to the same order but also between some mollusks and crustaceans. We found a high degree of skin test cross-reactivity between different species of shellfish and between shellfish and house-dust mites. Therefore, patients with a history of shellfish allergy should be cautious with all types of shellfish.

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[142] - Shibata R, Nishima S. Measurements of Serum Specific IgE Antibody to Fish Roe and Mollusks in Children With Seafood Allergy. AAAAI 60th Annual Meeting, San Francisco, 19-23 March 2004, Poster n°1167

Rationale Seafood is a major allergen in adults with food hypersensitivity in Japan. Recently seafood anaphylaxis is increasing in children. We measured serum specific IgE to salmon roe, Alaska Pollack roe, clam, oyster and scallop in children with seafood allergy to investigate sensitization to these allergens. Method s : Forty-five patients, the average age 3.6 years, with seafood allergy are enrolled in the study. Those consist of 28 fish allergy, 26 shellfish allergy, 13 mollusks allergy and 5 fish roe allergy. Specific IgE antibodies to salmon roe, Alaska Pollack roe, clam, oyster and scallop were measured by UniCAP specific IgE kit. Result s : Forty-one patients with fish and/or shellfish allergy were divided into 3 groups; group1 (15 cases): fish only, group2 (13 cases): fish+shellfish, group3 (13 cases): shellfish only. Positive IgE to one or more mollusks were identified 85% in group 3, 56% in group 2 and 27% in group 1. One third of the 3 groups were positive IgE to one or both fish roe. Twelve patients had history of hypersensitivity to mollusks and 8 of these were positive IgE to all 3 mollusks tested. Three patients with anaphylaxis to salmon or Alaska Pollack roe had positive IgE (Score 3 ~4) to both fish roes. Conclusions : The results suggest that measurements of serum specific IgE to these seafood allergens are useful for diagnosis of fish roe and mollusks in patients with fish or shellfish allergy.

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[143] - Sinanoglou VJ, Batrinou A, Konteles S, Sflomos K. Microbial population, physicochemical quality, and allergenicity of molluscs and shrimp treated with cobalt-60 gamma radiation. J Food Prot 2007;70:958-966

Frozen molluscs (squid, octopuses, and cuttlefish) and crustaceans (shrimp) were irradiated using a cobalt-60 gamma source, at different doses, in order to investigate the effects of gamma radiation on their microbial population, organoleptic characteristics, lipid profile, and tropomyosin content. Irradiation of shrimp and squid with either 2.5 or 4.7 kGy reduced mesophilic bacteria contamination to low or nondetectable levels, respectively, whereas irradiation of octopus and cuttlefish with the same doses reduced the bacterial population. Irradiation treatment had no significant (P > 0.05) effect on the total lipid content and the major detected classes of polar and neutral lipids, whereas it significantly (P < 0.05) increased the contents of neutral lipids in octopus mantle and in shrimp muscle and cephalothorax samples. The total fatty acid content and the omega-3: omega-6 fatty acid ration was not affected. A dose-dependent significant (P < 0.05) decrease in the ratio of polyunsaturated fatty acids:saturated fatty acids was observed. With the increase in radiation dose, redness (a) and yellowness (b) values showed a variation, whereas the lightness (L) value was significantly (P < 0.05) decreased in mollusc mantles and shrimp muscle and increased in shrimp cephalothorax. The total of color changes ( delta E) increased (P < 0.05) as the dose increased. Significant (P < 0.05) changes in textural properties were observed with radiation treatment in octopus tentacles and in squid and cuttlefish mantle. The amount of tropomyosin, which is the major mollusc and crustacean allergen in the irradiated organisms, was reduced by gamma radiation, depending on the dose.

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[144] - Carrillo T, de Castro FR, Cuevas M, Caminero J, Cabrera P. Allergy to limpet. Allergy 1991;46:515-519

Allergy to mollusk has rarely been described. The limpet, belonging to Phylum mollusca, is one of the most frequent mollusks in the Canary Islands, as in all warm maritime regions. We report two cases of atopic patients who developed anaphylactic reactions after ingestion of this mollusk. Type I hypersensitivity to limpet antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, and histamine release test to cooked limpet extract. The controls did not react to any of these tests. Allergic activity was only found with a cooked limpet extract; this suggests that the offending antigen/s may have been released by cooking this food.

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[145] - Ferrer A, Huertas J, Carnés J, Casanovas M, Fernández-Caldas E. Seafood Extracts: Raw or Boiled for the Diagnosis of Allergic Patients ? J Allergy Clin Immunol 2005;115(2 suppl.):S92

RATIONALE: Seafood is an important component of the human diet The aim of this study was to evaluate what kind of extract (boiled or raw) is more effective to diagnose seafood allergy METHODS: Raw (A) and boiled (B) extracts from 2 types of lobsters, prawns, squid, octopus, mussels and clams were manufactured. Extracts B were prepared after the raw materials were boiled for 30 minutes. Extract A and B were homogenized, separately, and extracted for 4 hours. Afterwards, the content was centrifuged, dialyzed, filtered, frozen and freezedried Antigenic profile of extract A and B were compared by SDS-PAGE and the protein content determined. Fifty-six seafood allergic patients were included in the study. They were allergic to at least one of the seafood tested All of them were skin prick tested with all A and B extracts RESULTS: Important antigenic differences were detected in the antigenic profile of both types of extracts by SDS-PAGE. However, the protein content remained similar. In vivo results showed that extracts B induced statistically significant larger wheal sizes than extracts A in all cases except for clams, where extract Aand B induced similar wheal sizes This could be explained because clams can be ingested either boiled, or raw. In vitro experiments by direct ELISA confirmed the in vivo results CONCLUSIONS: The use of boiled extracts seems to be more effective to detect seafood allergy. The antigenic profile of B extracts is considerably modified after boiling

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[146] - Castillo R, Carrilo T, Blanco C, Quiralte J, Cuevas M. Shellfish hypersensitivity: clinical and immunological characteristics. Allergol Immunopathol (Madr) 1994;22:83-87

Shellfish is one of the most frequent causes of food allergy. We studied 48 patients (25 male and 23 female) with a mean age of 24.2 +/- 1.8 with shellfish hypersensitivity. A clinical questionnaire was carried out and prick tests were performed using a series of aeroallergens and a battery of extracts of squid, shrimp, lobster, crab, mussel and clam. Prick tests were also performed using raw and boiled extracts from fresh squid, octopus and limpet. Total and specific IgE to these allergens were determined. The most frequent causes of symptoms were shrimp (33 cases) and squid (24 cases). The most frequently found symptoms were Urticaria/angioedema (39 patients), asthma (18 patients) and rhinitis (14 patients). Clinical association was found between Cephalopoedae and Lamelibranquiae (p < 0.05 for clam and p < 0.01 for mussel), but not among both groups and Crustaceans. Association between history and Prick was statistically significant for Crustaceae and Cephalopoedae (p < 0.01) but not for Lamalibranquiae. Association between history and CAP was not found for shellfish. Significant differences among prick-tests with raw and boiled extracts were not found. These results suggest that prick test yields better results than CAP does it, in shellfish hypersensitivity, that clinical association among shellfish hypersensitivity can occurs within the same and different Phylum reflecting common epitopes and that squid, octopus and limpet extracts contain a large amount of heat-stable allergens.

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[147] - Martín-García C, Carnés J, Blanco R, Martínez-Alonso JC, Callejo-Melgosa A, Frades A, et al. Selective Hypersensitivity to Boiled Razor Shell. J Investig Allergol Clin Immunol 2007;17:271-273

Many types of seafood require cooking before ingestion and it has been demonstrated that this cooking process may affect the antigenicity and allergenicity of the food. We describe a case of anaphylaxis caused by selective sensitization to razor shell, a mollusc. In vivo and in vitro studies confirmed sensitization to boiled razor shell. Analysis of the nature of the allergen yielded results that were consistent with the findings of other authors and suggested that allergens involved in seafood allergy are commonly high molecular weight proteins that, in most cases, are heat stable.

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[148] - Nakamura A, Sasaki F, Watanabe K, Ojima T, Ahn DH, Saeki H. Changes in Allergenicity and Digestibility of Squid Tropomyosin during the Maillard Reaction with Ribose. J Agric Food Chem 2006;54:9529-9534

The effect of the Maillard reaction on the allergenicity of squid tropomyosin (TM) was investigated. When TM was reacted with ribose (TM-ribose), its human-specific IgE-binding ability decreased markedly and &agr;-chymotryptic digestibility of TM was also altered at the early stage of the Maillard reaction. On the other hand, the modification of the lysine residues in TM using 2,4,6-trinitrobenzenesulfonic acid had no effect on the allergenicity and &agr;-chymotryptic digestibility of TM. Therefore, the structural change in TM induced by the Maillard reaction would cause the reduction of the allergenicity, rather than the block of lysine residues. Although peptic digestion diminished the specific IgE-binding ability of TM, the reduction of the allergenicity by the Maillard reaction remained after peptic digestion. These results suggest that hypersensitive reaction of TM-ribose in the human body might be lower than that of native TM. Keywords: Squid; tropomyosin; seafood allergy; allergenicity; Maillard reaction; digestibility.

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[149] - Nakamura A, Watanabe K, Ojima T, Ahn DH, Saeki H. Effect of Maillard Reaction on Allergenicity of Scallop Tropomyosin. J Agric Food Chem 2005;53:7559-7564

Scallop tropomyosin (TM), the major allergen of shellfish, was prepared from adductor muscles and reacted with four reducing sugars to investigate the effect of the Maillard reaction on the allergenicity of TM. The IgE-binding ability of TM increased significantly with the progress of the reaction with glucose, ribose, and maltose, but not with maltotriose. The allergenicity was enhanced at the early stage of the Maillard reaction, and the trend of the effect depended on the type of reducing sugar used. 2,4,6-Trinitrobenzenesulfonic acid treatment of the lysine residues in TM showed that the protein surface charge resulting from the Maillard reaction had no effect on the enhancement of the allergenicity. Thus, the change in the allergenicity would be closely related to the structural change caused by the Maillard reaction.

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[150] - Caiado J, Pregal A, Costa C, Lopes Silva S, Mendes A, Osório Ferreira E, et al. Evaluation of sensitivity of skin prick test (SPT) with commercial extracts, fresh food prick-to-prick and specific IgE in seafood allergy diagnosis. EAACI 25th Congress, Vienna, 10-14 June, 2006, Poster n°575

Background: Seafood is a common cause of food allergy and the diagnosis is based on the clinical history and a positive skin prick test (SPT); although the diagnostic accuracy of the SPT in food allergy is controversial, the use of fresh food seems to be superior to commercial extracts. OBJECTIVE: To evaluate the sensitivity of SPT with commercial extracts, fresh food prick-to-prick and specific IgE in the diagnosis of seafood allergy. METHODS: The study enrolled 40 patients with seafood allergy history (anaphylaxis, asthma, urticaria and/or angioedema), followed in an outpatient allergology unit (25 female/15 male; 15-64 years-old). All patients were submitted to a questionnaire, SPT with 2 different commercial extracts and prickto- prick to each seafood (shrimp, crab, lobster, clam and blue mussel). Serum was obtained from each patient to determine the specific IgE (UniCAP system) to the 5 seafood studied. Sign test was used for statistical analysis. RESULTS: Allergens eliciting a mean wheal diameter of 3 mm or greater than the negative control were considered positive; for specific IgE, cut-off of 0.35 KUA/l was considered; for the compute of sensitivity prick-to-prick was considered as gold standard. For individual commercial extracts the higher sensitivity values were approximately 58%, 68%, 73%, 41% and 39% for shrimp, crab, lobster, clam and blue mussel, respectively; the sensitivity was higher when assuming the two commercial extracts together: 60%, 81%, 80%, 48% and 50%. Considering specific IgE, lower sensitivities were observed: 43%, 55%, 43%, 26% and 23%. If we gather the specific IgE to 2 different extracts, the sensitivity increases to 70%, 87%, 83%, 56% and 54% respectively. Statistically significant differences were detected in mean diameter of the wheals between the commercial extracts and the prick-to-prick to all seafood (p<0,05), always larger in prick-to-prick. CONCLUSIONS: In this study, the most accurate test to diagnose seafood allergy was prick-to-prick. In high risk patients or when fresh food is not available, the simultaneous use of 2 different commercial extracts and specific IgE increase the sensitivity in seafood allergy diagnosis.

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[151] - Nettis E, Pannofino A, Dambra P, Loria MP, Di Maggio G, Damiani E, et al. IgE-mediated urticaria/angioedema after ingestion of mussels. Acta Derm Venereol 2001;81:62

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[152] - Castillo R, Carrilo T, Blanco C, Quiralte J, Cuevas M. Shellfish hypersensitivity: clinical and immunological characteristics. Allergol Immunopathol (Madr) 1994;22:83-87

Shellfish is one of the most frequent causes of food allergy. We studied 48 patients (25 male and 23 female) with a mean age of 24.2 +/- 1.8 with shellfish hypersensitivity. A clinical questionnaire was carried out and prick tests were performed using a series of aeroallergens and a battery of extracts of squid, shrimp, lobster, crab, mussel and clam. Prick tests were also performed using raw and boiled extracts from fresh squid, octopus and limpet. Total and specific IgE to these allergens were determined. The most frequent causes of symptoms were shrimp (33 cases) and squid (24 cases). The most frequently found symptoms were Urticaria/angioedema (39 patients), asthma (18 patients) and rhinitis (14 patients). Clinical association was found between Cephalopoedae and Lamelibranquiae (p < 0.05 for clam and p < 0.01 for mussel), but not among both groups and Crustaceans. Association between history and Prick was statistically significant for Crustaceae and Cephalopoedae (p < 0.01) but not for Lamalibranquiae. Association between history and CAP was not found for shellfish. Significant differences among prick-tests with raw and boiled extracts were not found. These results suggest that prick test yields better results than CAP does it, in shellfish hypersensitivity, that clinical association among shellfish hypersensitivity can occurs within the same and different Phylum reflecting common epitopes and that squid, octopus and limpet extracts contain a large amount of heat-stable allergens.

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[153] - Rodriguez del Rio P, Sanchez-Lopez J, HouchaimI A, Gonzalez-Gutierrez M, Pastor Vargas C, Fernandez-Rivas M. Allergy to Venus antiqua clam. Allergy 2008;63(suppl. 88):427

Background: Allergy to seafood is a well known and frequent food allergy, being shrimp allergy the most frequent one. We present the case of a patient with isolated allergy to King of Broderip (Venus antiqua). As far as we know, this is the first case of isolated allergy to clam in the medical literature. Case report: A 68 year-old man with a previous history of chronic bronchitis and high blood pressure who presented, 15- 30 min after the intake of canned clams, King of Broderip (Venus antiqua), palpebral oedema, scalp and palmo-plantar pruritus with shortness of breath that required antihistamines and corticosteroids. Skin prick tests (SPT) with commercial extracts of clam, shrimp, mussel, oyster and squid were negative. Prick-prick tests with fresh mussel, razor, cockle and Pullet carpet shell (Tapes pullastra, another variety of clam) were negative, but positive (7x5 mm) for King of Broderip (Venus antiqua). Total IgE was 245 kU/L, specific IgE to clam, crab, shrimp and mussel were negative (CAP Phadia). Oral challenges performed with canned mussel, razor and Pullet carpet shell were negative. An oral challenge was carried out with King of Broderip clam and 30 min after the last portion the patient developed a generalised urticaria, facial oedema and bronchospasm with normal blood pressure, that required inhaled salbutamol, intravenous corticosteroids, antihistamines and intramuscular epinephrine. The patient tolerated the ingestion of canned cockle from the same factory that manufactured the canned King of Broderip with a similar ingredient list. Conclusion: We present the case of a patient with a selective allergy to the clam King of Broderip (Venus antiqua), that tolerated other molluscs including the closely related clam Pullet carpet shell (Tapes pullastra).

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[154] - Piedade S, Gaspar A, Rosa S, Santa-Marta C, Paiva M, Matos V, et al. Seafood allergy and house dust mite sensitisation: what is the truth ? Allergy 2008;63(suppl. 88):10

Background: Seafood allergy is a usual food allergy often associated with severe lifethreatening systemic reactions. Nevertheless, the true prevalence of this clinical entity remains uncertain, namely in patients sensitised to house dust mites (HDM). Purpose: To determine the prevalence of seafood allergy in a specialized Immunoallergy outpatient clinic, and to evaluate the importance of HDM sensitisation as a risk factor. Methods: In 1067 patients, with >=6 years of age, consecutively observed in our Immunoallergy department during the period of 1 year, a normalized questionnaire and skin prick tests (SPT) with common aeroallergens were applied. All patients with symptoms related with seafood ingestion were studied with SPT (commercial extracts and fresh food) and specific IgE (sIgE) to the implicated food(s), HDM (Dermatophagoides pteronyssinus and Dermatophagoides farinae) and cockroach (Blattella germanica); food challenges were performed when needed. Results: During the one year period, 110 patients referred adverse reaction after seafood ingestion (10.3%), being the food allergy confirmed in 56 (5.2%). The prevalence of seafood allergy in HDM sensitised patients was significantly higher, 8.2% vs. 1.5% (OR55.9, CI95%52.5-14.4; P< 0.0001). The seafood allergic patients had a mean age of 27±15 years (ranged from 6 to 62 years), 34% with =<15 years of age. The male/female ratio was 0.8 : 1. The mean age of the onset of symptoms was 19±15 years (range from 6 months to 56 years). Symptoms occurred after the first ingestion of the seafood in 24% of the patients. Clinical manifestations were: anaphylaxis - 27 patients (2 required mechanical ventilation), mucocutaneous - 21 and respiratory - 8. They also had symptoms with inhalation in 25% of cases. The foods associated were: crustaceous - 51 patients, molluscs - 37 (gastropods - 20, bivalves - 15, cephalopods - 19). In 13 patients the SPT were positive only with the fresh food. The sIgE to the implicated food was positive in 60% of seafood allergic patients. Conclusion: Seafood allergy is an important problem in our population. HDM sensitisation proved to be a risk factor for the development of this food allergy, probably in the context of a cross-reactivity phenomenon. Anaphylaxis was the clinical presentation of the disease in half of patients. We emphasize the importance of performing SPT with fresh food in order to increase the diagnostic sensitivity.

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[155] - Takahashi N, Masuda K, Hiraki K, Yoshihara K, Huang HH, Khoo KH, et al. N-Glycan structures of squid rhodopsin. Eur J Biochem 2003;270:2627-2632

To determine the glycoforms of squid rhodopsin, N-glycans were released by glycoamidase A digestion, reductively aminated with 2-aminopyridine, and then subjected to 2D HPLC analysis [Takahashi, N., Nakagawa, H., Fujikawa, K., Kawamura, Y. & Tomiya, N. (1995) Anal. Biochem.226, 139-146]. The major glycans of squid rhodopsin were shown to possess the alpha1-3 and alpha1-6 difucosylated innermost GlcNAc residue found in glycoproteins produced by insects and helminths. By combined use of 2D HPLC, electrospray ionization-mass spectrometry and permethylation and gas chromatography-electron ionization mass spectrometry analyses, it was revealed that most (85%) of the N-glycans exhibit the novel structure Manalpha1-6(Manalpha1-3)Manbeta1-4GlcNAcbeta1-4(Galbeta1-4Fucalpha1-6)(Fucalpha1-3)GlcNAc.

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[156] - Geyer H, Wuhrer M, Kurokawa T, Geyer R. Characterization of keyhole limpet hemocyanin (KLH) glycans sharing a carbohydrate epitope with Schistosoma mansoni glycoconjugates. Micron 2004;35:105-106

Keyhole limpet hemocyanin (KLH) is known to share carbohydrate epitopes with Schistosoma mansoni. In order to define the structural basis for the observed serological cross-reactivity, KLH glycans were released either by enzyme treatment or by hydrazinolysis and probed with a rabbit hyperimmune serum directed against S. mansoni egg antigen. Both major, non-reacting oligosaccharide species as well as the minor compounds recognized were isolated by two-dimensional high performance liquid chromatography and in part by lectin affinity chromatography, and characterized by mass spectrometry. The results revealed that KLH carries predominantly high mannose-type glycans as well as short sugar chains. As a characteristic feature, a number of the latter glycans contained a Gal(beta1-6)Man-unit, which has not yet been found in glycoprotein-N-glycans. Oligosaccharides cross-reacting with schistosomal glycans comprised a terminal Fuc(alpha1-3)GalNAc-motif, which appears to represent the main carbohydrate epitope mediating cross-reactivity of KLH with glycoconjugates from S. mansoni.

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[157] - Wuhrer M, Dennis RD, Doenhoff MJ, Geyer R. A fucose-containing epitope is shared by keyhole limpet haemocyanin and Schistosoma mansoni glycosphingolipids. Mol Biochem Parasitol 2000;110:237-246

The glycolipids of Schistosoma mansoni adult worms, cercariae and eggs are recognised by schistosome infection serum and the monoclonal antibody M2D3H. The haemocyanin of the keyhole limpet, Megathura crenulata, is known to be immunoreactive to schistosomal infection sera and is, therefore, under investigation for the diagnosis of and vaccination against schistosomiasis. By dot-blot, inhibition-ELISA and inhibition-HPTLC immunostaining we have demonstrated that the M2D3H epitope is shared by both S. mansoni glycolipids and keyhole limpet haemocyanin (KLH). Analogously to the established epitopic importance of fucose to the immunorecognition of S. mansoni glycolipids, we have similarly defined the significance of the fucose residue(s) for the immunoreactivity between KLH and schistosomal infection serum and the monoclonal antibody M2D3H. Fucose was specifically removed from KLH by partial hydrolysis, monitored by ultrafiltration and carbohydrate component analysis. On removal of the fucose residue(s) the serological and immunological reactivity of KLH was greatly diminished, which implied that the fucose-containing M2D3H antigenic determinant was common to both S. mansoni glycolipids and KLH.

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[158] - Ishikawa M, Shimakura K, Nagashima Y, Shiomi K. Isolation and properties of allergenic proteins in the oyster Crassostrea gigas. Fisheries Sci 1998;63:610-614

Two allergens, designated as Cra gs 1 and 2, were isolated from oysters, Crassostrea gigas, by gel permeation chromatography on a Sephacryl S-300 column, ion exchange FPLC on a MonoQ HR 5/5 column or reverse phase HPLC on a TSKgel Phenyl 5PW-RP column. Although the allergens were separated from each other by ion exchange FPLC, they showed the same behaviour in gel permeation chromatography and reverse phase HPLC. Cra gs 1 and 2 were both 86 kDa glycoproteins with a carbohydrate content of approx. 5%, and were composed of 35 kDa subunits. They had high concn. of glutamic acid/glutamine, aspartic acid/asparagine, alanine and leucine, but were devoid of proline or tryptophan. Their reactivities against sera from sea food allergy patients were equivalent. Mol. masses and amino acid compositions suggest that the 2 Cra gs allergens are tropomyosin of C. gigas.

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[159] - Aalberse RC, Koshte V, Clemens JG. Immunoglobulin E antibodies that crossreact with vegetable foods, pollen, and Hymenoptera venom. J Allergy Clin Immunol 1981;68:356-364

IgE in some human sera reacted with an antigen present in a large number of unrelated foods: potato, spinach, wheat, buckwheat, peanut, honey and others. The antigen, which was periodate-sensitive and heat-stable, was also found in pollen. Even more surprisingly, these antibodies often reacted in vitro with bee and vespid venom and were sometimes apparently induced by Hymenoptera stings

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[160] - Malandain H, Giroux F, Cano Y. The influence of carbohydrate structures present in common allergen sources on specific IgE results. Eur Ann Allergy Clin Immunol 2007;39:216-220

BACKGROUND: Cross-reactive carbohydrate determinants (CCD) are well known interferants in specific IgE assays (sIgE). Glyco-epitopes are not restricted to CCD and extracts used to prepare in vitro tests contain many other glycoproteins able to bind glycan-specific IgE. The overall amounts of IgE-bindable glycan structures in allergen sources are unknown . OBJECTIVE: We aimed at quantifying the influence of N-glycan structures on IgE reactivity to commonly tested allergen sources . METHODS: IgE reactivity to 51 allergen extracts, one purified natural allergen and 10 recombinant allergens was measured on Phadia UniCAP system using 2 sera demonstrating significant levels of glycan-related IgE reactivity. Immobilized bromelain and horseradish peroxidase (HRP) were used to capture N-glycan-specific IgE from these sera. Residual IgE reactivity was measured for 42 allergen sources and 4 recombinant/purified allergens . RESULTS: An obviously excessive number of positive CAP-results were obtained with both sera, especially for plant-based allergen sources. Capture of glycan-specific IgE led to a decrease of serum IgE ractivity, variable among allergen sources and between sera. Among others, peanut results were proven largely interfered by the presence of glycan-specific IgE. Unexpectedly some allergen sources showed a slight influence of glycan-related reactivity, such as cockroach, mosquito, mussel, shrimp and domestic mites . CONCLUSION: In patients sensitized to pollens or to Hymenoptera venoms sIgE results should be interpreted with caution. One cannot substract the result of a glyco-reporter test (bromelain and/or HRP) in order to compute glycan-free slgE results for common allergen sources like peanuts. As long as the demonstration of a significant role for glycan structures in clinical allergic reactions is lacking, a simple pre-treatment able to discard glycan-specific IgE from serum would be useful to improve accuracy of in vitro diagnostic tests.

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