Substance Info: (and synonyms)
Shrimp (Crustacea) / Northern Shrimp

Background Info:

Family: Crangonidae.

An edible decapod (5 pairs of legs). Shrimp can be canned, breaded, frozen, sold in the shell or dried.

It is found in shallow and deep waters everywhere. The larger of the species, mostly in the Pacific, are called prawns. See also Crustaceans / Shellfish.

Shrimp is traditionally considered to be a highly allergenic food.


Adverse Reactions:


[ 1 / 43 ]

A 43-year-old man living in Madrid, (low prevalence of mite sensitization) had worked transporting dry-cured ham in a van for 13 years. A few years after starting, he developed moderate persistent rhinoconjunctivitis, cutaneous pruritus, and dyspnea that worsened on week days and improved at weekends and during holidays. Three years earlier he experienced 2 episodes of oral pruritus and lip angioedema immediately after eating boiled shrimp. Subsequently he developed oral pruritus on trying small amounts of other crustaceans at home. He tolerated cephalopods, molluscs, and dry-cured ham, including the ham he delivered. A prick to prick test with a portion of the dry-cured ham the patient transported was negative for the meat but positive for the crust of the ham. Total IgE was 287 kUA/L, and specific IgE 12.5 kUA/L for T putrescentiae and 3.11 kUA/L for shrimp, and negative for rPen a 1 (tropomyosin). A sample of dry-cured ham provided by the patient demonstrated extensive contamination with Tyrophagus species. The patient reported that the inside of his delivery van was filled with mites. A specific positive bronchial challenge with a commercial extract of T putrescentiae was positive. No late-phase response was observed. A low degree of crossreactivity between T putrescentiae and shrimp was demonstrated. The sera of the patient bound specific IgE to bands at approximately 26 kDa in the T putrescentiae extract and to 4 bands between 15 and 20 kDa in the shrimp extract. (Rodriguez 2012 ref.28401 7)

Rodriguez del RP, Tudela Garcia JI, Narganes NJ, Fernandez-Caldas E, Rodriguez-Garcia V, Subiza J. Occupational asthma caused by the inhalation of Tyrophagus putrescentiae allergens in a dry-cured ham transporter allergic to shrimp. J Investig Allergol Clin Immunol 2012;22(5):383-384

[ 2 / 43 ]

A 47-year-old female patient without pre-existing manifest atopic diseases experienced 5 episodes of severe anaphylactoid reactions within 1 year. All events occurred subsequently to physical activities (nordic walking, cycling, dancing). Before these activities the patient had eaten pasta or bread and in at least 3 cases also shrimps. Strong sensitization to flour proteins was shown, particularly against gluten (mainly rTri a19-Omega 5 gliadin), and strong sensitization for house dust mite and weak for crustaceans. Skin prick testing with commercial extract was initially negative for flour allergens so shrimp was initially considered to be the only reason for FDEIA. After a cereal- (and initially also crustacean-)free diet before physical exercise, no further anaphylactic reactions occurred.

Wüthrich B, Hofer T. Food-dependent, exercise-induced anaphylaxis (FDEIA) to wheat proteins, particularly to rTri alpha19-Omega-5-Gliadin, and light sensitization to crustaceans and house dust mite (so-called “house dust mite-crustaceans-syndrome”). Allergologie 2010;33(5):205–210

[ 3 / 43 ]

Concerning fish allergy, the major allergens are the ß isoforms of muscle parvalbumins. Fish parvalbumins share among themselves important homologies in amino acid composition, which gives rise to extensive cross-sensitizations. Allergic cross-reactions with frog parvalbumin have been described. Due to the frequent sensitization to parvalbumins, the role of other allergens is masked. Allergy to fish gelatin has been reported. Additional muscle allergens have been incompletely described, but their exact role remains to be defined. With respect to shellfish allergy, muscle tropomyosin is the major allergen. Tropomyosins give rise to important cross-sensitization between shellfish, but also with gastropods, mites, cockroaches and other arthropods. The myosin light chain has been shown to be an allergen in 60% of white shrimp-allergic patients. A muscle arginine kinase has been recognized as an allergen in a third of patients sensitized to black tiger shrimp. A sarcoplasmic calcium-binding protein of the same tiger shrimp is recognized by IgE antibodies of 60% of shrimp-allergic patients. (Hentges 2009 ref.23829 3)

Hentges F. Allergènes de poissons et crustacés Revue Française d'Allergologie 2009;49(3):156-159

[ 4 / 43 ]

A retrospective analysis of six Japanese cases of food-dependent exercise-induced anaphylaxis (FDEIA) seen over three years, reports that patients' ages were from 8 to 47 years of age. The trigger allergens were wheat, shrimp, and grapefruit. The trigger exercises were running, volleyball, as well as taking a bath. In four cases, the patients had history of allergic disease such as atopic dermatitis, allergic rhinitis, and so on. In two cases of wheat-dependent exercise-induced anaphylaxis, the IgE levels for omega5-gliadin (a major wheat allergen) in a RAST were positive. (Matsumoto 2009 ref.23639 7)

Matsumoto R, Ogawa T, Makino T, Okano M. A clinical study of admitted the review of cases of food-dependent exercise-induced anaphylaxis. [Japanese] Arerugi 2009 May;58(5):548-553

[ 5 / 43 ]

The most common reported shellfish allergies, in decreasing frequency are: shrimp, crab, lobster, clam, oyster, and mussel.

Case 1: A 22-month old male with history of milk allergy, reactive airway disease, and eczema: about 2 weeks prior to his visit, his father gave him one shrimp. There was no known previous exposure to shrimp. He immediately had swelling of his eyes and hives on his face without difficulty in breathing. Serum-specific IgE showed levels of 12.6 kU/L to shrimp, 12.3 kU/L to milk, 0.55 kU/L to egg white, 0.72 kU/L to wheat, 0.41 kU/L to soybean, 0.61 kU/L to peanut, and <0.35 kU/L to codfish. Though milk-specific IgE was high, he had been tolerating whole milk for 6 months prior to this visit. This case represents a typical Type I IgE-mediated food hypersensitivity reaction

Case 2: A 20-month old boy with severe eczema since infancy, was not avoiding any foods and was eating shrimp, fish, milk, peanuts, eggs, and soy without any obvious clinical reactions but he had uncontrolled eczema. Serum-specific IgE was 41.9 kU/L to shrimp, 11.6 kU/L to milk, 27.5 kU/L to peanut, 1.73 kU/L to egg white, 6.46 kU/L to soy and <0.35 kU/L to fish. He was told to avoid milk, peanuts, shrimp and all other shellfish and his eczema improved dramatically. Repeat-specific IgE at 3 yr of age was 28.7 kU/L to shrimp, 1.13 kU/L to codfish, 4.26 kU/L to milk, and 4.03 kU/L to peanut. Despite a mild increase in fish-specific IgE, he had been eating flatfish at home without any reactions. He also had severe dust mite allergy with specific IgE > 100 kU/l for both and Dermatophagoides farinae and D. pteronyssinus. This case represents combined IgE and non-IgE mediated reaction.

Case 3: A 16 yr old girl with history of allergic rhinitis had tongue/lip/eye swelling, urticaria, within 20 min after eating shrimp. Her symptoms progressed over 4 days to include difficulty breathing. Serum-specific IgE was 13.8 kU/L to shrimp, 0.56 kU/L to crab, 7.93 kU/L to lobster, 1.44 kU/L to langust, 15.6 kU/L to crawfish. Specific IgE was <0.35 kU/L to 24 types of flatfish and mussels. She was seen in clinic 6 months later and reported lip/facial swelling with urticaria several times per month, particularly on Fridays when shellfish or fish was served at her school. She did not eat food served by the cafeteria on these days, but ate in the cafeteria. Her symptoms extended on Fridays several hours after lunchtime and sometimes to Saturdays. She also had a similar episode of lip/facial swelling and urticaria when walking by the seafood (shellfish and fish) section at a local grocery store. Her skin prick test was positive for D. farinae and D. Pteronyssinus. Case 3 underscores the point that adolescent shellfish-allergic patients may have severe symptoms which are more similar to the clinical presentation in the adult population. (Kandyil 2009 ref.23817 5)

Kandyil RM, Davis CM. Shellfish allergy in children. Pediatr Allergy Immunol 2009 Aug;20(5):408-414

[ 6 / 43 ]

Immunological contact urticarial and/or protein contact dermatitis. Classically, the protein sources are divided into 4 main groups: group 1: fruits, vegetables, spices, plants, and woods; group 2: animal proteins; group 3: grains and group 4: enzymes. Taking into account the nature of the causal proteins, a wide variety of jobs can be affected. (Amaro 2008 ref.20923 7)

Amaro C, Goossens A. Immunological occupational contact urticaria and contact dermatitis from proteins: a review. Contact Dermatitis 2008 Feb;58(2):67-75.

[ 7 / 43 ]

Allergic asthma induced by occupational exposure to shrimp cooking vapors in a 19-year-old patient. Anaphylactic shock had occurred seven years previously by ingestion of fish food. The diagnosis of asthma induced by seafood cooking vapors was based on clinical history and the positivity of the allergy work-up. (Racil 2008 ref.24720 5)

Racil H, Ben Amar J, Rouhou SC, Chaouch N, Zarrouk M, Chabou A. Asthma due to shrimps cooking vapors. Rev Fr Allergol Immunol Clin 2008;48(8):558-560

[ 8 / 43 ]

Twenty consecutive patients with immediate adverse reactions to shrimp were evaluated, mean age 33y±16 years. Clinical manifestations after ingestion of shrimp were generalized urticaria and/or angioedema in eight patients, oral allergy syndrome in nine and severe anaphylaxis in 3. All patients were also sensitised to other crustaceans and reported similar symptoms after their ingestion. Other foods implicated were molluscs in 12 patients and egg in one patient. All patients were sensitized to inhalant allergens (20 to Dp;12 to cockroach, 13 to pollens, five to cat and five to dog. Serum specific IgE to Dp and to shrimp 3.5 KU/l was detected in 15 and in 12 patients respectively. IgE binding occurred predominantly at 35-40 Kda shrimp protein regions in 14 patients, to a 17 KDa band in two patients, to a 22 KDa band in one patient andto 43-50 KDa proteins in the remaining three patients. Iinhibition assays showed reciprocal cross-reactivity between shrimp and Dp in 10 patients. We could not prove the existence of cross-reactivity in 5 patients and it was not reciprocal in 5 patients. Therefore assays to shrimp clearly suggests the involvement of tropomyosins and these results confirm the role of these pan-allergens as major allergens in shrimp hypersensitivity in house -dust -mite-sensitized patients. Concurrent sensitization to shrimp and Dp can occur without cross-reactivity and different patterns of sensitization should be considered. (Carrapatoso 2008 ref.24719 7)

Carrapatoso I, Rodrigues F, Geraldes L, Faria E, Todo-Bom A, Loureiro C, Chieira C. Clinical and immunological patterns in patients with shrimp hypersensitivity and Dermatophagoides pteronyssinus cross-reactivity. Rev Port Imunoalergol 2008;16(5):449-466

[ 9 / 43 ]

Three patients are reported who react exclusively to shrimp cephalothorax, and can safely consume the abdomen of the shrimp. Case 1, a 43-year-old male with repeated episodes of urticaria 2 h after eating shrimp but only when he ingests the cephalothorax. Ingestion of the shrimp abdomen is tolerated without symptoms. Case 2, a 29-year-old female, had two episodes of urticaria and laryngeal oedema 6 h after eating shrimp, but had eaten shrimp previously without symptoms. She had negative skin prick tests, serum-specific IgE and food challenge, so she had eaten shrimp regularly. Two years later, she developed severe symptoms after eating the shrimp’s cephalothorax exclusively. The previous food challenge was made with the shrimp abdomen. Case 3, a 53-year-old male, had not only had several episodes of uvula oedema 6 h after eating shrimp, but also had eaten shrimp often without symptoms. He was sure that on the last episode he had eaten the shrimp’s cephalothorax. All patients had a negative open food challenge with shrimp abdomen and refused a challenge with cephalothorax. Skin prick tests were negative with the commercial extracts and with the shrimp abdomen in all patients. In all the three cases, SPT were positive with the shrimp cephalothorax. The sIgE was positive only in case 1. Extracts used for SPT, sIgE and immunoblotting are produced exclusively from the shrimp abdomen. A specific test was developed with shrimp’s cephalothorax extract. The immunoblot of shrimp abdomen was strongly positive in patient 1, also positive in patient 2 and negative in patient 3. Patients 1 and 2 had reactive bands at 35 (probably tropomyosin), 76, 85, 100, 140 and 230 kDa. Patient 1 also had a weak band at 40 kDa (probably arginine kinase). The immunoblot of shrimp cephalothorax showed a different band pattern and was positive in patients 1 and 2, with bands between 14 and 136 kDa. The most intense bands were at 40 (arginine kinase), 60, 73 and 107 kDa. Patient 3 has only a very weak band at 73 kDa. These results suggest that there are allergens in the shrimp cephalothorax that can be specific for that structure and seem to be absent, or exist only in small amounts, in the muscular tissue; arginine kinase could be one of these.

Rosa S, Prates S, Piedade S, Marta CS, Pinto JR. Are there shrimp allergens exclusive from the cephalothorax? Allergy 2007 Jan;62(1):85-87

[ 10 / 43 ]

Biphasic anaphylactic reactions have been reported to: hymenoptera, peach, penicillin, shrimp, peanut, tangerine, immunotherapy and unknown causes. (Ellis 2007 ref.16305 4)

Ellis AK, Day JH. Incidence and characteristics of biphasic anaphylaxis: a prospective evaluation of 103 patients. Ann Allergy Asthma Immunol 2007 Jan;98(1):64-69

[ 11 / 43 ]

Barnacle allergy is a rare condition. This study reports on the clinical and laboratory data of five patients, ages ranging from 2 to 29 years, with documented IgE-mediated allergy to barnacle. All patients had mite-related asthma and the allergic rhinoconjunctivitis; they all experienced mucocutaneous symptoms upon the ingestion of cooked barnacles. All of them had positive SPT to barnacle, and the immunoblotting showed several allergenic fractions with a wide molecular weight range (19 - 94 kDa). Patients 1 to 3 were all children who had symptoms upon their first ingestion of barnacle. Patient 3 also had symptoms related to the ingestion of shrimp, snail, squid and cuttlefish; patient 4 also experienced anaphylaxis with shrimp, and patient 5 had symptoms upon the ingestion of all other Crustacea, snail and octopus. All of them tolerated bivalves. (Marinho 2006 ref.16674 5)

Marinho S, Morais-Almeida M, Gaspar A, Santa-Marta C, Pires G, Postigo I, Guisantes J, Martinez J, Rosado-Pinto J. Barnacle allergy: allergen characterization and cross-reactivity with mites. J Investig Allergol Clin Immunol 2006;16(2):117-22.

[ 12 / 43 ]

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. (Tomikawa 2006 ref.16081 0)

Tomikawa M, Suzuki N, Urisu A, Tsuburai T, Ito S, Shibata R, Ito K, Ebisawa M. Characteristics of shrimp allergy from childhood to adulthood in Japan. [Japanese] Arerugi 2006 Dec;55(12):1536-1542

[ 13 / 43 ]

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. 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. From the age of 5 years, she had often had oral pain and mucosal swelling after eating shrimp. Similar episodes occurred after eating other crustaceans and mollusks such as crab, squid and octopus. There had been no symptoms with foodstuffs devoid of crustaceans and mollusks. Sometimes oral swelling appeared when she ate foods supplemented with shrimp, either raw or cooked. There was no history of fish allergy. Total serum lgE was 1072.7 lU/ml. Serum IgE reacted with several kinds of crustaceans and mollusks, including shrimp, crab and scallops. Serum IgE reacted with the 38 kDa bands for shrimp, crab and scallops, suggesting that tropomyosin was the major allergen. Cross-reactivity was demonstrated among shrimp, crab and scallops.
Seafood - IgE Ua/ml
Tropomyosin (shrimp) - 19.2
Shrimp - 18.9
Crab - 18.9
Squid - 10.5
Octopus - 8.99
Scallop - 4.95
Clam - 4.64
Mackerel - 2.89
Anisakis - 2.65
Tuna - 2.65
Oyster - 1.98
Horse mackerel - 1.3
(Zhang 2006 ref.24721 5)

Zhang Y, Matsuo H, Morita E. Cross-reactivity among shrimp, crab and scallops in a patient with a seafood allergy. J Dermatol 2006 Mar;33(3):174-7.

[ 14 / 43 ]

Urticaria from shrimp in a child. SPT was negative but DBPCFC was positive. (Wananukul 2005 ref.13832 7)

Wananukul S, Chatchatee P, Chatproedprai S. Food induced urticaria in children. Asian Pac J Allergy Immunol 2005 Dec;23(4):175-179

[ 15 / 43 ]

In the USA telephone study, 60–70% of adult patients with shellfish allergy experienced urticaria/angioedema and greater than 50% reported dyspnea or throat tightness with exposure to shellfish. Consistent with this, 50% of the reactions prompted evaluation by a physician or care in an emergency room. Despite severe symptoms, epinephrine was administered to only 16%. (Sicherer 2004 ref.12151 7)

Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of seafood allergy in the United States determined by a random telephone survey. J Allergy Clin Immunol 2004 Jul;114(1):159-65.

[ 16 / 43 ]

Sensitized individuals can develop urticaria, angioedema, laryngospasm, asthma, and life-threatening anaphylaxis. (In: Yu 2003 ref.12314 8) (Waring 1985 ref.806 73) (Daul 1987 ref.1469 0) (Bengtsson 1996 ref.14040 4)

Yu CJ, Lin YF, Chiang BL, Chow LP. Proteomics and immunological analysis of a novel shrimp allergen, Pen m 2. J Immunol 2003 Jan 1;170(1):445-53.

[ 17 / 43 ]

Consumption of seafood can produce allergic symptoms in susceptible individuals, and shellfish are one of the most frequently reported causes of allergic reactions. (In: Yu 2003 ref.12314 5) (Bernstein 1982 ref.14039 2) (O'Neil 1993 ref.119 37) (Daul 1993 ref.2758 7) (Daul 1990 ref.585 11)

Yu CJ, Lin YF, Chiang BL, Chow LP. Proteomics and immunological analysis of a novel shrimp allergen, Pen m 2. J Immunol 2003 Jan 1;170(1):445-53.

[ 18 / 43 ]

A young woman with a clinical history of multiple urticarial reactions after touching shrimp and lobster dishes was seen in an emergency department of a Mayo Clinic-affiliated hospital for an anaphylactic reaction that developed immediately after she kissed her boyfriend. The boyfriend had eaten several shrimp just before the kiss. (Steensma 2003 ref.12313 0)

Steensma DP. The kiss of death: a severe allergic reaction to a shellfish induced by a good-night kiss. Mayo Clin Proc 2003 Feb;78(2):221-2.

[ 19 / 43 ]

Allergy to airborne, heat-labile shrimp allergens. (Asero 2002 ref.5089 0)

Asero R, Mistrello G, Roncarolo D, Amato S. A case of allergy to airborne, heat-labile shrimp allergens. J Allergy Clin Immunol 2002;109(2 Pt 1):371-2

[ 20 / 43 ]

A study reports on 7 cases of food-dependant exercise induced-anaphylaxis. The responsible foods were wheat (2 cases), corn, barley, shrimp, apple, paprika and mustard. (Mathelier-Fusade 2002 ref. 7125 2)

Mathelier-Fusade P, Vermeulen C, Leynadier F. Responsibility of food in exercise-induced anaphylaxis: 7 cases. [French] Ann Dermatol Venereol 2002;129(5 Pt 1):694-7

[ 21 / 43 ]

Administration of aspirin before ingestion of food allergens (wheat or shrimp) induced urticaria in one patient and urticaria and hypotension in another, while aspirin alone or food alone elicited no response. The third patient developed urticaria only when he took all three items, i.e. aspirin, food and additional exercise, whereas provocation with any one or or two of these did not induce any symptoms. These findings suggest that aspirin upregulates type I allergic responses to food in patients with food-dependent exercise-induced anaphylaxis (FDEIA), and further shows that aspirin synergizes with exercise to provoke symptoms of FDEIA. (Harada 2001 ref.5639 0)

Harada S, Horikawa T, Ashida M, Kamo T, Nishioka E, Ichihashi M. Aspirin enhances the induction of type I allergic symptoms when combined with food and exercise in patients with food-dependent exercise-induced anaphylaxis. Br J Dermatol 2001;145(2):336-9

[ 22 / 43 ]

A 15-year-old man with food-dependent exercise-induced anaphylaxis, who had begun to run 4 hours after he had lunch on fried shrimps. After running about 2000 m, he suffered from general cutaneous erythema with itching, urticaria, angioedema of face and dyspnea. He had experienced the similar episodes associated with postprandial exercise before. Skin test and IgE-RAST were positive for shrimp. Exercise challenge test after having 20 g boiled shrimp was conducted, and the elevation of plasma histamine level was recognised. 25 cases with food-dependent exercised-induced anaphylaxis have reported in Japan. 13 of 25 cases were related with wheat, and 10 cases were related with shrimp. 14 of 25 cases had experienced the similar episodes.

Sowa J, Tomitaka A, Suzuki K, Matsunaga K. A case of food-dependent exercise-induced anaphylaxis (FDEIA) caused by wheat successfully induced by administration of aspirin and wheat. [Japanese] Arerugi 2001;50(6):547-50

[ 23 / 43 ]

A 5 year old who developed wheezing when entering a classroom of a teacher who had just eaten peanuts. Developed wheezing upon exposure to shrimp that was merely being cooked having never eaten seafood before. (Tan 2001 ref.10161 6)

Tan BM, Sher MR, Good RA, Bahna SL. Severe food allergies by skin contact. Ann Allergy Asthma Immunol 2001;86(5):583-6

[ 24 / 43 ]

A boy who at 5 years of age developed wheezing upon exposure to shrimp that was being cooked, even though he had no known record of ever eating seafood. At age 7, his total IgE was highly elevated, and specific IgE was strongly positive to egg yolk, crab, and shrimp. (Tan 2001 ref.10161 7)

Tan BM, Sher MR, Good RA, Bahna SL. Severe food allergies by skin contact. Ann Allergy Asthma Immunol 2001;86(5):583-6

[ 25 / 43 ]

In 148 Malaysian adults with symptoms of nasal congestion and rhinorrhea and 113 control subjects without rhinitis symptoms, skin prick test evaluation of 11 foods common to the Malaysian diet. 48% of the patients with rhinitis had positive SPT results to foods, compared with 4.4% of control subjects. The most commonly implicated foods were shrimp (48%) and rice (30%), which are common in the Malaysian diet. (Gendeh 2000 ref.7561 1)

Gendeh BS, Murad S, Razi AM, Abdullah N, Mohamed AS, Kadir KA. Skin prick test reactivity to foods in adult Malaysians with rhinitis. Otolaryngol Head Neck Surg 2000;122(5):758-62

[ 26 / 43 ]

Eighteen cases (7 males and 11 females) of food-dependent exercise-induced anaphylaxis were observed for several years in this Japanese study. The age of the patients at the first visit to our hospital ranged from 9 to 43 years. The offending foods were wheat in 9 cases, shrimp in 2 cases, shellfish in 1 case, fish in 1 case, and unknown foods in 5 cases. The inducing exercises were ball play games, running, riding a bicycle, swimming, kendo (Japanese fencing), walking, and so on. (Kano 2000 ref.16376 8)

Kano H, Juji F, Shibuya N, Narita M, Naritaka S, Suko M, Morita Y, Iwata T. Clinical courses of 18 cases with food-dependent exercise-induced anaphylaxis. [Japanese] Arerugi 2000 Jun;49(6):472-8.

[ 27 / 43 ]

Occupational allergy to squid, including an individual with food allergy to shrimp. (Tabka 1998 ref.16377 8)

Tabka F, Choudat D, Vacher JG, Thomas-Alliel S, Martin JC, Conso F. Allergie immediate au calmar Deux observations. Revue Francaise d Allergologie et d Immunologie Clinique 1998;38 (8):713-715

[ 28 / 43 ]

A series of 202 labial food challenges (LFC) performed over two years in 142 children with food allergy suspected from the case history, positive skin prick tests and specific serum IgE assays: 156 LFC were positive; and 46 negative, followed by positive single-blind, placebo-controlled food challenges (SBPCFC). The foods provoking reactions were egg white (75 cases), peanut (60 cases), mustard (23 cases), cow's milk (13 cases), cod (8 cases), kiwi fruit, shrimp (4 cases each), chicken, peanut oil (3 cases each), hazel nuts (2 cases), and snails, apple, fennel, garlic, chilli peppers, pepper, and duck (1 case each). LFC positivity was mostly (89.7% of cases) manifested as a labial edema with contiguous urticaria. There were systemic reactions in 4.5% of cases: generalized urticaria, hoarseness and rapid-onset and generalized eczema. The 46 infants with negative LFC results had positive SBPCFC. The reactions were in 34 cases generalized urticaria, 10 cases asthma attacks, 2 cases early and generalized eczema, and in one case general anaphylactic shock. The sensitivity of the LFC was 77%. The LFC was easy to perform with children. Positive results indicate the presence of food allergy, but negative results require further investigations preferably double-blind, placebo-controlled food challenge (DBPCFC).

Rance F, Dutau G. Labial food challenge in children with food allergy. Pediatr Allergy Immunol 1997;8(1):41-44

[ 29 / 43 ]

Death following inhalation of steam from shrimp. (Obafunwa 1996 ref.11946 7)

Obafunwa JO, Rushton P, Busuttil A. Inhalation of steaming seafood aroma: sudden death in an asthmatic. J Clin Forensic Med 1996;3:45-49.

[ 30 / 43 ]

Food-dependent exercise-induced anaphylaxis. (Tokunaga 1995 ref.713 89)

Tokunaga H, Kokubu F, Okamoto M, Miyamoto M, Hanyuuda M, Adachi M. A case of food-dependent exercise-induced anaphylaxis induced by shrimp. [Japanese] Arerugi 1995;44(11):1297-304

[ 31 / 43 ]

Anaphylaxis. A review of 266 cases. (Kemp 1995 ref.2958 2)

Allergic reactions, including urticaria after contact with shrimp, respiratory symptoms, angioedema, nausea, vomiting, diarrhoea, and local anaphylaxis. Anaphylaxis. (Kemp 1995 ref.2958 5) (Yunginger 1990 ref.34 242). (Samson 2004 ref.9173 3)

Kemp SF, Lockey RF, Wolf BL, Lieberman P. Anaphylaxis. A review of 266 cases. Arch Intern Med 1995;155(16):1749-54

[ 32 / 43 ]

Eleven Japanese 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. 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. Only one individual reported symptoms for abalone, resulting in pruritis with exercise. Although various foods have been reported as allergens, including wheat, shellfish, vegetables, nuts and fish, wheat is the most frequent causative food in Japan. (Dohi 1991 ref.451 89)

Dohi M, Suko M, Sugiyama H, Yamashita N, Tadokoro K, Juji F, Okudaira H, Sano Y, Ito K, Miyamoto T. Food-dependent, exercise-induced anaphylaxis: a study on 11 Japanese cases. J Allergy Clin Immunol 1991;87:34-40

[ 33 / 43 ]

A 15-year-old man with food-dependent exercise-induced anaphylaxis who had begun to run 4 hours after he had lunch on fried shrimps. When running about 2000 m, he suffered from general cutaneous erythema with itching, urticaria, angioedema of face and dyspnea. Skin test and IgE-RAST were positive for shrimp. Exercise challenge test after having 20 g boiled shrimp resulting in elevation of plasma histamine level. 25 cases with food-dependent exercised-induced anaphylaxis have reported in Japan. 13 of 25 cases were related with wheat, and 10 cases were related with shrimp. 14 of 25 cases had experienced the similar episodes. (Watanabe 1990 ref.1395 7)

Watanabe T, Sakamoto Y, et al. A case of food-dependent exercise-induced anaphylaxis [Japanese]. Arerugi 1990;39(11):1523-8

[ 34 / 43 ]

It is concluded that cross-allergy exists between chironomids and shrimp and that cross-allergy also might occur among chironomids, crustaceans and molluscs. (Eriksson 1989 ref.1472 7) (Subsequent studies have not confirmed this association. Ed.).

Eriksson NE, Ryden B, Jonsson P. Hypersensitivity to larvae of chironomids (non-biting midges). Cross-sensitization with crustaceans. Allergy 1989;44(5):305-13

[ 35 / 43 ]

In adults, symptoms of shellfish allergy can result from ingestion, contact, or inhalation. In one report, of a group of 30 shrimp-allergic patients, the most frequently reported sign was generalized itching (90%). In the same study, 61% had urticaria, 52% had angioedema of lips and tongue, 42% had pulmonary symptoms, 35% had gastrointestinal symptoms, and 13% had shock-like symptoms. (Daul 1988 ref.586 73)

Daul CB, Morgan JE, Hughes J, Lehrer SB. Provocation-challenge studies in shrimp-sensitive individuals. J Allergy Clin Immunol 1988;81:1180-1186

[ 36 / 43 ]

Possible exercise-induced anaphylaxis (from eating squid and shrimp together, with IgE measured to squid). (Mijake 1988 ref.490 23)

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

[ 37 / 43 ]

Thirty-three individuals with a history of immediate hypersensitivity reactions after shrimp ingestion and 29 nonshrimp-sensitive control subjects were evaluated with extracts of shrimp, crab, crayfish, and lobster. Most (28/33) shrimp-sensitive subjects had positive skin prick tests to shrimp extract, whereas skin tests were negative in 27/29 control subjects. Eighty-one percent of atopic and 41% of nonatopic shrimp-sensitive subjects had elevated shrimp-RAST ratios. There was a significant correlation between shrimp-RAST ratios and historical clinical symptom scores. (Daul 1987 ref.1469 2)

Daul CB, Morgan JE, et al. Immunologic evaluation of shrimp-allergic individuals. J Allergy Clin Immunol 1987;80(5):716-22

[ 38 / 43 ]

"Idiopathic" anaphylaxis. An evaluation of 102 patients with the initial diagnosis of idiopathic anaphylaxis with a battery of 79 food-antigen skin prick tests selected to include foods reported or suspected of provoking anaphylaxis. Only those patients whose episodes consisted of at least two of the following were included in the study: angioedema with or without hives, laryngeal edema leading to severe dyspnea, hypotension, or loss of consciousness. Thirty-two patients (31%) had positive tests to one or more food antigens. In five of these patients, subsequently eating a food that elicited a positive test provoked an anaphylactic reaction. In seven patients, 10 different antigens provoked anaphylaxis: aniseed, cashew nut, celery, flaxseed, hops, mustard, mushroom (species not specified), shrimp, sunflower, and walnut. The authors conclude that a battery of selected food-antigen skin prick tests provided a useful method for identifying an offending antigen in these patients and that some (7% in our series) cases of "idiopathic" anaphylaxis by history are not truly idiopathic. (Stricker 1986 ref.9257 4)

Stricker WE, Anorve-Lopez E, Reed CE. Food skin testing in patients with idiopathic anaphylaxis. J Allergy Clin Immunol 1986;77(3):516-9

[ 39 / 43 ]

In this study, 102 patients with the initial diagnosis of idiopathic anaphylaxis were evaluated with a battery of 79 food-antigen skin prick tests selected to include foods reported or suspected of provoking anaphylaxis. Thirty-two patients (31%) had positive tests to one or more food antigens. In five of these patients, subsequently eating a food that elicited a positive test provoked an anaphylactic reaction. Two patients eliminated the foods completely, stopped having reactions, and refused challenge. In these seven patients, 10 different antigens provoked anaphylaxis: aniseed, cashew nut, celery, flaxseed, hops, mustard, mushroom, shrimp, sunflower, and walnut. We conclude that a battery of selected food-antigen skin prick tests provided a useful method for identifying an offending antigen in these patients and that some (7% in our series) cases of "idiopathic" anaphylaxis by history are not truly idiopathic.
The 10 antigens with positive clinical correlation
Antigens A B C
Aniseed 1 5 20
Cashew nut 1 2 50
Celery 2 4 50
Flaxseed 1 1 100
Hops 1 2 50
Mushroom 1 3 33
Mustard 2 3 66
Shrimp 1 3 33
Sunflower seed 1 3 33
Walnut 1 1 100
A = Total No. of positive skin tests with positive correlation
B = Total No. of positive skin tests
C = Percent of positive skin tests with positive correlation

Total number of positive skin prick tests.
2 - Almond
5 - Aniseed
1 - Artichoke
1 - Baker's yeast
1 - Beet
1 - Brazil nut
2 - Brewer's yeast
1 - Caraway seed
2 - Cashew nut
5 - Castor bean
4 - Celery
8 - Chamomile
2 - Chestnut
1 - Chicory
1 - Clam
2 - Coconut
1 - Cottonseed
2 - Crab
1 - Fennel
4 - Filbert (hazelnut)
I - Flaxseed
1 - Garbanzo bean
2 - Ginger
1 - Halibut
1 - Honey
2 - Hops
3 - Horseradish
1 - Lentil
1 - Lima beans
2 - Lobster
2 - Mango
1 - Milk
5 - Millet
3 - Mushroom
3 - Mustard
1 - Nutmeg
2 - Pea
1 - Pistachio
3 - Poppy seed
2 - Sesame seed
3 - Shrimp
3 - Sunflower
1 - Thyme
1 - Tumeric
1 - Walnut
None for Allspice, Apple, Banana, Bay leaf, Black pepper, Buckwheat, Cantaloupe, Chicken, Chili pepper, Chocolate, Cinnamon, Clove, Cod, Corn, Cumin seed, Dill seed, Egg, Garlic, Juniper berry, Orange, Oyster, Peach, Peanut, Potato, Psyllium seed, Raspberry, Sage, Salmon, Soybean, Strawberry, Sweet potato, Tangerine, Tapioca, Vanilla.
7 patients with positive clinical correlation to a SPT
1 : Aniseed
2 : Shrimp
3 : Mustard, flaxseed
4 : Celery, hops
5 : Celery, mustard, sunflower
6 : Walnut, cashew nut
7 : Mushroom
(Stricker 1986 ref.9 3606)

Stricker WE, Anorve Lopez E, Reed CE. Food skin testing in patients with "idiopathic anaphylaxis". J Allergy Clin Immunol 1986;77:516-519

[ 40 / 43 ]

14 individuals with histories of reactions to shrimp were studied by immediate skin tests and RAST with extracts of shrimp, crab, crayfish, and lobster. Nine of these subjects (8/8 atopics and 1/6 nonatopics) had positive immediate skin tests and RAST (ratios greater than 3.0) to shrimp. Their skin tests and RAST ratios to the other crustacea were also frequently positive even, in several cases, in the absence of prior exposure. In contrast, only 1/10 volunteers with no history of intolerance to crustacea had a weak positive skin test to raw shrimp. These studies suggest that cross-reactivity among crustacea may exist. (Waring 1985 ref.806 37)

Waring NP, Daul C, deShazo R, McCants ML, Lehrer SE. Hypersensitivity reactions to ingested crustacea: Clinical evaluation and diagnostic studies in shrimp-sensitive individuals. J Allergy Clin Immunol 1985;76:440-445

[ 41 / 43 ]

Allergic interstitial cystitis caused by squid and shrimp hypersensitivity. (Yamada 1984 ref.2620 4)

Yamada T, Taguchi H, Nisimura H, Mita H, Sida T Allergic study of interstitial cystitis. (1) A case of interstitial cystitis caused by squid and shrimp hypersensitivity [Japanese] Arerugi 1984;33(5):264-8

[ 42 / 43 ]

Food-dependent exercise-induced anaphylaxis. (Maulitz 1979 ref.496 32)

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

[ 43 / 43 ]

Fifteen cases of systemic allergic reactions to ingcslant antigens arc reported. penicillin, pinto bean, halibut, rice, potato, Brazil nut, shrimp, milk, a cereal mix, garbanzo bean, tangerine, salicylsalicylic acid, and demethylchlortetracycline.

A 37-year-old woman with dyspnea, generalized urticaria and angioedema, and syncope. She was unconscious with laryngeal stridor, pulmonary wheezing, cyanosis, angioedema of the face and oropharynx, and generalized urticaria. Subsequently, 4 reactions of varying severity occurred. Pinto bean became apparent from a diet diary. A prick test with extract prepared from fresh, raw pinto bean caused a large local cutaneous reaction and was followed by mild generalized symptoms of dyspnea, wheezing, pruritus, and flushing.

A 27-year-old man, while ingesting halibut and toast, abruptly developed dyspnea, generalized urticaria, facial angioedema, dizziness, "faintness," diarrhea, nausea, and emesis. He was hypotensive. Wheezing, generalized urticaria, and facial angioedema were present. A similar reaction occurred several months earlier while ingesting halibut. A cutaneous prick test was strongly positive to halibut extract.

A 21-year-old woman experienced dyspnea, dizziness, pruritus, swelling of the face, weakness, headache, and abdominal cramps. These symptoms developed while ingesting rice. Similar reactions, including syncope, had previously occurred during ingestion of rice. She had facial angioedema, generalized urticaria, cyanosis, and wheezing. A cutaneous prick test was strongly positive with a dilute solution of rice extract.

A 17-year-old boy with wheezing, dyspnea, angioedema, dizziness, weakness, and chest pain described as "tightness" which occurred repeatedly after ingestion of potato. Cutaneous scratch tests were positive to potato extract.

A 28-year-old man who experienced immediate systemic allergic reactions numerous times after ingestion of Brazil nut, pistachio nut, and cashew. Reactions were characterized by rhinorrhea, dyspnea; cyanosis; angioedema of face, tongue, and pharynx; abdominal cramps; weakness; and dizziness. A cutaneous scratch test with Brazil nut extract was performed elsewhere and caused a large local reaction and wheezing.
A 24-year-old with a history of ingestion of shrimp and lobster which had repeatedly caused rhinorrhea, angioedema of face and oropharynx, urticaria, dyspnea, wheezing, dizziness, and syncope. A cutaneous prick test with shrimp extract was markedly positive. He later ingested shrimp casserole to avoid insulting a girl friend despite knowledge of his sensitivity to this food. Pruritus, generalized urticaria, swelling of the face and neck, dyspnea, dysphagia, laryngeal stridor, weakness, and dizziness developed immediately.
A 5-month-old with reactions which invariably followed ingestion of pasteurized but otherwise uncooked milk. Reactions were characterized by pallor, cyanosis, muscle flaccidity, and generalized urticaria.. On one occasion, milk was accidentally spilled on him; urticaria developed at all sites of contact. Further cutaneous testing was deferred. He tolerated milk in baked foods.
A 49-year-old man with dyspnea, swelling of the face and oropharynx, pruritus, urticaria, and dyspnea which developed while he was ingesting a cereal mix. Angioedema of the face, generalized urticaria, cyanosis, and wheezing were present. Cutaneous prick tests were positive with the specific lot of cereal mix which the patient was ingesting. Cutaneous tests with individual ingredients of the cereal mix were negative. The reaction is attributed to the specific lot of cereal mix and may have been caused by a contaminant.
Case 10
A 39-year-old with dizziness, dyspnea, wheezing, generalized pruritus, and swelling of the face and oropharynx. Positive findings included rhinorrhea, lacrimation, generalized urticaria, and angioedema of the face and oropharynx. Partially cooked garbanzo bean (chick-pea) was ingested immediately prior to his reaction. A cutaneous prick test with this food was positive. He tolerated well-cooked beans.

Case 11
A 33-year-old woman suddenly developed generalized pruritus, dyspnea, abdominal "cramps," nausea, and dizziness while eating a meal. Physical findings included generalized urticaria, angioedema of face and oropharynx, and wheezing. Tangerine was among the foods ingested before the reaction. A cutaneous prick test with fresh tangerine juice was positive. She subsequently ingested lemonade and fresh orange without adverse effect. Cutaneous tests with fresh orange juice were negative.

A 37-year-old man with adverse effects to salicylsalicylic acid and acetylsalicylic acid.

A 34-year-old male physician experienced within 20 minutes of ingestion of demethylchlortetracycline, headache, transient syncope, dyspnea, "tightness in the chest," angioedema of the face and hands, and generalized urticaria developed. Findings were generalized urticaria, periorbital edema, and edema of the hands and feet.

A 22-year-old man with chest pain dyspnea, swelling of the face, generalized pruritus, and syncope developed while lie was ingesting a meal. Similar reactions had occurred 5 times previously. The causative antigen was undetermined, but all reactions followed ingestion of various foods containing a large mold content. (Golbert, 1969 ref.286 73)

Golbert, T, Patterson, R, Pruzansky, JJ. Systemic allergic reactions to ingested antigens. J Allergy 1969;44:96-107

Occupational reactions

[ 1 ]

A 47-year-old man had started approximately 10 years ago as truck driver delivering fish and other seafood stored on crushed ice. Two years prior to presentation, the patient first developed itchiness, redness and swelling of the conjunctivae and eyelids one to two minutes after a single drop of ice water splashed into his eye. Tthereafter, he developed several times within minutes after incidental direct contact to fish, crustaceans, or the storage ice pruritus, erythema and urticaria restricted to the contact sites on the hands and forearms. Carrying a full container by pressing it against the lower abdomen resulted in not only wheals at the contact sites but generalized urticaria. One year later when consuming a zander/Sander filet which he had been offered by a client, he suffered from generalized urticaria with facial angioedema, nausea, vomiting and defecation. Skin prick testing showed IgE-mediated sensitization for herring/Clupea (after 20 minutes wheal diameter 15 mm) and shrimp/Penaeus (after 20 minutes wheal diameter 22 mm including pseudopods). During the skin testing procedure the patient developed generalized pruritus and dyspnoea. Allergen-specific serum IgE against herring/Clupea, sardine/Sardina (f308), swordfish and shrimp (f24) was measured as 29.2, 6.6, 4.2, and 19.2 kU/L, respectively. (Seitz 2008 ref.23456 7)

Seitz CS, Bröcker EB, Trautmann A. Occupational allergy due to seafood delivery: Case report. J Occup Med Toxicol 2008 May 30;3:11.

[ 2 ]

A report of a 19-year-old patient with allergic asthma induced by occupationall exposure to shrimp cooking vapors. Anaphylactic shock had been experienced seven years previously caused by ingestion of fish food. Diagnosis was based on clinical history and a positivite allergy work-up. (Leduc 2008 ref.22860 7)

H. Racil, J. Ben Amar, S.C. Rouhou, N. Chaouch, M. Zarrouk, A. Chabou Asthme par inhalation de fumées de cuisson de crevettes Revue francaise d allergologie 2008;48(8):558-560

[ 3 ]

Occupational protein contact dermatitis. (Scharer 2002 ref.5820 4)

Scharer L, Hafner J, Wüthrich B, Bucher C. Occupational protein contact dermatitis from shrimps. Contact Dermatitis 2002;46(3):181-2

[ 4 ]

A restaurant seafood handler with IgE-mediated occupational asthma and contact urticaria to both shrimp and scallops. Independent hypersensitivity to both seafoods was demonstrated by skin testing, inhalation challenge, and immunoassays. Bronchial challenge with extracts of shrimp and scallops each produced an isolated early asthmatic response. Prominent protein allergens for shrimp boiling water at 21, 26, and 35 to 38 kD; for raw shrimp at 26 and 38 kD; for scallops boiling water at 20, 35 to 39 and 42 kD; and for raw scallops at 36 to 38 and 41 kD was shown. Significant inhibition of the 35 to 39-kD band of each shrimp and scallops extract was demonstrated. The primary cross-reactive allergen of shrimp and scallops was the 35 to 39 kD heat-stable allergen, previously demonstrated to be muscle topomyosin in both phyla. (Goetz 2000 ref.24794 7)

Goetz DW, Whisman BA. Occupational asthma in a seafood restaurant worker: cross-reactivity of shrimp and scallops. Ann Allergy Asthma Immunol 2000 Dec;85(6 Pt 1):461-6.

[ 5 ]

Occupational allergy to squid, including an individual with food allergy to shrimp. (Tabka 1998 ref.16377 8)

Tabka F, Choudat D, Vacher JG, Thomas-Alliel S, Martin JC, Conso F. Allergie immediate au calmar Deux observations. Revue Francaise d Allergologie et d Immunologie Clinique 1998;38 (8):713-715

[ 6 ]

Occupational asthma to lobster and shrimp. (Lemiere 1996 ref.828 37)

Lemiere C, Desjardins A, Lehrer S, Malo JL. Occupational asthma to lobster and shrimp. Allergy 1996;51(4):272-3

[ 7 ]

Asthma and rhinoconjunctivitis due to occupational allergy. (Desjardins 1995 ref.721 93) One subject reacted to inhalation of clam vapour.

Desjardins A, Malo JL, L'Archeveque J, Cartier A, McCants M, Lehrer SB. Occupational IgE-mediated sensitization and asthma caused by clam and shrimp. J Allergy Clin Immunol 1995;96(5 Pt 1):608-17

[ 8 ]

Shrimp-allergic patients often have respiratory allergy; also an occupational allergen for seafood processors. (Daul 1990 ref.585 20)

Daul CB, Morgan JE, Lehrer SB. The natural history of shrimp hypersensitivity. J Allergy Clin Immunol 1990;86:88-93

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