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. 2020 Apr;8(4):1359-1370.e2.
doi: 10.1016/j.jaip.2019.12.027. Epub 2020 Jan 7.

Prevalence and Characteristics of Shellfish Allergy in the Pediatric Population of the United States

Helen T Wang  1 , Christopher M Warren  2 , Ruchi S Gupta  3 , Carla M Davis  4
Affiliations

Prevalence and Characteristics of Shellfish Allergy in the Pediatric Population of the United States

Helen T Wang et al. J Allergy Clin Immunol Pract. 2020 Apr.

Abstract

Background: Shellfish allergy (SA) is one of the most common food allergies causing anaphylaxis in adults and children. There are limited data showing the prevalence of SA in US children.

Objective: To determine the prevalence and reaction characteristics of SA in the US pediatric population.

Methods: A cross-sectional food allergy prevalence survey was administered via phone and the Web by the National Opinion Research Center at the University of Chicago from 2015 to 2016. Point prevalence SA estimates, complex survey weighted proportions, and 95% CIs were determined. Relative proportions of demographic characteristics were compared using weighted Pearson χ2 statistics.

Results: The prevalence of SA was 1.3% (95% CI, 1.1-1.5), with more children allergic to crustaceans (1.2%; 95% CI, 1.0-1.3) than to mollusks (0.5%; 95% CI, 0.4-0.6). Mean ages of shellfish, crustacean, and mollusk allergy diagnoses were 5.0 (95% CI, 4.4-5.6), 5.1 (95% CI, 4.6-5.6), and 7.7 (95% CI, 5.7-9.7) years, respectively. More than half (54.9%; 95% CI, 48.1-61.4) of pediatric patients with SA had more than 1 lifetime food allergy-related emergency room visit, but only 45.7% (95% CI, 39.2-52.4) carried an epinephrine autoinjector. Children with SA were more likely to be black/Hispanic/Latino and have comorbid asthma, allergic rhinitis, or a parental history of asthma, environmental, or other food allergies (P < .001).

Conclusions: The epidemiology of SA in the US pediatric population shows that crustacean allergy is more common than mollusk allergy. A disparity in SA children and epinephrine autoinjector carriage exists. Results from this study will lead to increased awareness of the need for detailed histories, specific diagnostic tests, and rescue epinephrine for anaphylaxis in US children with SA.

Keywords: Children; Crustacean allergy; Mollusk allergy; Prevalence; Shellfish allergy.

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Figures

Figure 1.
Figure 1.
A. Food Allergy Categorization Flow Diagram B. List of allergic reaction symptoms highlighting stringent symptoms indicative of convincing shellfish allergy.
Figure 1.
Figure 1.
A. Food Allergy Categorization Flow Diagram B. List of allergic reaction symptoms highlighting stringent symptoms indicative of convincing shellfish allergy.
Figure 2.
Figure 2.
Comorbidities Among Shellfish Allergies and Other Co-existing Food Allergies. Each cell has the percentage of children with each column allergy who also are allergic to the row allergen
See this image and copyright information in PMC

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