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. 2024 Jul 22;3(4):100309.
doi: 10.1016/j.jacig.2024.100309. eCollection 2024 Nov.

Fish and shellfish allergy: Presentation and management differences in the UK and US-analysis of 945 patients

Alla Nakonechna  1   2   3 , Ard van Bergen  4 , Ariharan Anantharachagan  5 , Dilani Arnold  3 , Nicole Johnston  6 , Kari Nadeau  7 , Krzysztof Rutkowski  8 , Sayantani B Sindher  9 , Panida Sriaroon  10 , Iason Thomas  8 , Pavaladurai Vijayadurai  5 , Annette Wagner  11 , Carla M Davis  12
Affiliations

Fish and shellfish allergy: Presentation and management differences in the UK and US-analysis of 945 patients

Alla Nakonechna et al. J Allergy Clin Immunol Glob. .

Abstract

Background: Seafood allergy (SA), including allergy to shellfish (crustacean and mollusks) and fish, is among the 4 most common food allergies causing anaphylaxis, but there are limited data showing SA clinical management in different countries.

Objective: We sought to characterize a large cohort of patients with fish and shellfish allergy and to facilitate standardization of future care for this increasingly common allergic disease.

Methods: We performed a retrospective, observational, noninterventional study from 945 patients from 2015 to 2019 in 7 hospitals in the United States and the United Kingdom to evaluate SA. A chi-square test was used to detect differences in family history, medical history, and current symptoms between patients in 2 countries.

Results: Underdiagnosed anaphylaxis in patients with SA was associated with underuse of epinephrine (adrenaline) autoinjectors in both countries. Oral food challenge was used only when skin or serologic test results were negative. Asthma and allergic rhinitis were more common in the US patients with SA, but eczema was more common in UK patients with SA (P < .001). Respiratory, gastrointestinal, and neurological symptoms were higher in UK patients with SA than in US patients with SA (P < .001).

Conclusions: In international multicenter cohorts of patients with fish and shellfish allergy, there are opportunities for improvement in management. Physician identification of anaphylaxis, use of diagnostic oral food challenges, and anaphylaxis treatment with epinephrine are areas with significant knowledge gaps in need of improvement in the United Kingdom and the United States. There is an opportunity for the development of unified, standardized diagnostic protocols for SA with distribution for allergists and trainees.

Keywords: Seafood allergy; anaphylaxis; epinephrine (adrenaline) autoinjectors; fish allergy; fish specific IgE; oral food challenge; shellfish allergy; shellfish specific IgE; total IgE.

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Conflict of interest statement

Disclosure of potential conflict of interest: K. Nadeau reported receiving grants from the 10.13039/100000060National Institute of Allergy and Infectious Diseases, the National Heart, Lung, and Blood Institute, the 10.13039/100000066National Institute of Environmental Health Sciences, and Food Allergy Research and Education; serving as director of the World Allergy Organization; serving as advisor for Cour Pharma; serving on the National Scientific Committee of the 10.13039/100014247Immune Tolerance Network and the National Institutes of Health clinical research centers; being cofounder of Before Brands, Latitude, Alladapt, and IgGenix outside the submitted work; and having patents for an oral formula for decreasing food allergy risk and treatment for food allergy, for granulocyte-based methods for detecting and monitoring immune system disorders issued, for methods and assays for detecting and quantifying pure subpopulations of white blood cells in immune system disorders, and for microfluidic device and diagnostic methods for allergy testing based on detection of basophil activation pending. S. B. Sindher is funded by the National Institute of Allergy and Infectious Disease, Consortium for Food Allergy Research (CoFAR), Regeneron, DBV Technologies, Aimmune Therapeutics, Novartis, and Sanofi, and is an advisory member for AstraZeneca. P. Sriaroon is funded by Food Allergy Research and Education. C. M. Davis receives research contract funding from DBV Technologies, Regeneron, and Aimmune Therapeutics, grant funding from the National Institute of Allergy and Infectious Disease (grant no. R34AI157948) (CoFAR and Consortium of Eosinophilic Gastrointestinal Disease Researchers), and the Food Allergy Research and Education. The rest of the authors declare that they have no relevant conflicts of interest.

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