Seafood Allergy in Asia: Geographical Specificity and Beyond

Screening and Interaction Analysis of Shark-Derived Nanobodies against Crayfish Major Allergen Pro c 2

Pro c 2 (arginine kinase) is a major allergen in crayfish (Procambarus clarkii). Shark-derived variable domains of new antigen receptors (VNARs) have advantages in developing allergen detection and immunotherapy. This study constructed a VNAR domain library from Chiloscyllium plagiosum immunized with Pro c 2. Three VNARs (VNAR-11, VNAR-20, and VNAR-29) against Pro c 2 obtained by screening the library were expressed in the HEK293F cells, fusing with the immunoglobulin (Ig) G1 Fc fragment (VNAR-Fc-11, VNAR-Fc-29, and VNAR-Fc-20). The VNAR-Fc fusions bound to Pro c 2 with an affinity KD ranging from 0.2131 ∼ 465.3 μM, with the ability to inhibit patients' IgE binding to Pro c 2. VNAR-20 and VNAR-29 displayed more stable binding with Pro c 2 during molecular dynamics simulation. The binding sites of the VNARs are distributed in the conserved IgE epitopes of arginine kinase. These achievements indicate the application potential of VNARs in allergen detection and allergy therapeutics.

Deciphering the Cross-Reactivity of Tropomyosin across Three Molluscan Species: Insights into the Role of Conserved T-Cell and B-Cell Epitopes

Haliotis discus hannai tropomyosin (HTM), Alectryonella plicatula tropomyosin (ATM), and Mimachlamys nobilis tropomyosin (MTM) were reported as significant seafood allergens capable of eliciting severe allergic reactions. However, studies of cross-reactivity and epitope mapping among them are notably limited. This study discovered their cross-reactivity property through inhibition of IgG/IgE binding capacity and promotion of specific CD4+T-cell proliferation. For T-cell epitopes, 3, 4, and 3 epitopes were identified from the splenocytes of mice immunized with HTM, ATM, and MTM, respectively. In terms of B-cell epitopes, a combination of bioinformatics techniques and serological assays identified 4, 3, and 4 epitopes for HTM, ATM, and MTM, respectively. Sequence logo analysis revealed 2 conserved T-cell epitopes and 5 conserved B-cell epitopes, which may be critical for the observed cross-reactivity property. In conclusion, these findings provide crucial molecular evidence that could enhance the prevention of allergic reactions to aquatic mollusks.

Comparison of Conventional IgE Assay and Measurement of Specific IgE to Haemocyanin for the Diagnosis of Adult Crab Allergy

Five potential allergens of freshwater crab (Somanniathelphusa sinensis), including hemocyanin, have been discovered. Specific IgE to haemocyanin was increased in crab-allergic than in crab-tolerant patients. The add-on of specific IgE to hemocyanin to skin prick test enhanced the specificity of the crab allergy diagnosis. IgE, immunoglobulin E; rHM, recombinant haemocyanin; sIgE, specific IgE; SPT: skin prick test.

Respiratory symptoms, sensitisation and occupational exposure in the shrimp processing industry

Introduction

Shellfish processing workers are highly susceptible to respiratory illnesses such as allergies and asthma. This study examined respiratory symptoms and biomarkers of allergy and asthma in Norwegian shrimp processing plant workers and evaluated allergenic and irritant protein exposures in the workplace.

Material and methods

The study included 35 shrimp processing workers and 21 controls. Respiratory symptoms were assessed via questionnaire; blood samples were analysed for allergy and asthma biomarkers and specific IgE levels. Air samples were analysed for protein levels and composition.

Results

Shrimp processing workers had four to five times higher odds of reporting acute upper and chronic lower respiratory symptoms than the controls. They also had significantly higher plasma levels of IL4, CCL20, CSF2 and MMP12, with 11% of the exposed workers showing elevated levels of shrimp and crab specific IgE. Furthermore, exposed workers showed increased plasma levels of SFTPD and CHI3L1 post-shift. The median total protein exposure was 6 µg/m3, with peaks up to 66 µg/m3 in the cooking and peeling department. Total protein levels were correlated with CCL20, IL13, and basophil counts. Ninety-five shrimp proteins were identified, including seven known and eight potential allergens. Tropomyosin levels were generally high, particularly in the cooking and peeling department.

Conclusion

Shrimp workers had a higher prevalence of respiratory symptoms and biomarkers of allergy and asthma. The work environment contained tropomyosin and other allergenic proteins as well as irritants, highlighting the need for protective measures, especially in the cooking and peeling departments.

Is hen's egg a significant allergen in adults too? Findings from an investigation into food allergy prevalence

INTRODUCTION

Data on adult food allergies (FAs) remain limited compared to the pediatric population, and this study investigates the prevalence and clinical characteristics of FAs among adults.

METHODS

This retrospective study included adults aged 18-80 diagnosed with FAs at the Immunology and Allergy Diseases Clinic of Ankara Bilkent City Hospital, Turkey, between 2019 and 2024.

RESULTS

During the study period, 10,505 patients were examined to diagnose and manage various allergic and immunologic conditions. Among these, 563 patients were suspected of having FAs, which was confirmed in 33 patients (mean age 34.74 ± 12.57 years; 60.6% female), yielding a frequency of 0.31%. The primary allergens identified included hen's egg (n = 6, 18.2%), fish and shellfish (n = 4, 12.1%), and various nuts such as peanuts (n = 2, 6.1%), hazelnut (n = 1, 3.0%), and almond (n = 1, 3.0%) as well as seeds like sesame (n = 2, 6.1%) and sweet corn (n = 2, 6.1%) and fruits such as banana (n = 4, 12.1%) and kiwi (n = 4, 12.1%). The median time interval between food consumption and allergic reactions was 10 minutes (2-120). Anaphylaxis was the most frequently observed clinical presentation (n = 24, 72.7%). Emergency treatments included antihistamines and steroids (n = 15, 65.2%), antihistamines, steroids, and epinephrine (n = 5, 21.7%), or epinephrine alone (n = 3, 13.0%). Egg allergy was the most prevalent allergen (n = 6, 18.2%), characterized by a rapid onset of allergic reactions (median of 5 minutes); two patients reacted regardless of cooking methods and four showed tolerance to thoroughly cooked eggs, with component-resolved diagnostics indicating sensitization to ovalbumin (Gal d2) but not ovomucoid (Gal d1).

CONCLUSION

Our study demonstrates a low frequency of FAs in adults yet highlights the seriousness of reactions like anaphylaxis. Hen's egg allergy was notably prevalent, underscoring the need for increased awareness and improved diagnostic strategies to effectively manage FAs in the adult population.

Sensitization profile of Thai children with fish allergy

INTRODUCTION

Fish allergies are common food allergies, and in Thailand, the prevalence of fish allergies in children ranges from 0.29% to 1.1%. Common fish allergens include parvalbumin, enolase, and aldolase.

METHOD

This cross-sectional study included children with immunoglobulin E (IgE)-mediated fish allergies. The diagnosis was based on clinical history with a positive skin prick test (SPT) and/or specific IgE (sIgE). Serum IgE binding profiles to allergens in fish extracts were analyzed.

RESULT

Eleven children, with a median age of 3 years, were recruited; the median age of onset was 1.25 years. Cutaneous symptoms were the most frequent clinical manifestation (63.6%). Tilapia and catfish were the most common triggers. All participants showed positive SPT and/or sIgE results for fish species. The immunoblot analysis revealed IgE binding to 40-50 kDa protein in all participants, while only seven participants (63.6%) showed IgE binding to the 11 kDa protein.

CONCLUSION

Tilapia and catfish are the most common triggers of fish allergies in Thai children. The 40-50 kDa proteins were identified as a major fish allergen in tested cohort.

Molecular and Immunological Characterization of Troponin C: An Allergen from Scylla paramamosain

Scylla paramamosain, a crustacean of substantial importance, is a frequent trigger of food allergies. This study examined the molecular and immunological properties of troponin C from S. paramamosain (Scy p TnC) as an allergen. The findings indicated that thermal stability of Scy p TnC comprised 150 amino acids and facilitated the induction of CD63/CD203c in basophils from crab allergy patients. Furthermore, treatment of Scy p TnC with chemical denaturants caused structural degradation, which resulted in diminished IgG binding capacity. Subsequently, 6 linear epitopes and 4 conformational epitope regions of TnC were predicted, with epitopes at the C-terminal being conserved throughout 9 discovered TnCs. Concurrently, mice sensitized with Scy p TnC exhibited markedly increased levels of IgE and IL-4 release, provoking a Th2 immune response. The results reveal crab allergens and enhance existing knowledge regarding allergenic components in crabs, thereby facilitating the advancement of molecular diagnostics and targeted therapeutic strategies.

Identification and Allergenicity Analysis of Tropomyosin: A Heat-Stable Allergen in Lateolabrax japonicus

Lateolabrax japonicus, a prevalent aquatic delicacy, is known to elicit allergic reactions in certain individuals. Nevertheless, the investigation into its allergenic components has remained notably inadequate. In the research, an approximately 35 kDa heat-stable protein of L. japonicus raw/steamed extracts was verified as tropomyosin (TM) by LC-MS/MS. Open reading frame of TM (852 bp) was acquired via PCR amplification, encoding 284 amino acids. The IgE-binding frequency of TM expressed in Escherichia coli was 22.5% among 80 fish-sensitized patients. Furthermore, TM had the ability to activate basophils in 7 patients. In the Balb/c mice model, compared with the PBS group, the levels of specific antibodies (IgE, IgG1, and IgG2a), CD19+ B cells, IL-4, and IL-10 were significantly increased in the TM group. However, the opposite was indeed the case for CD4+ TCR-β, CD4+ CD25+ Fox p 3+ cells, and IFN-γ. These findings regarding an allergen assist in conducting component-resolved diagnoses and therapeutic research for fish allergy.

Efficient Hydrolysis of Fish Parvalbumin by Marine Bacterial Protease VSP2V-280: Allergen Removal

Parvalbumin is a major allergen in fish. However, there is currently no effective and safe way to remove this allergen from fish. In this study, protease gene VSP2V-280 of marine bacteria Virgibacillus sp. SP2 was cloned and expressed. The protease enzyme showed maximum activity at 50°C and pH 10.0. Ca2+ and Cu2+ promoted the enzyme. The enzyme showed good parvalbumin degradation efficiency in fish. Based on the gel analysis, when 0.3 mg/mL of parvalbumin was incubated with protease VSP2V-280 (30 U/mL) containing 1 mM Ca2+ for 3 h, the parvalbumin removal rate reached 97%. The enzyme was further used for parvalbumin removal from Ctenopharyngodon idella, Pelteobagrus fulvidraco, Parabramis pekinensis, and Carassius auratus. The parvalbumin removal rate reached 93% in 4 h at an enzyme dosage of 72 U/mL. The study showed the potential of VSP2V-280 to remove parvalbumin from aquatic products.

Shrimp allergen extract immunotherapy induces prolonged immune tolerance in a gastro-food allergy mouse model

Food allergies are a global health problem that continues to grow annually, with a prevalence of more than 10%. Shrimp allergy is the most common and life-threatening allergy. There is no cure for food allergies, but shrimp allergen extract (SAE) offers promise as a treatment through allergen-specific immunotherapy (AIT). However, whether SAE induces immunological tolerance in seafood allergies remains to be established. This study aimed to determine the effectiveness of SAE in inducing immunological tolerance in a gastro-food allergy mouse model. For the immunotherapy evaluation, mice (n = 24) were intraperitoneally (i.p.) sensitized with 1 mg alum and 100 μg SAE in PBS on days 0, 7, and 14 and randomly divided into four groups of six: a negative control (NC) and high- to low-dose immunotherapy (HI, MI, and LI). The untreated group (n = 6) only received 1 mg alum in PBS (i.p.). All groups were challenged with 400 μg SAE (i.g.) on days 21, 22, 23, 53, and 58. Following the challenge, SAE-sensitized mice from the immunotherapy group were treated (i.p.) with 10 μg SAE for LI, 50 μg SAE for MI, and 100 μg SAE for HI on days 32, 39, and 46. The untreated and NC groups only received PBS (i.p.). All mice were euthanized on day 59. As the results, we found that SAE immunotherapy reduced systemic allergy symptom scores, serum IL-4 levels, IL-4 and FcεR1α mRNA relative expression, and mast cell degranulation in ileum tissue in allergic mice while increasing Foxp3 and IL-10 mRNA relative expression. Notably, we observed an increased ratio of IL-10 to IL-4 mRNA expression, demonstrating the efficacy of SAE immunotherapy in promoting desensitization. Thus, SAE can be developed as an immunotherapeutic agent for food allergies by inducing prolonged allergy tolerance with a wide range of allergen targets.

A Crystal Structure of Pro c 2 Provides Insights into Cross-Reactivity of Aquatic Allergens from the Phosphagen Kinase Family

Arginine kinase (AK) from the phosphagen kinase family is a cross-reactive shellfish allergen. Structurally related cross-reactive allergens are involved in the pathogenesis of allergic symptoms. This study aimed to unravel the cross-reactivity of AK from a structural perspective. The crystal structure of Procambarus clarkii AK (Pro c 2) was resolved at 1.57 Å resolution, which showed a well-conserved structure not only to shellfish AKs but also to fish creatine kinase (CK), another allergen from the phosphagen kinase family. In Western blot, the CK corresponding protein in fish muscles was found to be reactive with AK-specific immunoglobulin (Ig) G. Recombinant Pro c 2 (rPro c 2) and CKs from Lateolabrax japonicus (rCK-L) and Ctenopharyngodon idell (rCK-C) were then produced, and the IgE reactivity of rCK-L and rCK-C, as well as their IgG/IgE cross-reactivity with rPro c 2, was confirmed by immunological assays. This study demonstrated the cross-reactivity among aquatic allergens from the phosphagen kinase family due to their structural similarity.

Revealing antimicrobial resistance profile and associated factors of Vibrio vulnificus isolated from clinical, environmental, and seafood samples across asia: A systematic review and meta-analysis

The escalating antimicrobial resistance (AMR) in highly virulent Vibrio vulnificus poses a significant public health concern in Asia. Profiling the antibiogram of this pathogen is crucial for revealing its complex AMR patterns and guiding the selection of appropriate medications. Although previous studies have provided valuable insights regarding V. vulnificus AMR, they are constrained by limited sample diversity, inconsistent methodologies, and insufficient regional data. Moreover, no systematic attempt has been made to synthesize V. vulnificus AMR data across various sources and regions in Asia. A systematic review and meta-analysis are thus conducted in this study to assess the current AMR status of V. vulnificus isolated from clinical, environmental, and seafood samples. By synthesizing data from 32 articles across 13 Asian countries, a broader antibiogram has been provided, covering 13 major antimicrobial groups against V. vulnificus. Subgroup and regression analyses were also performed using study-level and country-specific covariates to explore the associated risk factors. The findings revealed low AMR rates for tetracyclines (4.89 %), quinolones (1.85 %), nitrofurans (0.86 %), and phenicols (0.61 %), highlighting their potential as primary treatment options. Conversely, high AMR rates were detected for lincosamides (80.32 %), polypeptides (64.42 %), and glycopeptides (56.14 %), necessitating careful consideration for their clinical use. For study-level covariates, subgroup and meta-regression analyses revealed that variations in the type of antimicrobial (R 2  = 26.5 %, p < 0.0001), country (R 2  = 18.33 %, p < 0.0001), and pathogen source (R 2  = 10.46 %, p = 0.0007) significantly contributed to between-study heterogeneity in the detected AMR rates across studies. Moreover, the analyses of country-specific covariates indicated that antimicrobial consumption (AMC) in healthcare systems (R 2  = 29.3, p = 0.06) and the country's gross domestic product (GDP) (R 2  = 28.59, p = 0.06) affected the variations in AMR rates across countries to some extent. Consideration of study-level and country-specific covariates is thus recommended for future research to effectively mitigate the threat of V. vulnificus AMR across Asia and reduce its pervasive impact on public health.

Food Allergy in Children in China

The prevalence of food allergies in China seems to be increasing, but there are limited studies describing the pattern of food allergies across the country. This review highlights regional variations observed across China, with data indicating a higher prevalence in the more economically developed eastern and southern coastal regions compared to inland areas. Egg and milk are the most common allergies among children under 3 years old; for children above 3 years old, specific food allergens also show regional differences, with shellfish allergies being more common in southern and eastern coastal areas, while wheat and fruit allergies are more prevalent in northern regions. Emerging peanut and tree nut allergies have also been observed in China's megacities, although the prevalence remains relatively low compared to Western countries. These geographic and environmental influences highlight the complexity of the food allergy landscape in China and the need for a more nuanced understanding of the underlying drivers. Despite the growing burden of food allergies, significant gaps exist in effectively managing these conditions in China. Lack of standardised diagnostic tools, limited access to oral food challenges and a shortage of trained allergists pose major challenges. Another critical gap is the limited availability and affordability of epinephrine autoinjectors, essential for managing life-threatening anaphylactic reactions. Addressing these systemic deficiencies in China's food allergy management infrastructure will require concerted efforts from policymakers, healthcare systems and pharmaceutical companies. Investing in the development of standardised diagnostics, expanding the allergy speciality workforce and ensuring equitable access to emergency care and treatment options are crucial steps towards improving health outcomes for the millions of individuals affected by food allergies in China.

Elucidation of high-pressure processing toward microbial inhibition, physicochemical properties, collagen fiber and muscle structure of blood clam edible portion

Impact of high-pressure processing (HP-P) on microbial inactivation, protein oxidation, collagen fiber, and muscle structure of the edible portion (EP) of blood clams (BC) was investigated. Aerobic plate count, Vibrio parahaemolyticus, V. vulnificus, other Vibrio spp. and Shewanella algae counts were not detectable when HP-P pressure of ≥300 MPa was applied. Carbonyl, disulphide bond content, and surface hydrophobicity upsurged as HP-P with augmenting pressure was employed. Protein with ∼53 kDa appeared when HP-P at 100 and 200 MPa was implemented. Increased pressure enhanced gap formation and abnormal muscle cell structure arrangements. HP-P also affected connective tissue, causing size reduction and disruption of the collagen filament fibers. However, firmness and toughness of BC-EP with HP-P ≤ 300 MPa were comparable to those of the control. HP-P at 300 MPa was therefore appropriate for treatment of BC with maintained textural properties, while less protein oxidation, collagen fiber and muscle structure disruption occurred.

Early-Life Risk Factors and Clinical Features of Food Allergy Among Thai Children

Background: Food allergy affects 1%-10% of children under five worldwide, with genetic and early-life factors playing a primary role. Reported factors include a family history of allergic diseases, personal atopic dermatitis, cesarean section, dietary restrictions during pregnancy and lactation, and the timing of introducing solid foods. This study was aimed at identifying various factors associated with food allergy and evaluate each food allergy's clinical features. Methods: We conducted a case-control study with a participant ratio of 1:2 between cases and controls. Data were gathered from both groups of participants, and questionnaires included living area, sex, and natal history (birth details, maternal diet during pregnancy and breastfeeding, feeding history during infancy, family history of atopic diseases, and household smoking). Results: All 72 cases with food allergy and 145 controls were included in the study. Term birth comprised a protective factor for developing food allergy (adjusted odds ratio [aOR] 0.213, p value 0.022). In contrast, personal atopic dermatitis (aOR 20.097, p value 0.001) and a family history of allergic disease constituted risks (aOR 3.183, p value 0.002). Food allergy was unrelated to cesarean section, low birth weight, dietary restrictions during lactation and pregnancy, exclusive breastfeeding, or the early introduction of complementary foods. The three most common food allergens were egg white (40.2%), wheat (34.7%), and cow's milk (30.5%), respectively. Conclusions: In this study, risk factors associated with food allergy comprised a personal history of atopic dermatitis and a family allergic disease, which may be used as predictive factors for developing food allergy among Thai children.

Combined Integrative RNA-Seq and Serological sIgE Analysis Enhances Understanding of Fish Allergen Profiles and Diagnostic Strategy for Fish Allergy

Fish allergy is a significant health concern, with diagnosis and management complicated by diverse fish species and allergens. We conducted a comprehensive RNA-seq analysis of eight fish species to identify allergen profiles, integrating ImmunoCAP sIgE data to explore associations with allergen expression and diagnostic performance. Over 30 putative fish allergens were identified, with varying sequence similarities and expression levels, roughly classifying fish into two groups based on parvalbumin (PV) expression. Higher similarities in allergen expression correlated with stronger sIgE data relationships among fish extracts. High PV expression and conserved PV sequences were linked to elevated sIgE measurements, potentially indicating higher allergenicity. For diagnosis, species-specific extract sIgE remained the best indicator of corresponding fish allergy diagnosis, while incorporating multiple sIgE data enhanced performance. In component-resolved diagnosis (CRD), the current panel with PV alone showed comparable performance to fish extract for PV-high fish allergy, while PV-low fish may require the inclusion of more minor allergens for improved CRD accuracy. This RNA-seq allergen analysis helps reveal fish allergen profiles, classify fish groups, and predict allergenicity, potentially improving CRD design and food management in fish allergy.

What molecular allergy teaches us about genetics and epidemiology of allergies

PURPOSE OF REVIEW

To delineate pertinent information regarding the application of molecular allergology within the realm of both genetic and epidemiological facets of allergic diseases.

RECENT FINDINGS

The emergence of molecular allergy has facilitated the comprehension of the biochemical characteristics of allergens originating from diverse sources. It has allowed for the exploration of sensitization trajectories and provided novel insights into the influence of genetics and environmental exposure on the initiation and development of allergic diseases. This review delves into the primary discoveries related to the genetics and epidemiology of allergies, facilitated by the application of molecular allergy. It also scrutinizes the impact of environmental exposure across varied geoclimatic, socioeconomic, and lifestyle contexts. Additionally, the review introduces specific models of molecular allergy within the realms of plants and animals.

SUMMARY

The utilization of molecular allergy in clinical practice holds crucially acknowledged diagnostic and therapeutic implications. From a research standpoint, there is a growing need for the widespread adoption of molecular diagnostic tools to achieve a more profound understanding of the epidemiology and natural progression of allergic diseases.

Gastropod Allergy: A Comprehensive Narrative Review

Food allergies have increased significantly in recent decades, with shellfish being a leading cause of food allergy and anaphylaxis worldwide, affecting both children and adults. The prevalence of shellfish allergies is estimated to be approximately 0.5-2.5% of the general population, varying significantly by geographical location, age, and consumption habits. Although mollusk consumption has risen, the prevalence of mollusk allergies remains unknown. While extensive research has focused on crustacean allergies, mollusk allergies, particularly those related to gastropods, have received comparatively less attention. Clinical manifestations of shellfish allergy range from localized symptoms to life-threatening systemic reactions, such as anaphylaxis. Notably, severe bronchospasm is a predominant clinical feature in cases involving gastropods. Several allergens have been identified in mollusks, including paramyosin, tropomyosin, and sarcoplasmic calcium-binding protein. In gastropods, documented allergens include tropomyosin, paramyosin, the heavy chain of myosin, and Der p 4 amylase. Diagnosis typically involves a thorough clinical history, skin testing, in vitro quantification of immunoglobulin (Ig) E, and confirmation through an oral challenge, although the latter is reserved for selected cases. This narrative review highlights the limited research on gastropod allergy. It provides a comprehensive list of purified and recombinant allergens and discusses the applications of component-resolved diagnosis as well as current therapeutic developments.

Variation in Shrimp Allergens: Place of Origin Effects on Food Safety Assessment

Due to the widespread use of shellfish ingredients in food products, accurate food labelling is urgently needed for consumers with shellfish allergies. Most crustacean allergen detection systems target the immunorecognition of the allergenic protein tropomyosin. However, this mode of detection may be affected by an origin-dependent protein composition. This study determined if the geographic location of capture, or aquaculture, influenced the allergenic protein profiles of Black Tiger Shrimp (Penaeus monodon), one of the most farmed and consumed shrimp species worldwide. Protein composition was analysed in shrimp from nine different locations in the Asia-Pacific by SDS-PAGE, immunoblotting, and mass spectrometry. Ten of the twelve known shrimp allergens were detected, but with considerable differences between locations. Sarcoplasmic calcium-binding protein, myosin light chain, and tropomyosin were the most abundant allergens in all locations. Hemocyanin-specific antibodies could identify up to six different isoforms, depending on the location of origin. Similarly, tropomyosin abundance varied by up to 13 times between locations. These findings suggest that allergen abundance may be related to shrimp origin and, thus, shrimp origin might directly impact the readout of commercial crustacean allergen detection kits, most of which target tropomyosin, and this should be considered in food safety assessments.

Shrimp Extract Exacerbates Allergic Immune Responses in Mice: Implications on Clinical Diagnosis of Shellfish Allergy

Tropomyosin has been identified as the major cross-reactive shellfish allergen, but recent studies showed the presence of other clinically relevant allergens. This study aims at determining the allergic immune responses of mice sensitized with raw and boiled shrimp extracts in comparison to recombinant tropomyosin (rTM). Female Balb/c mice were intragastrically sensitized and challenged with raw, boiled shrimp or rTM. Systemic, cellular and humoral allergic responses were compared, while allergenicity of the extracts was also compared by skin prick test (SPT) and immunoblot on shrimp allergic subjects. We showed that rTM and shrimp extracts induced IgE- and Th2-mediated allergic responses in mice, distinguished by remarkable intestinal inflammation in small intestine across all regimens. Notably, boiled shrimp extract exhibited the highest sensitization rate (73.7% of mice developed positive TM-specific IgE response) when compared with raw extract (47.8%) and rTM (34.8%). Mice sensitized with boiled extract manifested the highest allergen-specific IgE and Th2 cytokine responses than the others. Immunoblot results indicated that tropomyosin remained the major allergen in extract-based sensitization and had stronger allergenicity in a heat-treated form comparing to untreated TM, which was in line with the SPT results that boiled extract induced larger wheal size in patients. Hemocyanin and glycogen phosphorylase were also identified as minor allergens associated with manifestation of shrimp allergy. This study shows that boiled extract enhanced sensitization and Th2 responses in agreement with the higher allergenicity of heat-treated TM. This study thus presents three shrimp allergy murine models suitable for mechanistic and intervention studies, and in vivo evidence implies higher effectiveness of boiled extract for the clinical diagnosis of shellfish allergy.

A detailed intake-status profiling of seafoods in adult food-protein-induced enterocolitis syndrome patients

BACKGROUND

Adults with food-protein-induced enterocolitis syndrome (FPIES) often develop severe abdominal symptoms after eating seafood. However, no investigation of a food elimination strategy for adult FPIES patients has been performed to date.

METHODS

We conducted a retrospective cohort study of seafood-avoidant adults by telephone interview, based on the diagnostic criteria for adult FPIES reported by González et al. We compared the clinical profiles, abdominal symptoms, and causative seafoods between FPIES and immediate-type food allergy (IgE-mediated FA) patients. We also profiled the detailed intake-status of seafoods in adult FPIES patients.

RESULTS

Twenty-two (18.8 %) of 117 adults with seafood-allergy were diagnosed with FPIES. Compared with the IgE-mediated FA patients, FPIES patients had an older age of onset, more pre-existing gastrointestinal and atopic diseases, more episodes, longer latency and duration of symptoms, more nausea, abdominal distention, and severe abdominal pain, and more frequent vomiting and diarrhea. In particular, abdominal distention-reflecting intestinal edema and luminal fluid retention-may be the most distinctive characteristic symptom in adult FPIES (p < 0.001). Bivalves, especially oysters, were the most common cause of FPIES. Strikingly, intake-status profiling revealed that many FPIES patients can safely ingest an average of 92.6 % of seafood species other than the causative species.

CONCLUSIONS

There are many differentiators between FPIES and IgE-mediated FA, which may reflect differences in the underlying immunological mechanisms. Although seafood FPIES is unlikely to induce tolerance, many patients can ingest a wide variety of seafood species after a long period from onset.

Risk Factors for Severe Seafood Allergy Among Adults in an Urban City in Vietnam

Purpose

Increasing seafood consumption is associated with more frequent reports of food allergy. Little is known about seafood allergy (SFA) among adults in Vietnam. We investigated the characteristics of individuals with SFA and the risk factors for severe SFA.

Patients and methods

A cross-sectional, web-based survey was conducted among individuals aged ≥ 18 years from universities in Ho Chi Minh City (Vietnam) between December 2021 and July 2022. The survey was based on a structured, validated questionnaire related to FA. Strict definitions of "convincing allergy" were used. Multivariate analysis was used to estimate the risk factors for severe SFA after adjusting for covariates. Data were analyzed using JASP (v.0.16.3) and SPSS (v.22.0).

Results

Totally, 1038 out of 2137 (48.57%) individuals completed the questionnaire, of whom 285 (27.46%) had reported SFA. Convincing SFA accounted for 20.13% (209/1038) of the cases, with convincing shellfish allergy being more common than fish allergy. Participants with comorbid shellfish and fish allergy had higher prevalence of atopic dermatitis, peanut/nut allergy, other food allergy, and cutaneous and upper airway symptoms compared to participants with shellfish allergy (p < 0.05). The spectrum of reactive seafood was diverse and characterized by local species. The age of symptom onset was most commonly during late childhood and adolescence, with most reactions persisting into adulthood. A history of anaphylaxis, comorbid peanut, and tree nut allergy, and ≥3 allergens were associated with severe SFA.

Conclusion

Features of causative, coexisting seafood allergy, and risk factors for severe SFA were demonstrated, which can provide a reference for future studies.

Prevalence and risk factors of seafood-borne Vibrio vulnificus in Asia: a systematic review with meta-analysis and meta-regression

Vibrio vulnificus is a free-living marine bacterium associated with the contamination of fish and shellfish-the most consumed seafood in Asia. Owing to its potentially lethal clinical consequences, the consumption of seafood contaminated with V. vulnificus has become a growing public health concern. This systematic review with meta-analysis and meta-regression aimed to integrate data on the prevalence of seafood-borne V. vulnificus specifically in Asia and assess the potential risk factors that can influence the outcomes. A comprehensive literature search of four electronic databases yielded 279 relevant studies, among which 38 fulfilled the inclusion criteria. These selected studies were subjected to risk-of-bias assessment and data extraction by three independent researchers. A meta-analysis of the eligible studies estimated the overall prevalence of seafood-borne V. vulnificus in Asia to be 10.47% [95% confidence interval (CI): 6.8-15.8%], with bivalve shellfish, such as oysters, mussels, clams, and cockles being the most contaminated seafood. The highest prevalence was reported in Japan, where 47.6% of the seafood samples tested positive for V. vulnificus. The subgroup and meta-regression analyses identified three potential covariates-detection method, publication year, and country-associated with between-study heterogeneity. Furthermore, data visualization displayed the variations in V. vulnificus prevalence across the studies, associated with differences in sample type, sample size, and sampling stage. This study provides valuable insights into the prevalence of V. vulnificus in fish and shellfish across the entire Asian continent and highlights the potential factors that cause variation in the prevalence rates among the studies. These findings underscore the importance of enhancing hygiene measures throughout the seafood supply chain to mitigate V. vulnificus infection risks and ensure the safety of consumers.

Intervention Efficacy of Slightly Processed Allergen/Meat in Oral Immunotherapy for Seafood Allergy: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis in Mouse Models and Clinical Patients

Background: Seafood allergy is a significant global health concern that greatly impacts a patient's quality of life. The intervention efficacy of oral immunotherapy (OIT), an emerging intervention strategy, for seafood allergy remains controversial. This study aimed to perform a systematic review and meta-analysis to evaluate the efficacy of slightly processed allergen/meat from fish and crustacea in OIT, both in mouse models and clinical patients. Methods: A comprehensive literature search was performed in four mainstream databases and the EBSCOhost database to identify all relevant case-control and cohort studies. The aim was to elucidate the intervention efficacy, encompassing various processing methods and assessing the efficacy of multiple major allergens in OIT. Results: The meta-analysis included five case-control studies on crustacean allergens in mouse models and 11 cohort studies on meat from fish and crustacea in clinical patients for final quantitative assessments. In mouse models, crustacean allergen substantially decreased the anaphylactic score after OIT treatment (mean difference (MD) = -1.30, p < 0.01). Subgroup analyses with low-level heterogeneities provided more reliable results for crab species (MD = -0.63, p < 0.01, I2 = 0), arginine kinase allergen (MD = -0.83, p < 0.01, I2 = 0), and Maillard reaction processing method (MD = -0.65, p < 0.01, I2 = 29%), respectively. In clinical patients, the main meta-analysis showed that the slightly processed meat significantly increased the incidence rate of oral tolerance (OT, incidence rate ratio (IRR) = 2.90, p < 0.01). Subgroup analyses for fish meat (IRR = 2.79, p < 0.01) and a simple cooking treatment (IRR = 2.36, p = 0.01) also demonstrated a substantial increase in the incidence rate of OT. Sensitivity and meta-regression analyses successfully identified specific studies contributing to heterogeneity in mouse models and clinical patients, although these studies did not impact the overall significant pooled effects. Conclusions: This meta-analysis provides preliminary evidence for the high intervention efficacy of slightly processed allergen/meat from fish and crustacea in OIT, both in mouse models and clinical patients. The Maillard reaction and cooking processing methods may emerge as potentially effective approaches to treating allergen/meat in OIT for clinical patients, offering a promising and specific treatment strategy for seafood allergy. However, these findings should be interpreted cautiously, and further supporting evidence is necessary.

Bypassing the build-up phase for oral immunotherapy in shrimp-allergic children

Background

Oral immunotherapy is an effective treatment for food allergies; however, its use in clinical practice is limited by resources and lack of standardized protocols for foods other than peanut. Previous studies have suggested that shrimp has a higher threshold for reaction than other allergenic foods, suggesting it may be safe to directly administer maintenance doses of immunotherapy.

Methods

Children aged 3-17 years who had 1) skin prick test ≥3 mm and/or specific IgE level ≥0.35 kU/L and convincing objective IgE-mediated reaction to shrimp, or 2) no ingestion history and specific IgE level ≥5 kU/L, underwent a low-dose oral food challenge to 300 mg shrimp protein, with the goal of continuing daily ingestion of the 300 mg maintenance dose as oral immunotherapy.

Results

Between January 2020 and April 2023, 17 children completed the low-dose oral food challenge. Nine (53%) tolerated this amount with no reaction, and 8 (47%) had a mild reaction (isolated oral pruritis or redness on chin). Sixteen (94%) continued maintenance low-dose oral immunotherapy eating 300 mg shrimp protein daily. None of the patients developed anaphylaxis related to the immunotherapy.

Conclusion

Our case series suggests that some shrimp allergic patients being considered for oral immunotherapy should be offered a low-dose oral food challenge, to potentially bypass the build-up phase of immunotherapy.

Allergen Diversity and Abundance in Different Tissues of the Redclaw Crayfish (Cherax quadricarinatus)

Shellfish allergy affects ~2.5% of the global population and is a type I immune response resulting from exposure to crustacean and/or molluscan proteins. The Australian Redclaw crayfish (Cherax quadricarinatus) is a freshwater species endemic to and farmed in northern Australia and is becoming an aquaculture species of interest globally. Despite being consumed as food, allergenic proteins from redclaw have not been identified or characterised. In addition, as different body parts are often consumed, it is conceivable that redclaw tissues vary in allergenicity depending on tissue type and function. To better understand food-derived allergenicity, this study characterised allergenic proteins in various redclaw body tissues (the tail, claw, and cephalothorax) and how the stability of allergenic proteins was affected through cooking (raw vs. cooked tissues). The potential of redclaw allergens to cross-react and cause IgE-binding in patients allergic to other shellfish (i.e., shrimp) was also investigated. Raw and cooked extracts were prepared from each body part. SDS-PAGE followed by immunoblotting was performed to determine allergen-specific antibody reactivity to sarcoplasmic calcium-binding protein and hemocyanin, as well as to identify redclaw proteins binding to IgE antibodies from individual and pooled sera of shrimp-allergic patients. Liquid chromatography-mass spectrometry (LC/MS) was utilised to identify proteins and to determine the proportion within extracts. Known crustacean allergens were found in all tissues, with a variation in tissue distribution (e.g., higher levels of hemocyanin in the claw and cephalothorax than in the tail). The proportion of some allergens as a percentage of remaining heat-stable proteins increased in cooked tissues. Previously described heat-stable allergens (i.e., hemocyanin and sarcoplasmic calcium-binding protein) were found to be partially heat-labile. Immunoblotting indicated that shrimp-allergic patients cross-react to redclaw allergens. IgE-binding bands, analysed by LC/MS, identified up to 11 known shellfish allergens. The findings of this study provide fundamental knowledge into the diagnostic and therapeutic field of shellfish allergy.

A Positive Causal Effect of Shrimp Allergy on Major Depressive Disorder Mediated by Allergy- and Immune-Related Pathways in the East Asian Population

BACKGROUND

Observational studies have implied a potential correlation between allergic diseases and major depressive disorder (MDD). However, the relationship is still inconclusive as it is likely to be interfered with by substantial confounding factors and potential reverse causality. The present study aimed to investigate causal correlation of the two diseases by a Mendelian randomization (MR) study and further elucidate the underlying molecular mechanisms.

METHODS

With the biggest summary datasets of a genome-wide association study (GWAS) in the East Asian population, we conducted a two-sample, bidirectional MR study to assess the causal correlation between shrimp allergy (SA) and MDD. Subsequently, we identified the pleiotropic genes' susceptibility to the two diseases at whole-genome and tissue-specific levels, respectively. Enriched GO sets and KEGG pathways were also discovered to elucidate the potential underlying mechanisms.

RESULTS

With the most suitable MR method, SA was identified as a causal risk factor for MDD based on three different groups of independent genetic instruments, respectively (p < 2.81 × 10-2). In contrast, we did not observe a significant causal effect of MDD on SA. The GWAS-pairwise program successfully identified seven pleiotropic genetic variants (PPA3 > 0.8), indicating that the two diseases indeed have a shared genetic basis. At a whole-genome level, the MAGMA program identified 44 pleiotropic genes, which were enriched in allergy-related pathways, such as antigen processing and presentation pathway (p = 1.46 × 10-2). In brain-specific tissue, the S-MultiXcan program found 17 pleiotropic genes that were significantly enriched in immune-related pathways and GO sets, including asthma-related pathway, T-cell activation-related, and major histocompatibility complex protein-related GO sets. Regarding whole-blood tissue, the program identified six pleiotropic genes that are significantly enriched in tolerance induction-related GO sets.

CONCLUSIONS

The present study for the first time indicated a significant causal effect of SA on the occurrence of MDD, but the reverse was not true. Enrichment analyses of pleiotropic genes at whole-genome and tissue-specific levels implied the involvement of allergy and immune-related pathways in the shared genetic mechanism of the two diseases. Elucidating the causal effect and the acting direction may be beneficial in reducing the incidence rate of MDD for the massive group of SA patients in the East Asian region.

Food allergy knowledge, attitude and management among preschool personnel in Malaysia

BACKGROUND

Children are vulnerable, and they may experience their first serious food allergy reaction at school, where they spend much of their time. The present study aims to determine the level of food allergy knowledge, attitude and management (KAM) among preschool personnel in Klang Valley, Malaysia.

METHODS

A cross-sectional study was conducted with 292 personnel working in Klang Valley preschools. The participants completed an online questionnaire asking about sociodemographic information and food allergy KAM. Mann-Whitney U and chi-squared tests were used to compare the KAM level between public and private preschool personnel and examine the association of KAM of food allergy with various sociodemographic factors, respectively.

RESULTS

Some 86.3% of the participants demonstrated a low level of food allergy knowledge, 64.7% showed a negative food allergy attitude and 57.9% indicated fair food allergy management. The total mean score for food allergy knowledge was higher (p < 0.01) among the private preschool personnel compared to the public group, although there was no significant difference in attitude (p = 0.244) or practice (p = 0.171). Age group (p < 0.01) and monthly income (p < 0.05) were significantly associated with the level of attitude, whereas no sociodemographic factor was associated with knowledge and management of food allergy.

CONCLUSIONS

Most preschool personnel in Klang Valley have a low level of food allergy knowledge, negative attitudes and a fair level of ability to manage food allergy reactions. The findings of the present study may guide future studies to improve the food allergy KAM of preschool personnel and provide a safer environment for children with food allergies.

IgE-Mediated Shellfish Allergy in Children

Shellfish, including various species of mollusks (e.g., mussels, clams, and oysters) and crustaceans (e.g., shrimp, prawn, lobster, and crab), have been a keystone of healthy dietary recommendations due to their valuable protein content. In parallel with their consumption, allergic reactions related to shellfish may be increasing. Adverse reactions to shellfish are classified into different groups: (1) Immunological reactions, including IgE and non-IgE allergic reactions; (2) non-immunological reactions, including toxic reactions and food intolerance. The IgE-mediated reactions occur within about two hours after ingestion of the shellfish and range from urticaria, angioedema, nausea, and vomiting to respiratory signs and symptoms such as bronchospasm, laryngeal oedema, and anaphylaxis. The most common allergenic proteins involved in IgE-mediated allergic reactions to shellfish include tropomyosin, arginine kinase, myosin light chain, sarcoplasmic calcium-binding protein, troponin c, and triosephosphate isomerase. Over the past decades, the knowledge gained on the identification of the molecular features of different shellfish allergens improved the diagnosis and the potential design of allergen immunotherapy for shellfish allergy. Unfortunately, immunotherapeutic studies and some diagnostic tools are still restricted in a research context and need to be validated before being implemented into clinical practice. However, they seem promising for improving management strategies for shellfish allergy. In this review, epidemiology, pathogenesis, clinical features, diagnosis, and management of shellfish allergies in children are presented. The cross-reactivity among different forms of shellfish and immunotherapeutic approaches, including unmodified allergens, hypoallergens, peptide-based, and DNA-based vaccines, are also addressed.

Development of gastro-food allergy model in shrimp allergen extract-induced sensitized mice promotes mast cell degranulation

Background: Food allergies have become more common in the last decade. Shrimp is one of the most dominant food allergy triggers in Asian countries, including Indonesia. After ingesting allergens, B cells will produce allergen-specific Immunoglobin E (IgE). In the sensitization period, repeated allergen exposure promotes Mast Cell (MC) degranulation in intestinal tissue and releases several inflammatory mediators, thereby causing hypersensitivity reactions. Shrimp Allergen Extract (SAE) is an immunotherapy and diagnostic agent currently being developed in Indonesia. In this study, we investigated the effect of SAE administration on eliciting an MC immunological response. Methods: Mice were divided into a non-sensitized and sensitized group. The non-sensitized group only received 1 mg of alum (i.p), whereas the sensitized group received 1 mg of alum and 100 μg of SAE on days 0, 7, and 14. Then, both groups were challenged with 400 μg SAE (p.o) on days 21, 22, and 23 following systemic allergic symptom observation. Results: We showed that SAE was able to increase systemic allergic symptoms significantly in the sensitized mice through repeated challenge (1.33±0.21; 1.83±0.17; and 2.00±0.00), compared to non-sensitized mice (0.17±0.17). Moreover, histopathological analysis showed that the SAE administration causes an increase of MC degranulation in the ileum tissue of the sensitized mice (44.43%±0.01), compared to non-sensitized mice (35.45%±0.01) Conclusions: This study found that SAE could induce allergic reactions in mice by influencing critical effector cells, MCs.

EAACI Molecular Allergology User's Guide 2.0

Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE-mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE-mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well-defined, highly pure molecules for component-resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.

Varying Approaches to Management of IgE-Mediated Food Allergy in Children Around the World

Food allergy is a chronic disease that affects individuals of all ages and is a significant public health problem globally. This narrative overview examines clinical management strategies for IgE-mediated food allergy in children around the world to understand variations in practice. Information was drawn from clinical practice guidelines, recent research, the websites of professional and governmental bodies with expertise in food allergy, and clinical experts from a broad cross-section of geographical regions. The structure and delivery of clinical services, allergen avoidance and food labeling, and resources to support the management of allergic reactions in the community are discussed in detail. The adoption of emerging food immunotherapies is also explored. Wide variations in clinical management of food allergy were apparent across the different countries. Common themes were continuing issues with access to specialist care and recognition of the need to balance risk reduction with dietary and social restrictions to avoid unnecessary detrimental impacts on the quality of life of food allergy sufferers. Findings highlight the need for standardized presentation of practice and priorities, and may assist clinicians and researchers when engaging with government and funding agencies to address gaps.

Validation of the food allergy quality of life questionnaire series in Chinese families with food-allergic children

BACKGROUND

Anxiety from accidental exposure and vigilant dietary monitoring impair the quality of life (QoL) of food-allergic patients. A comprehensive food allergy-specific questionnaire allows patients to accurately report their QoL. This study validated the Food Allergy Quality of Life Questionnaire (FAQLQ) series and assessed the QoL of Chinese food-allergic patients and their caregivers.

METHODS

FAQLQ series developed by EuroPrevall consists of four separate questionnaires for parents, children, adolescents and adults. All questionnaires were translated into traditional Chinese by standard forward and backward methods. A cross-sectional study was conducted on food-allergic patients and children's parents using an age-appropriate questionnaire. The performance indices of FAQLQ and their correlation with independent measures of food allergy were analyzed, and factor analysis was performed to confirm the factor structure of FAQLQ questionnaires.

RESULTS

Cross-sectional validation was performed on 214 participants, with 40 reassessed for test-retest reliability. Overall scores for the FAQLQ series had good internal consistency with Cronbach's α ≥.90. Good construct validity was demonstrated by correlations between FAQLQ-Parent Form, FAQLQ-Child Form, FAQLQ-Teenager Form, FAQLQ-Adult Form and Food Allergy Independent Measure (FAIM) scores, except in 0- to 3-year-old children. Test-retest analyses revealed a significant correlation between total FAQLQ score, parent-reported FAIM and food anxiety domain in 4-6 years, and between total score and FAIM in 7-12 years. Exploratory factor analysis categorized items in the FAQLQ series into three to four domains.

CONCLUSION

FAQLQ series provide a valid and reliable measure for QoL in Chinese food-allergic patients and caregivers, except for parents of children aged 0-3 years. Items for all FAQLQ questionnaires are categorized into different functional domains in our population.

Immunological Cross-Reactivity Involving Mollusc Species and Mite-Mollusc and Cross-Reactive Allergen PM Are Risk Factors of Mollusc Allergy

Marine molluscs are seafood consumed worldwide and could cause food allergies, while investigation on their sensitizing components and cross-reactivity seems to be rare. Furthermore, allergy to mites may result in anaphylaxis in mollusc-allergic individuals owing to their cross-reactivity. The aim of the study was to identify cross-reactive allergens and investigate the cross-reactivity between different mollusc groups and mite-mollusc. The extracted mollusc and dust mite proteins were separated by SDS-PAGE, and IgE-binding components were recognized by immunoblotting with sera from patients sensitized to mollusc and mite. Cross-reactivity of different mollusc groups and mite-mollusc was assessed using ELISA and inhibition ELISA. The results of the immune detection, ELISA, and inhibition ELISA indicated that different mollusc groups and mite-mollusc showed varying degrees of cross-reactivity. The most frequently recognized cross-reactive protein was paramyosin from different mollusc groups and dust mite, while cross-reactive allergen paramyosin in the mite extract was identified and evaluated by MS and Allermatch, respectively. Inhibition ELISA studies also revealed that paramyosin played an important role in molluscan and mite-molluscan cross-reactivity. These findings contribute to a better understanding of the cross-reactivity involving mollusc species and mite-mollusc, which can be used to assist in the diagnosis and treatment of mite- and mollusc-allergic disorders.