Although rare, Vibrio vulnificus is the leading cause death related to seafood consumption in the United States. In addition to the above specific five types of shellfish toxicity, the differential diagnosis should include bacterial toxins, viral and bacterial infections. Exposure to such toxins in individuals with underlying asthma or chronic obstructive pulmonary disease can lead to shortness of breath, non productive cough and wheezing.Īdverse reactions to shellfish from bacterial and viral etiologies These irritant toxin aerosols can cause conjunctival irritation, sneezing and rhinorrhea that resemble an allergic response. Unlike other shellfish toxins, the brevetoxins can aerosolize by surf and wave action along the beach during red tides. Brevis blooms are also known as "red tides" because of the red coloration of seawater. In the United States, the illness is generally associated with the consumption of shellfish harvested along the coast of Gulf of Mexico from Florida to Texas and sporadically along the southern Atlantic coast. Karenia brevis is the dinoflagellate that synthesizes brevetoxins, a group of related heat-stable toxins that are responsible for the clinical manifestations of neurotoxic shellfish poisoning. Muscular aches, dizziness, reversal of hot and cold temperature sensation occur along with nausea, vomiting, abdominal pain and diarrhea. Symptoms include numbness of lips, tongue and throat which then spread to other parts of the body. The onset occurs within 3 hours of ingestion of shellfish contaminated with brevetoxins. It resembles a mild case of paralytic shellfish poisoning but without paralysis. Neurotoxic shellfish poisoning is characterized by both gastrointestinal and neurologic symptoms. Another study however, revealed that children with shrimp allergy have higher specific IgE antibody levels, show more intense binding to shrimp peptides, and a greater epitope diversity than in adults, suggesting that sensitization to shrimp might decrease by age. In a study of 11 subjects with shrimp hypersensitivity, shrimp-specific IgE levels in all subjects were relatively constant during the 24 months of the study and were not affected by shrimp challenge. Only a few studies evaluated the natural history of shellfish allergy, and they seem to indicate that it is long-lasting. Specific shellfish allergy can reflect regional consumption of that particular species. In a study of children residing in Singapore, the prevalence of shellfish allergy was more common in native children (4-6 years, 1.19% 14-16 years, 5.23%) compared to expatriate children (4-6 years, 0.55% 14-16 years, 0.96%). The prevalence of shellfish allergy in Asian countries is higher than in western countries, and this might reflect the geographic consumption of shellfish. In a decreasing frequency, the causative types of shellfish were shrimp, crab, lobster, clam, oyster and mussel. Shellfish allergy was much lower in children than in adults (0.5 vs 2.5%). In the United States, a telephone survey of 14,948 individuals revealed that 2-3% believed to have seafood allergy: 2.2% to shellfish and 0.6% to fish.
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In an international survey using a questionnaire administered to 17,280 adults (aged 20-44 years) from 15 countries, symptoms related to seafood were reported to be caused by shrimp in 2.3%, oyster in 2.3%, and fish in 2.2%. Shellfish is one of the leading causes of food allergy in adults and is a common cause of food-induced anaphylaxis.
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Specific immunotherapy is not currently available and requires the development of safe and effective protocols. Management of shellfish allergy is basically strict elimination, which in highly allergic subjects may include avoidance of touching or smelling and the availability of self-administered epinephrine.
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The diagnosis requires a thorough medical history supported by skin testing or measurement of specific IgE level, and confirmed by appropriate oral challenge testing unless the reaction was life-threatening. Newly described allergens and subtle differences in the structures of tropomyosin between different species of shellfish could account for the discrepancy between in vitro cross-antigenicity and clinical cross-allergenicity. Tropomyosin is the major allergen and is responsible for cross-reactivity between members of the shellfish family, particularly among the crustacea. The manifestations of shellfish allergy vary widely, but it tends to be more severe than most other food allergens. The approximate prevalence of shellfish allergy is estimated at 0.5-2.5% of the general population, depending on degree of consumption by age and geographic regions.
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The popularity of shellfish has been increasing worldwide, with a consequent increase in adverse reactions that can be allergic or toxic.