As a selected group of children with uncomplicated GERD or EoE were without nutritional deficiencies but had maladaptive feeding, providing anticipatory guidance to minimize mealtime challenges, monitoring for improvement, or referring to a feeding therapist, may be beneficial. A trial of food allergen restriction may provide additional benefit for those with EoE.

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RATIONALE: Shellfish and house dust mite (HDM) allergies are common in North America. Often, both allergies are seen in the same patient. It is hypothesized that the homology of tropomyosin or other potentially shared proteins is the main factor for this co-existence. We discuss the findings of a patient population that presents with shellfish allergy and are assessed for HDM allergy. METHODS: We undertook a retrospective chart review of 27 new consult patients, aged 9 to 50, who were referred for possible shellfish allergy. Our primary endpoint was to assess for presence of HDM sensitization in this population using skin prick test results. RESULTS: Of the 27 patients, 18 skin tested positive for lobster, shrimp and crab; 4 for lobster and shrimp, but not crab; 3 for shrimp and crab, but not lobster; and 2 for lobster alone. 24 of 27 patients (89%) were found to be skin test sensitive for HDM. The 3 not allergic to HDM included a 16 and a 13 year old male allergic to lobster, shrimp and crab; while the third was a 19 year old female allergic to shrimp and crab. We did not see any correlation between shellfish and HDM skin test size. CONCLUSIONS: In our patient population, 24 of 27 shellfish allergic patients were sensitized to HDM. Patients being evaluated for shellfish allergy should be assessed for potential HDM allergy. HDM immunotherapy need be applied cautiously, limiting crustacean exposure, to reduce risk of inducing clinically significant allergic reactions while treating patients.