Mite-Induced Asthma and IgE Levels to Shrimp, Mite, Tropomyosin, Arginine Kinase, and Der p 10 Are the Most Relevant Risk Factors for Challenge-Proven Shrimp Allergy

Abstract

Background: Shrimp sensitization is common in the general population, but the presence of symptoms is only moderately related to sensitization. A point still at issue is which in vivo and/or in vitro tests (food challenge, component-resolved diagnosis, house dust mite [HDM] sensitization) can help in distinguishing shrimp-allergic subjects from subjects that are sensitized but tolerant. Methods: The aim of this study was to evaluate the role of IgE to the different shrimp and mite allergens in distinguishing shrimp challenge-positive from challenge-negative patients. Subjects with suspected hypersensitivity reactions to shrimp, positive skin prick tests (SPTs), and/or anti-shrimp IgE were submitted to open and double-blind placebo-controlled food challenges (DBPCFC). Specific IgE to shrimp, mites, and the recombinants rPen a 1, rDer p 1, 2, and 10 were tested using ImmunoCAP-FEIA. IgE immunoblotting was performed to identify the patients' allergenic profiles. Results: In total, 13 out of 51 (25.5%) patients with reported reactions to shrimp were truly shrimpallergic (7 DBPCFC positive and 6 with documented severe reactions). These patients had significantly higher skin test wheal diametersthan nonallergic patients,as well as higher levels of IgE to rPen a 1 and rDer p 10. HDM-induced asthma and thesimultaneous presence of anti-nDer p 1, 2, and 10 IgE levels increased the risk of true shrimp allergy. Conclusion: Food challenge tests are mandatory for the diagnosis of shrimp allergy. Tropomyosin is associated with clinical reactivity. HDM-induced asthma and anti-mite IgE are risk factors for shrimp allergy.

A WAO — ARIA — GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020

“…Furthermore, diagnosed asthma to HDM and IgE to nDer p 1, 2, and 10 predicted a higher risk for clinically relevant shrimp allergy. 131 Tropical climates, although scarcely studied, are a suitable environment for the development of mite sensitization; indeed, mites are the most prevalent allergen source in the tropics, followed by pets and cockroaches, 132 whereas pollen and molds are less relevant than in North America and Europe. In tropical places where helminth infections are prevalent, cross-reactivity between mites and tropomyosins from the nematode Ascaris lumbricoides are associated with asthma symptoms.…”

“…The control subjects only showed positive challenges with arginine kinase and hemocyanin. IgE to HDM Der p 10 is associated with clinically relevant cross-reactive syndromes to shrimp, 130,131 as discussed in more detail in the Mite section below. However, high shrimp-sIgE levels and high IgE to Der p 10 were revealed as specific risk markers for genuine shrimp allergy that is independent of HDM sensitization.…”

Relación entre la sensibilización a camarón y ácaros. Exploración de la reactividad cruzada por tropomiosina

“…Se ha documentado que la sensibilización a los ácaros es un factor de riesgo para alergia a camarón, 38 sin embargo, poco se sabe de la relevancia clínica de la sensibilización a camarón en pacientes con alergias respiratorias a los ácaros. En este estudio encontramos que ocho pacientes (25 %) presentaron síntomas, ya sea por historia previa altamente sugestiva de reacción o prueba de provocación positiva, de los cuales 50 % padecía asma versus solo 33.33 % de pacientes con asma entre los individuos sensibilizados sin relevancia clínica, lo que parece indicar que la relevancia clínica de la sensibilización está fuertemente relacionada con la presencia de asma.…”

Recent Advances in Clinical Allergy and Immunology

“…The characterization of Dutch patients with sesame allergy revealed a 14-kDa protein identified as oleosin (Ses i 4 and/or Ses i 5) as the major allergen and, furthermore, the possibility of a cross-reactivity of sesame with various tree nuts [48]. Indicators for a shrimp allergy are high levels of IgE to rPen a 1 and rDer p 10; the presence of a house dust mite-induced asthma and simultaneous IgE to Der p 1, 2, and 10 might help to distinguish between subjects with shrimp allergy and those that are sensitized but tolerant [51]. …”