🕷️ Crawler Inspector

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Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 152 (from laksa021)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa152.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://en.wikipedia.org/wiki/Shellfish_allergy\')), getAhrefsUnparsedNoserviceFromURL(\'https://en.wikipedia.org/wiki/Shellfish_allergy\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy","crawl_time":1751546517,"first_indexed_time":1441761120,"http_code":200,"src_unparsed":"org,wikipedia!en,\/wiki\/Shellfish_allergy s443","src_root_hash":"17790707453426894952","history_drop_reason":null,"meta_title":"Shellfish allergy - Wikipedia","meta_descriptions":[],"attrs_boilerpipe_text":"Type of food allergy caused by shellfish Shellfish allergy  is among the most common  food allergies . \" Shellfish \" is a colloquial and  fisheries  term for  aquatic invertebrates  used as  food , including various species of  molluscs  such as  clams ,  mussels ,  oysters  and  scallops ,  crustaceans  such as  shrimp ,  lobsters  and  crabs , and  cephalopods  such as  squid  and  octopus . However, scientifically these groups are in completely different Phyla and some in different Classes. Clams, mussels, oysters, and scallops are in the Phylum Mollusca and Class Bivalvia, squid and octopus are in the Class Cephalopoda. Crustaceans are in the Phylum Arthropoda and Class Crustacea.  Their chemistry is different and to understand the underlying mechanisms of various allergies to these animals requires an understanding of the diversity of the different proteins found and a knowledge of their proper scientific name and classification. Shellfish allergy is an  immune hypersensitivity  to  proteins  found in shellfish. Symptoms can be either rapid or gradual in onset. The latter can take hours to days to appear. The former may include  anaphylaxis , a potentially life-threatening condition which requires treatment with  epinephrine . Other presentations may include  atopic dermatitis  or  inflammation of the esophagus . [ 2 ]  Shellfish is one of the eight common food allergens, responsible for 90% of allergic reactions to foods:  cow's milk ,  eggs ,  wheat ,  shellfish ,  peanuts ,  tree nuts , fish, and  soy beans . [ 3 ] [ 4 ] Unlike early childhood allergic reactions to milk and eggs, which often lessen as the children age, [ 5 ]  shellfish allergy tends to first appear in school-age children and older, and persist in adulthood. [ 6 ]  Strong predictors for adult-persistence are anaphylaxis, high shellfish-specific serum  immunoglobulin E  (IgE) and robust response to the skin prick test. Adult onset of shellfish allergy is common in workers in the shellfish catching and processing industry. [ 7 ] [ 8 ] Signs and symptoms of anaphylaxis Food allergy symptoms usually occur within minutes after exposure but can be delayed to hours depending on the nature of the immune system response. [ 9 ]  Symptoms may include rash,  hives , itching of mouth, lips, tongue, throat, eyes, skin, or other areas, swelling of lips, tongue, eyelids, or the whole face, difficulty swallowing, runny or congested nose, hoarse voice, wheezing, shortness of breath, diarrhea, abdominal pain, lightheadedness, fainting, nausea, or vomiting. [ 9 ]  Symptoms of allergies vary from person to person and may vary from incident to incident. [ 9 ]  Serious danger regarding allergies can begin when the respiratory tract or blood circulation is affected. The former can be indicated by wheezing, a blocked airway and  cyanosis , and the latter by weak pulse, pale skin, and fainting. When these symptoms occur the allergic reaction is called  anaphylaxis . [ 9 ]  Anaphylaxis occurs when  IgE antibodies  are involved, [ 10 ]  and areas of the body that are not in direct contact with the food become affected and show severe symptoms. [ 9 ] [ 11 ]  Untreated, this can proceed to  vasodilation , a low blood pressure situation called  anaphylactic shock . [ 11 ] The cause is typically the eating of shellfish or foods that contain shellfish. The shellfish types causing clinical allergy are, in decreasing incidence: \n Shrimp Crab Lobster Clam Oyster Mussel. [ 12 ] Once an allergic reaction has occurred it usually remains a lifelong sensitivity. [ 13 ]  The immune system overreacts to proteins found in shellfish, most commonly to  tropomyosin , but often to other proteins, such as  arginine kinase ,  myosin light chain  and sarcoplasmic calcium-binding protein. [ 14 ] [ 15 ] [ 16 ]  The allergic reaction to fish is to a different protein,  parvalbumin ; there is no cross-reactivity between fish and shellfish allergy. [ 6 ] [ 17 ] [ 18 ] Cross-contact, also referred to as cross-contamination, occurs when foods are being processed in factories or at food markets, or are being prepared for cooking in restaurants and home kitchens. The allergenic proteins are transferred from one food to another. [ 19 ] The food-borne parasite  Anisakis  is a genus of  nematodes  known to be present in  squid . [ 20 ] Anisakis  are directly infective to humans whenever infected squid (or marine fish) are consumed raw or slightly processed, causing a condition called  anisakiasis . Symptoms from consuming live nematodes include severe abdominal pain,  nausea , and vomiting. [ 21 ]  In addition, there can be an allergic reaction to  Anisakis  proteins, even if the food in question was frozen or cooked before being consumed, killing the nematodes, as some of the nematode proteins are resistant to cold and heat. [ 20 ]  Allergic reactions can include hives, asthma and true anaphylactic reactions. [ 13 ] [ 22 ] Occupational exposure [ edit ] An industry review conducted in 1990 estimated that 28.5 million people worldwide were engaged in some aspect of the seafood industry: fishing, aquaculture, processing and industrial cooking. [ 23 ]  Men predominate in fishing, women in processing facilities. [ 7 ]  Exposure to shellfish allergenic proteins includes inhalation of wet  aerosols  from fresh shellfish handling, and dermal contact through skin breaks and cuts. [ 7 ] [ 8 ]  Prevalence of seafood-induced adult asthma is reported as in the range of 7% to 36% (higher for  crustaceans  and lower for bony fish). [ 8 ]  Prevalence of skin allergy reactions, often characterized by itchy rash (hives), range from 3% to 11%. [ 8 ]  The shellfish-induced health outcomes are mainly due to the protein  tropomyosin  causing an IgE mediated immune system response. [ 7 ] [ 8 ] Cross-reactivity to non-shellfish [ edit ] Tropomyosin , the major allergen in shellfish allergy, is also found in  dust mites  and  cockroaches . [ 15 ] [ 16 ]  Exposure to inhaled tropomyosins from dust mites is thought to be the primary sensitizer for shellfish allergy, an example of inhalant-to-food cross-reactivity. [ 24 ]  Epidemiological surveys have confirmed correlation between shellfish and dust mite sensitizations. [ 25 ]  An additional confirmation was seen in Orthodox Jews with no history of shellfish consumption, in that skin tests confirming  dust mite allergy  were also positive for shellfish tropomyosin. [ 15 ] [ 25 ]  In addition to tropomyosin, arginine kinase and  hemocyanin  seem to have a role in cross-reactivity to dust mites. [ 14 ] Exercise as contributing factor [ edit ] Exercise can be a contributing factor to an allergic food response. There is a condition called food-dependent, exercise-induced anaphylaxis. [ 26 ] [ 27 ]  For people with this condition, exercise alone is not sufficient, nor is consumption of a food to which they are mildly allergic, but when the food in question is consumed within a few hours before high-intensity exercise, the result can be anaphylaxis. Shellfish are specifically mentioned as a causative food. [ 26 ] [ 27 ] [ 28 ]  One theory is that exercise is stimulating the release of mediators such as histamine from IgE-activated mast cells. [ 28 ]  Two of the reviews postulate that exercise is not essential for the development of symptoms, but rather that it is one of several augmentation factors, citing evidence that the culprit food in combination with alcohol or aspirin will result in a respiratory anaphylactic reaction. [ 26 ] [ 28 ] Conditions caused by food allergies are classified into three groups according to the mechanism of the allergic response: [ 4 ] IgE-mediated (classic) – the most common type, manifesting acute changes that occur shortly after eating, and may progress to  anaphylaxis Non-IgE mediated – characterized by an immune response not involving  immunoglobulin E ; may occur hours to days after eating, complicating diagnosis IgE and non-IgE-mediated – a hybrid of the above two types Allergic reactions  are hyperactive responses of the immune system to generally innocuous substances, such as food proteins. [ 29 ]  Why some proteins trigger allergic reactions while others do not is not entirely clear. One theory holds that proteins which resist digestion in the stomach, therefore reaching the small intestine relatively intact, are more likely to be allergenic, but studies have shown that digestion may abolish, decrease, have no effect, or even increase the allergenicity of food allergens. [ 30 ]  The heat of cooking structurally degrades protein molecules, potentially making them less allergenic. [ 31 ] [ 32 ] The  pathophysiology  of allergic responses can be divided into two time periods: The first is an  acute response  that occurs within minutes after exposure to an allergen. [ 33 ]  This phase can either subside or progress into a \"late-phase reaction\" which can substantially prolong the symptoms of a response, and result in more tissue damage hours later. [ 34 ]  In the early stages of acute allergic reaction,  lymphocytes  previously sensitized to a specific protein or protein fraction react by quickly producing a particular type of antibody known as secreted IgE (sIgE), which circulates in the blood and binds to IgE-specific receptors on the surface of other kinds of immune cells called  mast cells  and  basophils . Both of these are involved in the acute inflammatory response. [ 33 ]  Activated mast cells and basophils undergo a process called  degranulation , during which they release  histamine  and other inflammatory chemical mediators called ( cytokines ,  interleukins ,  leukotrienes , and  prostaglandins ) into the surrounding tissue causing several systemic effects, such as vasodilation,  mucous  secretion,  nerve  stimulation, and  smooth-muscle  contraction. [ 33 ]  This results in  runny nose , itchiness,  shortness of breath , and potentially  anaphylaxis . [ 33 ]  Depending on the individual, the allergen, and the mode of introduction, the symptoms can be system-wide (classical anaphylaxis), or localized to particular body systems;  asthma  is localized to the respiratory system while hives and eczema are localized to the skin. [ 33 ]  In addition to reacting to oral consumption, skin and asthma reactions can be triggered by inhallation or contact if there are skin abrasions or cuts. [ 7 ] [ 8 ] Hives allergic reaction on arm After the chemical mediators of the acute response subside, late-phase responses can often occur due to the migration of other  white blood cells  such as  neutrophils ,  lymphocytes ,  eosinophils , and  macrophages  to the initial reaction sites. This is usually seen 2–24 hours after the original reaction. [ 34 ]  Cytokines from mast cells may also play a role in the persistence of long-term effects. Late-phase responses seen in asthma are slightly different from those seen in other allergic responses, although they are still caused by release of mediators from eosinophils. [ 35 ] In addition to IgE-mediated responses, shellfish allergy can manifest as  atopic dermatitis , especially in infants and young children. [ 36 ]  Some will display both, so that a child could react to an oral food challenge with allergic symptoms, followed a day or two later with a flare up of atopic dermatitis and\/or gastrointestinal symptoms, including allergic  eosinophilic esophagitis . [ 37 ] Shellfish allergenic proteins [ edit ] Several proteins from shellfish are either clearly involved in allergenic reactions or suspected to be. Tropomyosin, arginine kinase, myosin light chain and sarcoplasmic calcium-binding protein are widely present across shellfish species. [ 14 ] [ 15 ] [ 16 ] [ 38 ] Troponin ,  actin ,  triosephosphate isomerase  and  hemocyanin  are also identified as allergenic proteins. [ 1 ] [ 15 ]  As of a 2016 review, only three (tropomyosin, arginine kinase and sarcoplasmic calcium-binding protein) were available for routine diagnostic skin testing. [ 15 ]  Shellfish do not manifest the proteins β-parvalbumin (found in bony fishes) or α-parvalbumin (found in cartilaginous fishes such as sharks and rays), so there is not cross-reactivity of shellfish allergy to fish allergy. [ 6 ] [ 17 ] [ 18 ] Diagnosis of shellfish allergy is based on the person's history of allergic reactions,  skin prick test  and measurement of shellfish-specific serum  immunoglobulin E  (IgE or sIgE). Confirmation is by double-blind, placebo-controlled food challenges. [ 17 ]  Self-reported shellfish allergy often fails to be confirmed by food challenge. [ 39 ] Reviews of food allergens in general stated that introducing solid foods at 4–6 months may result in the lowest subsequent allergy risks for eczema, allergic rhinitis and more severe reactions. [ 40 ]  The evidence is best for peanuts, eggs and milk. [ 41 ]  The literature is sparse for consequences of early introduction of shellfish. [ 41 ] Epinephrine autoinjectors are portable single-dose epinephrine-dispensing devices used to treat anaphylaxis. Treatment for accidental ingestion of shellfish products by allergic individuals varies depending on the sensitivity of the person. An  antihistamine  such as  diphenhydramine  may be prescribed. Sometimes  prednisone  will be prescribed to prevent a possible late phase  Type I hypersensitivity  reaction. [ 42 ]  Severe allergic reactions (anaphalaxis) may require treatment with an  epinephrine pen , which is an injection device designed to be used by a non-healthcare professional when emergency treatment is warranted. [ 43 ]  Unlike for egg allergy, for which there is active research on trying  oral immunotherapy  (OIT) to desensitize people to egg allergens, [ 44 ]  reviews mention that there are no published clinical trials evaluating oral immunotherapy for shellfish allergy. [ 6 ] [ 12 ] Unlike milk and egg allergies, [ 5 ] [ 45 ]  shellfish allergy usually persists into adulthood. [ 12 ] [ 13 ] Incidence and prevalence are terms commonly used in describing disease  epidemiology . Incidence is newly diagnosed cases, which can be expressed as new cases per year per million people. Prevalence is the number of cases alive, expressible as existing cases per million people during a period of time. [ 46 ]  Worldwide, the prevalence of shellfish allergy is increasing because shellfish consumption is increasing, [ 47 ]  and among adults shellfish is the most common anaphylaxis-eliciting food. [ 12 ]  Reviews cite self-reported shellfish allergy in range of 0.5 to 2.5 percent in the general population. [ 1 ] [ 39 ] [ 48 ]  Prevalence is higher in coastal southeast Asian countries, where shellfish consumption is more common. [ 1 ] [ 12 ] [ 49 ] [ 50 ]  Self-reported allergy prevalence is always higher than food-challenge confirmed allergy, which one review put at 0% to 0.9% (the higher value in southeast Asia). [ 51 ] Whether food allergy prevalence is increasing or not, food allergy awareness has increased, with impacts on the quality of life for children, their parents and their immediate caregivers. [ 52 ] [ 53 ] [ 54 ] [ 55 ]  In the United States, the  Food Allergen Labeling and Consumer Protection Act  (FALCPA), made law in August 2004, effective January 1, 2006, [ 56 ]  causes people to be reminded of allergy problems every time they handle a food package. Although not regulated under FALCPA, restaurants have added allergen warnings to menus. The  Culinary Institute of America , a premier school for chef training, has courses in allergen-free cooking and a separate teaching kitchen. [ 57 ]  School systems have protocols about what foods can be brought into the school. Despite all these precautions, people with serious allergies are aware that accidental exposure can easily occur at other peoples' houses, at school or in restaurants. [ 58 ] Regulation of labeling [ edit ] An example of \"MAY CONTAIN TRACES OF...\" as a means of listing trace amounts of allergens in a food product due to cross-contamination during manufacture. In response to the risk that certain foods pose to those with food allergies, some countries have responded by instituting labeling laws that require food products to clearly inform consumers if their products contain major allergens or byproducts of major allergens among the ingredients intentionally added to foods. Laws and regulations passed in the US and by the European Union recommend labeling but do not require mandatory declaration of the presence of trace amounts in the final product as a consequence of unintentional cross-contamination. [ 56 ] [ 59 ] [ 60 ] Ingredients intentionally added [ edit ] FALCPA requires companies to disclose on the label whether a packaged food product contains any of these eight major food allergens, added intentionally: cow's milk, peanuts, eggs, shellfish, fish, tree nuts, soy and wheat. [ 56 ]  This list originated in 1999 from the World Health Organisation Codex Alimentarius Commission. [ 61 ]  To meet FALCPA labeling requirements, if an ingredient is derived from one of the required-label allergens, then it must either have its \"food sourced name\" in parentheses, for example \"Casein (milk),\" or as an alternative, there must be a statement separate but adjacent to the ingredients list: \"Contains milk\" (and any other of the allergens with mandatory labeling). [ 56 ] [ 60 ]  The European Union requires listing for those eight major allergens plus molluscs,  celery , mustard, lupin, sesame and  sulfites . [ 59 ]  In Japan, a food-labeling system for five specific allergenic ingredients (egg, milk, wheat, buckwheat, peanut) was mandated under law on April 1, 2002. Additional labeling of shrimp\/prawn and crab became mandatory in 2008. This applies to packaged food, but not to restaurants. [ 62 ]","attrs_markdown":"[Jump to content](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#bodyContent)\n\nMain menu\n\nMain menu\n\nmove to sidebar\n\nhide\n\nNavigation\n\n- [Main page](https:\/\/en.wikipedia.org\/wiki\/Main_Page \"Visit the main page [z]\")\n- [Contents](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contents \"Guides to browsing Wikipedia\")\n- [Current events](https:\/\/en.wikipedia.org\/wiki\/Portal:Current_events \"Articles related to current events\")\n- [Random article](https:\/\/en.wikipedia.org\/wiki\/Special:Random \"Visit a randomly selected article [x]\")\n- [About Wikipedia](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:About \"Learn about Wikipedia and how it works\")\n- [Contact us](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contact_us \"How to contact Wikipedia\")\n\nContribute\n\n- [Help](https:\/\/en.wikipedia.org\/wiki\/Help:Contents \"Guidance on how to use and edit Wikipedia\")\n- [Learn to edit](https:\/\/en.wikipedia.org\/wiki\/Help:Introduction \"Learn how to edit Wikipedia\")\n- [Community portal](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Community_portal \"The hub for editors\")\n- [Recent changes](https:\/\/en.wikipedia.org\/wiki\/Special:RecentChanges \"A list of recent changes to Wikipedia [r]\")\n- [Upload file](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:File_upload_wizard \"Add images or other media for use on Wikipedia\")\n- [Special pages](https:\/\/en.wikipedia.org\/wiki\/Special:SpecialPages)\n\n[![](https:\/\/en.wikipedia.org\/static\/images\/icons\/wikipedia.png) ![Wikipedia](https:\/\/en.wikipedia.org\/static\/images\/mobile\/copyright\/wikipedia-wordmark-en.svg) ![The Free Encyclopedia](https:\/\/en.wikipedia.org\/static\/images\/mobile\/copyright\/wikipedia-tagline-en.svg)](https:\/\/en.wikipedia.org\/wiki\/Main_Page)\n\n[Search](https:\/\/en.wikipedia.org\/wiki\/Special:Search \"Search Wikipedia [f]\")\n\nAppearance\n\n- [Donate](https:\/\/donate.wikimedia.org\/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en)\n- [Create account](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CreateAccount&returnto=Shellfish+allergy \"You are encouraged to create an account and log in; however, it is not mandatory\")\n- [Log in](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UserLogin&returnto=Shellfish+allergy \"You're encouraged to log in; however, it's not mandatory. [o]\")\n\nPersonal tools\n\n- [Donate](https:\/\/donate.wikimedia.org\/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en)\n- [Create account](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CreateAccount&returnto=Shellfish+allergy \"You are encouraged to create an account and log in; however, it is not mandatory\")\n- [Log in](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UserLogin&returnto=Shellfish+allergy \"You're encouraged to log in; however, it's not mandatory. [o]\")\n\nPages for logged out editors [learn more](https:\/\/en.wikipedia.org\/wiki\/Help:Introduction)\n\n- [Contributions](https:\/\/en.wikipedia.org\/wiki\/Special:MyContributions \"A list of edits made from this IP address [y]\")\n- [Talk](https:\/\/en.wikipedia.org\/wiki\/Special:MyTalk \"Discussion about edits from this IP address [n]\")\n\n## Contents\nmove to sidebar\n\nhide\n\n- [(Top)](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy)\n- [1 Signs and symptoms](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Signs_and_symptoms)\n- [2 Causes](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Causes)\n  Toggle Causes subsection\n  - [2\\.1 Eating shellfish](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Eating_shellfish)\n  - [2\\.2 Cross-contact](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Cross-contact)\n  - [2\\.3 Shellfish parasite](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Shellfish_parasite)\n  - [2\\.4 Occupational exposure](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Occupational_exposure)\n  - [2\\.5 Cross-reactivity to non-shellfish](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Cross-reactivity_to_non-shellfish)\n  - [2\\.6 Exercise as contributing factor](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Exercise_as_contributing_factor)\n- [3 Mechanisms](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Mechanisms)\n  Toggle Mechanisms subsection\n  - [3\\.1 Allergic response](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Allergic_response)\n  - [3\\.2 Shellfish allergenic proteins](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Shellfish_allergenic_proteins)\n- [4 Diagnosis](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Diagnosis)\n- [5 Prevention](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Prevention)\n- [6 Treatment](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Treatment)\n- [7 Prognosis](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Prognosis)\n- [8 Epidemiology](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Epidemiology)\n- [9 Regulation](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Regulation)\n  Toggle Regulation subsection\n  - [9\\.1 Regulation of labeling](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Regulation_of_labeling)\n    - [9\\.1.1 Ingredients intentionally added](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Ingredients_intentionally_added)\n- [10 See also](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#See_also)\n- [11 References](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#References)\n- [12 External links](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#External_links)\n\nToggle the table of contents\n\n# Shellfish allergy\n2 languages\n\n- [العربية](https:\/\/ar.wikipedia.org\/wiki\/%D8%AD%D8%B3%D8%A7%D8%B3%D9%8A%D8%A9_%D8%A7%D9%84%D9%85%D8%AD%D8%A7%D8%B1 \"حساسية المحار – Arabic\")\n- [Español](https:\/\/es.wikipedia.org\/wiki\/Alergia_a_los_mariscos \"Alergia a los mariscos – Spanish\")\n\n[Edit links](https:\/\/www.wikidata.org\/wiki\/Special:EntityPage\/Q23037743#sitelinks-wikipedia \"Edit interlanguage links\")\n\n- [Article](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy \"View the content page [c]\")\n- [Talk](https:\/\/en.wikipedia.org\/wiki\/Talk:Shellfish_allergy \"Discuss improvements to the content page [t]\")\n\nEnglish\n\n- [Read](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy)\n- [Edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit \"Edit this page [e]\")\n- [View history](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=history \"Past revisions of this page [h]\")\n\nTools\n\nTools\n\nmove to sidebar\n\nhide\n\nActions\n\n- [Read](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy)\n- [Edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit \"Edit this page [e]\")\n- [View history](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=history)\n\nGeneral\n\n- [What links here](https:\/\/en.wikipedia.org\/wiki\/Special:WhatLinksHere\/Shellfish_allergy \"List of all English Wikipedia pages containing links to this page [j]\")\n- [Related changes](https:\/\/en.wikipedia.org\/wiki\/Special:RecentChangesLinked\/Shellfish_allergy \"Recent changes in pages linked from this page [k]\")\n- [Upload file](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:File_Upload_Wizard \"Upload files [u]\")\n- [Permanent link](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&oldid=1292971393 \"Permanent link to this revision of this page\")\n- [Page information](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=info \"More information about this page\")\n- [Cite this page](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CiteThisPage&page=Shellfish_allergy&id=1292971393&wpFormIdentifier=titleform \"Information on how to cite this page\")\n- [Get shortened URL](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UrlShortener&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FShellfish_allergy)\n- [Download QR code](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:QrCode&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FShellfish_allergy)\n\nPrint\/export\n\n- [Download as PDF](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:DownloadAsPdf&page=Shellfish_allergy&action=show-download-screen \"Download this page as a PDF file\")\n- [Printable version](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&printable=yes \"Printable version of this page [p]\")\n\nIn other projects\n\n- [Wikidata item](https:\/\/www.wikidata.org\/wiki\/Special:EntityPage\/Q23037743 \"Structured data on this page hosted by Wikidata [g]\")\n\nAppearance\n\nmove to sidebar\n\nhide\n\n[![This is a good article. 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Click here for more information.\")\n\nFrom Wikipedia, the free encyclopedia\n\nType of food allergy caused by shellfish\n\nMedical condition\n\n| Shellfish allergy |   |\n|---|---|\n| [![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Seafood_on_platter.jpg\/250px-Seafood_on_platter.jpg)](https:\/\/en.wikipedia.org\/wiki\/File:Seafood_on_platter.jpg) |   |\n| Shellfish (shrimp, crab legs, mussels) on platter |   |\n| [Specialty](https:\/\/en.wikipedia.org\/wiki\/Medical_specialty \"Medical specialty\") | [Immunology](https:\/\/en.wikipedia.org\/wiki\/Immunology \"Immunology\") [![Edit this on Wikidata](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/8\/8a\/OOjs_UI_icon_edit-ltr-progressive.svg\/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https:\/\/www.wikidata.org\/wiki\/Q23037743?uselang=en#P1995 \"Edit this on Wikidata\") |\n| Frequency | Shellfish allergy frequency estimated at ~0.5-2.5% (self-reported)[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Khora2016-1) |\n\n**Shellfish allergy** is among the most common [food allergies](https:\/\/en.wikipedia.org\/wiki\/Food_allergy \"Food allergy\"). \"[Shellfish](https:\/\/en.wikipedia.org\/wiki\/Shellfish \"Shellfish\")\" is a colloquial and [fisheries](https:\/\/en.wikipedia.org\/wiki\/Fisheries \"Fisheries\") term for [aquatic](https:\/\/en.wikipedia.org\/wiki\/Aquatic_animal \"Aquatic animal\") [invertebrates](https:\/\/en.wikipedia.org\/wiki\/Invertebrate \"Invertebrate\") used as [food](https:\/\/en.wikipedia.org\/wiki\/Food \"Food\"), including various species of [molluscs](https:\/\/en.wikipedia.org\/wiki\/Mollusca \"Mollusca\") such as [clams](https:\/\/en.wikipedia.org\/wiki\/Clam \"Clam\"), [mussels](https:\/\/en.wikipedia.org\/wiki\/Mussel \"Mussel\"), [oysters](https:\/\/en.wikipedia.org\/wiki\/Oyster \"Oyster\") and [scallops](https:\/\/en.wikipedia.org\/wiki\/Scallop \"Scallop\"), [crustaceans](https:\/\/en.wikipedia.org\/wiki\/Crustacean \"Crustacean\") such as [shrimp](https:\/\/en.wikipedia.org\/wiki\/Shrimp \"Shrimp\"), [lobsters](https:\/\/en.wikipedia.org\/wiki\/Lobster \"Lobster\") and [crabs](https:\/\/en.wikipedia.org\/wiki\/Crab \"Crab\"), and [cephalopods](https:\/\/en.wikipedia.org\/wiki\/Cephalopod \"Cephalopod\") such as [squid](https:\/\/en.wikipedia.org\/wiki\/Squid \"Squid\") and [octopus](https:\/\/en.wikipedia.org\/wiki\/Octopus \"Octopus\"). However, scientifically these groups are in completely different Phyla and some in different Classes. Clams, mussels, oysters, and scallops are in the Phylum Mollusca and Class Bivalvia, squid and octopus are in the Class Cephalopoda. Crustaceans are in the Phylum Arthropoda and Class Crustacea. Their chemistry is different and to understand the underlying mechanisms of various allergies to these animals requires an understanding of the diversity of the different proteins found and a knowledge of their proper scientific name and classification. Shellfish allergy is an [immune hypersensitivity](https:\/\/en.wikipedia.org\/wiki\/Immune_hypersensitivity \"Immune hypersensitivity\") to [proteins](https:\/\/en.wikipedia.org\/wiki\/Protein \"Protein\") found in shellfish. Symptoms can be either rapid or gradual in onset. The latter can take hours to days to appear. The former may include [anaphylaxis](https:\/\/en.wikipedia.org\/wiki\/Anaphylaxis \"Anaphylaxis\"), a potentially life-threatening condition which requires treatment with [epinephrine](https:\/\/en.wikipedia.org\/wiki\/Epinephrine_\\(medication\\) \"Epinephrine (medication)\"). Other presentations may include [atopic dermatitis](https:\/\/en.wikipedia.org\/wiki\/Atopic_dermatitis \"Atopic dermatitis\") or [inflammation of the esophagus](https:\/\/en.wikipedia.org\/wiki\/Allergic_eosinophilic_esophagitis \"Allergic eosinophilic esophagitis\").[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-2) Shellfish is one of the eight common food allergens, responsible for 90% of allergic reactions to foods: [cow's milk](https:\/\/en.wikipedia.org\/wiki\/Milk \"Milk\"), [eggs](https:\/\/en.wikipedia.org\/wiki\/Egg_\\(food\\) \"Egg (food)\"), [wheat](https:\/\/en.wikipedia.org\/wiki\/Wheat \"Wheat\"), [shellfish](https:\/\/en.wikipedia.org\/wiki\/Crustacea \"Crustacea\"), [peanuts](https:\/\/en.wikipedia.org\/wiki\/Peanut \"Peanut\"), [tree nuts](https:\/\/en.wikipedia.org\/wiki\/Tree_nuts \"Tree nuts\"), fish, and [soy beans](https:\/\/en.wikipedia.org\/wiki\/Soy \"Soy\").[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-3)[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-NHS-4)\n\nUnlike early childhood allergic reactions to milk and eggs, which often lessen as the children age,[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Urisu2014-5) shellfish allergy tends to first appear in school-age children and older, and persist in adulthood.[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Thal2015-6) Strong predictors for adult-persistence are anaphylaxis, high shellfish-specific serum [immunoglobulin E](https:\/\/en.wikipedia.org\/wiki\/Immunoglobulin_E \"Immunoglobulin E\") (IgE) and robust response to the skin prick test. Adult onset of shellfish allergy is common in workers in the shellfish catching and processing industry.[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2013-7)[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Jeebhay2001-8)\n\n## Signs and symptoms\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=1 \"Edit section: Signs and symptoms\")\\]\n\n[![Signs and symptoms of anaphylaxis](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Signs_and_symptoms_of_anaphylaxis.png\/500px-Signs_and_symptoms_of_anaphylaxis.png)](https:\/\/en.wikipedia.org\/wiki\/File:Signs_and_symptoms_of_anaphylaxis.png \"Signs and symptoms of anaphylaxis\")\n\nSigns and symptoms of anaphylaxis\n\nFood allergy symptoms usually occur within minutes after exposure but can be delayed to hours depending on the nature of the immune system response.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-medlineplus-9) Symptoms may include rash, [hives](https:\/\/en.wikipedia.org\/wiki\/Hives \"Hives\"), itching of mouth, lips, tongue, throat, eyes, skin, or other areas, swelling of lips, tongue, eyelids, or the whole face, difficulty swallowing, runny or congested nose, hoarse voice, wheezing, shortness of breath, diarrhea, abdominal pain, lightheadedness, fainting, nausea, or vomiting.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-medlineplus-9) Symptoms of allergies vary from person to person and may vary from incident to incident.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-medlineplus-9) Serious danger regarding allergies can begin when the respiratory tract or blood circulation is affected. The former can be indicated by wheezing, a blocked airway and [cyanosis](https:\/\/en.wikipedia.org\/wiki\/Cyanosis \"Cyanosis\"), and the latter by weak pulse, pale skin, and fainting. When these symptoms occur the allergic reaction is called [anaphylaxis](https:\/\/en.wikipedia.org\/wiki\/Anaphylaxis \"Anaphylaxis\").[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-medlineplus-9) Anaphylaxis occurs when [IgE antibodies](https:\/\/en.wikipedia.org\/wiki\/IgE_antibodies \"IgE antibodies\") are involved,[\\[10\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-10) and areas of the body that are not in direct contact with the food become affected and show severe symptoms.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-medlineplus-9)[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Sicherer2014-11) Untreated, this can proceed to [vasodilation](https:\/\/en.wikipedia.org\/wiki\/Vasodilation \"Vasodilation\"), a low blood pressure situation called [anaphylactic shock](https:\/\/en.wikipedia.org\/wiki\/Anaphylactic_shock \"Anaphylactic shock\").[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Sicherer2014-11)\n\n## Causes\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=2 \"Edit section: Causes\")\\]\n\n### Eating shellfish\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=3 \"Edit section: Eating shellfish\")\\]\n\nThe cause is typically the eating of shellfish or foods that contain shellfish. The shellfish types causing clinical allergy are, in decreasing incidence:\n\n- Shrimp\n- Crab\n- Lobster\n- Clam\n- Oyster\n- Mussel.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Wai2020-12)\n\nOnce an allergic reaction has occurred it usually remains a lifelong sensitivity.[\\[13\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Prester2016-13) The immune system overreacts to proteins found in shellfish, most commonly to [tropomyosin](https:\/\/en.wikipedia.org\/wiki\/Tropomyosin \"Tropomyosin\"), but often to other proteins, such as [arginine kinase](https:\/\/en.wikipedia.org\/wiki\/Arginine_kinase \"Arginine kinase\"), [myosin light chain](https:\/\/en.wikipedia.org\/wiki\/Myosin_light_chain \"Myosin light chain\") and sarcoplasmic calcium-binding protein.[\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Gelis2020-14)[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2016-15)[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Pedrosa2015-16) The allergic reaction to fish is to a different protein, [parvalbumin](https:\/\/en.wikipedia.org\/wiki\/Parvalbumin \"Parvalbumin\"); there is no cross-reactivity between fish and shellfish allergy.[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Thal2015-6)[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Tong2018-17)[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Ruethers2018-18)\n\n### Cross-contact\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=4 \"Edit section: Cross-contact\")\\]\n\nCross-contact, also referred to as cross-contamination, occurs when foods are being processed in factories or at food markets, or are being prepared for cooking in restaurants and home kitchens. The allergenic proteins are transferred from one food to another.[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-19)\n\n### Shellfish parasite\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=5 \"Edit section: Shellfish parasite\")\\]\n\nThe food-borne parasite *[Anisakis](https:\/\/en.wikipedia.org\/wiki\/Anisakis \"Anisakis\")* is a genus of [nematodes](https:\/\/en.wikipedia.org\/wiki\/Nematode \"Nematode\") known to be present in [squid](https:\/\/en.wikipedia.org\/wiki\/Squid \"Squid\").[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Morozin2019-20) *Anisakis* are directly infective to humans whenever infected squid (or marine fish) are consumed raw or slightly processed, causing a condition called [anisakiasis](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#Anisakiasis). Symptoms from consuming live nematodes include severe abdominal pain, [nausea](https:\/\/en.wikipedia.org\/wiki\/Nausea \"Nausea\"), and vomiting.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Aibinu2019-21) In addition, there can be an allergic reaction to *Anisakis* proteins, even if the food in question was frozen or cooked before being consumed, killing the nematodes, as some of the nematode proteins are resistant to cold and heat.[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Morozin2019-20) Allergic reactions can include hives, asthma and true anaphylactic reactions.[\\[13\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Prester2016-13)[\\[22\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Audicana-22)\n\n### Occupational exposure\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=6 \"Edit section: Occupational exposure\")\\]\n\nAn industry review conducted in 1990 estimated that 28.5 million people worldwide were engaged in some aspect of the seafood industry: fishing, aquaculture, processing and industrial cooking.[\\[23\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-23) Men predominate in fishing, women in processing facilities.[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2013-7) Exposure to shellfish allergenic proteins includes inhalation of wet [aerosols](https:\/\/en.wikipedia.org\/wiki\/Aerosol \"Aerosol\") from fresh shellfish handling, and dermal contact through skin breaks and cuts.[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2013-7)[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Jeebhay2001-8) Prevalence of seafood-induced adult asthma is reported as in the range of 7% to 36% (higher for [crustaceans](https:\/\/en.wikipedia.org\/wiki\/Crustaceans \"Crustaceans\") and lower for bony fish).[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Jeebhay2001-8) Prevalence of skin allergy reactions, often characterized by itchy rash (hives), range from 3% to 11%.[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Jeebhay2001-8) The shellfish-induced health outcomes are mainly due to the protein [tropomyosin](https:\/\/en.wikipedia.org\/wiki\/Tropomyosin \"Tropomyosin\") causing an IgE mediated immune system response.[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2013-7)[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Jeebhay2001-8)\n\n### Cross-reactivity to non-shellfish\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=7 \"Edit section: Cross-reactivity to non-shellfish\")\\]\n\n[Tropomyosin](https:\/\/en.wikipedia.org\/wiki\/Tropomyosin \"Tropomyosin\"), the major allergen in shellfish allergy, is also found in [dust mites](https:\/\/en.wikipedia.org\/wiki\/House_dust_mites \"House dust mites\") and [cockroaches](https:\/\/en.wikipedia.org\/wiki\/Cockroach \"Cockroach\").[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2016-15)[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Pedrosa2015-16) Exposure to inhaled tropomyosins from dust mites is thought to be the primary sensitizer for shellfish allergy, an example of inhalant-to-food cross-reactivity.[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Wong2019-24) Epidemiological surveys have confirmed correlation between shellfish and dust mite sensitizations.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Wong2016-25) An additional confirmation was seen in Orthodox Jews with no history of shellfish consumption, in that skin tests confirming [dust mite allergy](https:\/\/en.wikipedia.org\/wiki\/Dust_mite_allergy \"Dust mite allergy\") were also positive for shellfish tropomyosin.[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2016-15)[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Wong2016-25) In addition to tropomyosin, arginine kinase and [hemocyanin](https:\/\/en.wikipedia.org\/wiki\/Hemocyanin \"Hemocyanin\") seem to have a role in cross-reactivity to dust mites.[\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Gelis2020-14)\n\n### Exercise as contributing factor\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=8 \"Edit section: Exercise as contributing factor\")\\]\n\nExercise can be a contributing factor to an allergic food response. There is a condition called food-dependent, exercise-induced anaphylaxis.[\\[26\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Feldweg2017-26)[\\[27\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Pravettoni2016-27) For people with this condition, exercise alone is not sufficient, nor is consumption of a food to which they are mildly allergic, but when the food in question is consumed within a few hours before high-intensity exercise, the result can be anaphylaxis. Shellfish are specifically mentioned as a causative food.[\\[26\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Feldweg2017-26)[\\[27\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Pravettoni2016-27)[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Kim2013-28) One theory is that exercise is stimulating the release of mediators such as histamine from IgE-activated mast cells.[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Kim2013-28) Two of the reviews postulate that exercise is not essential for the development of symptoms, but rather that it is one of several augmentation factors, citing evidence that the culprit food in combination with alcohol or aspirin will result in a respiratory anaphylactic reaction.[\\[26\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Feldweg2017-26)[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Kim2013-28)\n\n## Mechanisms\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=9 \"Edit section: Mechanisms\")\\]\n\n### Allergic response\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=10 \"Edit section: Allergic response\")\\]\n\nConditions caused by food allergies are classified into three groups according to the mechanism of the allergic response:[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-NHS-4)\n\n1. IgE-mediated (classic) – the most common type, manifesting acute changes that occur shortly after eating, and may progress to [anaphylaxis](https:\/\/en.wikipedia.org\/wiki\/Anaphylaxis \"Anaphylaxis\")\n2. Non-IgE mediated – characterized by an immune response not involving [immunoglobulin E](https:\/\/en.wikipedia.org\/wiki\/Immunoglobulin_E \"Immunoglobulin E\"); may occur hours to days after eating, complicating diagnosis\n3. IgE and non-IgE-mediated – a hybrid of the above two types\n\n[Allergic reactions](https:\/\/en.wikipedia.org\/wiki\/Allergic_reactions \"Allergic reactions\") are hyperactive responses of the immune system to generally innocuous substances, such as food proteins.[\\[29\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Con2007-29) Why some proteins trigger allergic reactions while others do not is not entirely clear. One theory holds that proteins which resist digestion in the stomach, therefore reaching the small intestine relatively intact, are more likely to be allergenic, but studies have shown that digestion may abolish, decrease, have no effect, or even increase the allergenicity of food allergens.[\\[30\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-30) The heat of cooking structurally degrades protein molecules, potentially making them less allergenic.[\\[31\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-31)[\\[32\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-32)\n\nThe [pathophysiology](https:\/\/en.wikipedia.org\/wiki\/Pathophysiology \"Pathophysiology\") of allergic responses can be divided into two time periods: The first is an [acute response](https:\/\/en.wikipedia.org\/wiki\/Acute_\\(medical\\) \"Acute (medical)\") that occurs within minutes after exposure to an allergen.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Janeway-33) This phase can either subside or progress into a \"late-phase reaction\" which can substantially prolong the symptoms of a response, and result in more tissue damage hours later.[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Grimbaldeston2006-34) In the early stages of acute allergic reaction, [lymphocytes](https:\/\/en.wikipedia.org\/wiki\/Lymphocyte \"Lymphocyte\") previously sensitized to a specific protein or protein fraction react by quickly producing a particular type of antibody known as secreted IgE (sIgE), which circulates in the blood and binds to IgE-specific receptors on the surface of other kinds of immune cells called [mast cells](https:\/\/en.wikipedia.org\/wiki\/Mast_cell \"Mast cell\") and [basophils](https:\/\/en.wikipedia.org\/wiki\/Basophil \"Basophil\"). Both of these are involved in the acute inflammatory response.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Janeway-33) Activated mast cells and basophils undergo a process called [degranulation](https:\/\/en.wikipedia.org\/wiki\/Degranulation \"Degranulation\"), during which they release [histamine](https:\/\/en.wikipedia.org\/wiki\/Histamine \"Histamine\") and other inflammatory chemical mediators called ([cytokines](https:\/\/en.wikipedia.org\/wiki\/Cytokine \"Cytokine\"), [interleukins](https:\/\/en.wikipedia.org\/wiki\/Interleukin \"Interleukin\"), [leukotrienes](https:\/\/en.wikipedia.org\/wiki\/Leukotriene \"Leukotriene\"), and [prostaglandins](https:\/\/en.wikipedia.org\/wiki\/Prostaglandin \"Prostaglandin\")) into the surrounding tissue causing several systemic effects, such as vasodilation, [mucous](https:\/\/en.wikipedia.org\/wiki\/Mucous_membrane \"Mucous membrane\") secretion, [nerve](https:\/\/en.wikipedia.org\/wiki\/Nerve \"Nerve\") stimulation, and [smooth-muscle](https:\/\/en.wikipedia.org\/wiki\/Smooth_muscle \"Smooth muscle\") contraction.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Janeway-33) This results in [runny nose](https:\/\/en.wikipedia.org\/wiki\/Rhinorrhea \"Rhinorrhea\"), itchiness, [shortness of breath](https:\/\/en.wikipedia.org\/wiki\/Dyspnea \"Dyspnea\"), and potentially [anaphylaxis](https:\/\/en.wikipedia.org\/wiki\/Anaphylaxis \"Anaphylaxis\").[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Janeway-33) Depending on the individual, the allergen, and the mode of introduction, the symptoms can be system-wide (classical anaphylaxis), or localized to particular body systems; [asthma](https:\/\/en.wikipedia.org\/wiki\/Asthma \"Asthma\") is localized to the respiratory system while hives and eczema are localized to the skin.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Janeway-33) In addition to reacting to oral consumption, skin and asthma reactions can be triggered by inhallation or contact if there are skin abrasions or cuts.[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2013-7)[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Jeebhay2001-8)\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/63\/EMminor2010.JPG\/250px-EMminor2010.JPG)](https:\/\/en.wikipedia.org\/wiki\/File:EMminor2010.JPG)\n\nHives allergic reaction on arm\n\nAfter the chemical mediators of the acute response subside, late-phase responses can often occur due to the migration of other [white blood cells](https:\/\/en.wikipedia.org\/wiki\/White_blood_cells \"White blood cells\") such as [neutrophils](https:\/\/en.wikipedia.org\/wiki\/Neutrophil \"Neutrophil\"), [lymphocytes](https:\/\/en.wikipedia.org\/wiki\/Lymphocyte \"Lymphocyte\"), [eosinophils](https:\/\/en.wikipedia.org\/wiki\/Eosinophil \"Eosinophil\"), and [macrophages](https:\/\/en.wikipedia.org\/wiki\/Macrophage \"Macrophage\") to the initial reaction sites. This is usually seen 2–24 hours after the original reaction.[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Grimbaldeston2006-34) Cytokines from mast cells may also play a role in the persistence of long-term effects. Late-phase responses seen in asthma are slightly different from those seen in other allergic responses, although they are still caused by release of mediators from eosinophils.[\\[35\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-35)\n\nIn addition to IgE-mediated responses, shellfish allergy can manifest as [atopic dermatitis](https:\/\/en.wikipedia.org\/wiki\/Atopic_dermatitis \"Atopic dermatitis\"), especially in infants and young children.[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-36) Some will display both, so that a child could react to an oral food challenge with allergic symptoms, followed a day or two later with a flare up of atopic dermatitis and\/or gastrointestinal symptoms, including allergic [eosinophilic esophagitis](https:\/\/en.wikipedia.org\/wiki\/Eosinophilic_esophagitis \"Eosinophilic esophagitis\").[\\[37\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-37)\n\n### Shellfish allergenic proteins\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=11 \"Edit section: Shellfish allergenic proteins\")\\]\n\nSeveral proteins from shellfish are either clearly involved in allergenic reactions or suspected to be. Tropomyosin, arginine kinase, myosin light chain and sarcoplasmic calcium-binding protein are widely present across shellfish species.[\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Gelis2020-14)[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2016-15)[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Pedrosa2015-16)[\\[38\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Faber2017-38) [Troponin](https:\/\/en.wikipedia.org\/wiki\/Troponin \"Troponin\"), [actin](https:\/\/en.wikipedia.org\/wiki\/Actin \"Actin\"), [triosephosphate isomerase](https:\/\/en.wikipedia.org\/wiki\/Triosephosphate_isomerase \"Triosephosphate isomerase\") and [hemocyanin](https:\/\/en.wikipedia.org\/wiki\/Hemocyanin \"Hemocyanin\") are also identified as allergenic proteins.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Khora2016-1)[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2016-15) As of a 2016 review, only three (tropomyosin, arginine kinase and sarcoplasmic calcium-binding protein) were available for routine diagnostic skin testing.[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lopata2016-15) Shellfish do not manifest the proteins β-parvalbumin (found in bony fishes) or α-parvalbumin (found in cartilaginous fishes such as sharks and rays), so there is not cross-reactivity of shellfish allergy to fish allergy.[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Thal2015-6)[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Tong2018-17)[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Ruethers2018-18)\n\n## Diagnosis\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=12 \"Edit section: Diagnosis\")\\]\n\nDiagnosis of shellfish allergy is based on the person's history of allergic reactions, [skin prick test](https:\/\/en.wikipedia.org\/wiki\/Skin_prick_test \"Skin prick test\") and measurement of shellfish-specific serum [immunoglobulin E](https:\/\/en.wikipedia.org\/wiki\/Immunoglobulin_E \"Immunoglobulin E\") (IgE or sIgE). Confirmation is by double-blind, placebo-controlled food challenges.[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Tong2018-17) Self-reported shellfish allergy often fails to be confirmed by food challenge.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Nwaru2014-39)\n\n## Prevention\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=13 \"Edit section: Prevention\")\\]\n\nReviews of food allergens in general stated that introducing solid foods at 4–6 months may result in the lowest subsequent allergy risks for eczema, allergic rhinitis and more severe reactions.[\\[40\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Ferraro2019-40) The evidence is best for peanuts, eggs and milk.[\\[41\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Perkins2016-41) The literature is sparse for consequences of early introduction of shellfish.[\\[41\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Perkins2016-41)\n\n## Treatment\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=14 \"Edit section: Treatment\")\\]\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/39\/Epi-Pen_2016.jpg\/250px-Epi-Pen_2016.jpg)](https:\/\/en.wikipedia.org\/wiki\/File:Epi-Pen_2016.jpg)\n\nEpinephrine autoinjectors are portable single-dose epinephrine-dispensing devices used to treat anaphylaxis.\n\nTreatment for accidental ingestion of shellfish products by allergic individuals varies depending on the sensitivity of the person. An [antihistamine](https:\/\/en.wikipedia.org\/wiki\/Antihistamine \"Antihistamine\") such as [diphenhydramine](https:\/\/en.wikipedia.org\/wiki\/Diphenhydramine \"Diphenhydramine\") may be prescribed. Sometimes [prednisone](https:\/\/en.wikipedia.org\/wiki\/Prednisone \"Prednisone\") will be prescribed to prevent a possible late phase [Type I hypersensitivity](https:\/\/en.wikipedia.org\/wiki\/Type_I_hypersensitivity \"Type I hypersensitivity\") reaction.[\\[42\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-42) Severe allergic reactions (anaphalaxis) may require treatment with an [epinephrine pen](https:\/\/en.wikipedia.org\/wiki\/Epinephrine_pen \"Epinephrine pen\"), which is an injection device designed to be used by a non-healthcare professional when emergency treatment is warranted.[\\[43\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-EAACI2014-43) Unlike for egg allergy, for which there is active research on trying [oral immunotherapy](https:\/\/en.wikipedia.org\/wiki\/Oral_immunotherapy \"Oral immunotherapy\") (OIT) to desensitize people to egg allergens,[\\[44\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-44) reviews mention that there are no published clinical trials evaluating oral immunotherapy for shellfish allergy.[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Thal2015-6)[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Wai2020-12)\n\n## Prognosis\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=15 \"Edit section: Prognosis\")\\]\n\nUnlike milk and egg allergies,[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Urisu2014-5)[\\[45\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-45) shellfish allergy usually persists into adulthood.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Wai2020-12)[\\[13\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Prester2016-13)\n\n## Epidemiology\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=16 \"Edit section: Epidemiology\")\\]\n\nIncidence and prevalence are terms commonly used in describing disease [epidemiology](https:\/\/en.wikipedia.org\/wiki\/Epidemiology \"Epidemiology\"). Incidence is newly diagnosed cases, which can be expressed as new cases per year per million people. Prevalence is the number of cases alive, expressible as existing cases per million people during a period of time.[\\[46\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-46) Worldwide, the prevalence of shellfish allergy is increasing because shellfish consumption is increasing,[\\[47\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Tsabouri2012-47) and among adults shellfish is the most common anaphylaxis-eliciting food.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Wai2020-12) Reviews cite self-reported shellfish allergy in range of 0.5 to 2.5 percent in the general population.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Khora2016-1)[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Nwaru2014-39)[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Rona2007-48) Prevalence is higher in coastal southeast Asian countries, where shellfish consumption is more common.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Khora2016-1)[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Wai2020-12)[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Tham2018-49)[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lee2012-50) Self-reported allergy prevalence is always higher than food-challenge confirmed allergy, which one review put at 0% to 0.9% (the higher value in southeast Asia).[\\[51\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Moone2016-51)\n\n## Regulation\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=17 \"Edit section: Regulation\")\\]\n\nWhether food allergy prevalence is increasing or not, food allergy awareness has increased, with impacts on the quality of life for children, their parents and their immediate caregivers.[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Ravid2015-52)[\\[53\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Morou2014-53)[\\[54\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Lange2014-54)[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Velde2013-55) In the United States, the [Food Allergen Labeling and Consumer Protection Act](https:\/\/en.wikipedia.org\/wiki\/Food_Allergen_Labeling_and_Consumer_Protection_Act \"Food Allergen Labeling and Consumer Protection Act\") (FALCPA), made law in August 2004, effective January 1, 2006,[\\[56\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-FDA2004-56) causes people to be reminded of allergy problems every time they handle a food package. Although not regulated under FALCPA, restaurants have added allergen warnings to menus. The [Culinary Institute of America](https:\/\/en.wikipedia.org\/wiki\/Culinary_Institute_of_America \"Culinary Institute of America\"), a premier school for chef training, has courses in allergen-free cooking and a separate teaching kitchen.[\\[57\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-57) School systems have protocols about what foods can be brought into the school. Despite all these precautions, people with serious allergies are aware that accidental exposure can easily occur at other peoples' houses, at school or in restaurants.[\\[58\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Shah2008-58)\n\n### Regulation of labeling\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=18 \"Edit section: Regulation of labeling\")\\]\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/42\/US_Allergen_Information_Example.jpg\/330px-US_Allergen_Information_Example.jpg)](https:\/\/en.wikipedia.org\/wiki\/File:US_Allergen_Information_Example.jpg)\n\nAn example of \"MAY CONTAIN TRACES OF...\" as a means of listing trace amounts of allergens in a food product due to cross-contamination during manufacture.\n\nIn response to the risk that certain foods pose to those with food allergies, some countries have responded by instituting labeling laws that require food products to clearly inform consumers if their products contain major allergens or byproducts of major allergens among the ingredients intentionally added to foods. Laws and regulations passed in the US and by the European Union recommend labeling but do not require mandatory declaration of the presence of trace amounts in the final product as a consequence of unintentional cross-contamination.[\\[56\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-FDA2004-56)[\\[59\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-EU2015-59)[\\[60\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-FDAreadlabel2017-60)\n\n#### Ingredients intentionally added\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=19 \"Edit section: Ingredients intentionally added\")\\]\n\nFALCPA requires companies to disclose on the label whether a packaged food product contains any of these eight major food allergens, added intentionally: cow's milk, peanuts, eggs, shellfish, fish, tree nuts, soy and wheat.[\\[56\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-FDA2004-56) This list originated in 1999 from the World Health Organisation Codex Alimentarius Commission.[\\[61\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-Allen2014-61) To meet FALCPA labeling requirements, if an ingredient is derived from one of the required-label allergens, then it must either have its \"food sourced name\" in parentheses, for example \"Casein (milk),\" or as an alternative, there must be a statement separate but adjacent to the ingredients list: \"Contains milk\" (and any other of the allergens with mandatory labeling).[\\[56\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-FDA2004-56)[\\[60\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-FDAreadlabel2017-60) The European Union requires listing for those eight major allergens plus molluscs, [celery](https:\/\/en.wikipedia.org\/wiki\/Celery \"Celery\"), mustard, lupin, sesame and [sulfites](https:\/\/en.wikipedia.org\/wiki\/Sulfite \"Sulfite\").[\\[59\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-EU2015-59) In Japan, a food-labeling system for five specific allergenic ingredients (egg, milk, wheat, buckwheat, peanut) was mandated under law on April 1, 2002. Additional labeling of shrimp\/prawn and crab became mandatory in 2008. This applies to packaged food, but not to restaurants.[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_note-62)\n\n## See also\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=20 \"Edit section: See also\")\\]\n\n- [List of allergens](https:\/\/en.wikipedia.org\/wiki\/List_of_allergens \"List of allergens\") (food and non-food)\n\n## References\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=21 \"Edit section: References\")\\]\n\n1. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Khora2016_1-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Khora2016_1-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Khora2016_1-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Khora2016_1-3)\n   Khora SS (August 2016). \"Seafood-Associated Shellfish Allergy: A Comprehensive Review\". *Immunol Invest*. **45** (6): 504–30\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1080\/08820139.2016.1180301](https:\/\/doi.org\/10.1080%2F08820139.2016.1180301). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [27404324](https:\/\/pubmed.ncbi.nlm.nih.gov\/27404324). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [23368221](https:\/\/api.semanticscholar.org\/CorpusID:23368221).\n2. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-2)**\n   National Report of the Expert Panel on Food Allergy Research, NIH-NIAID 2003\n   \n   [\"National Report of the Expert Panel on Food Allergy Research\"](https:\/\/web.archive.org\/web\/20061004001123\/http:\/\/www3.niaid.nih.gov\/about\/organization\/dait\/PDF\/june30_2003.pdf) (PDF). 30 June 2003. Archived from [the original](http:\/\/www3.niaid.nih.gov\/about\/organization\/dait\/PDF\/june30_2003.pdf) (PDF) on 2006-10-04. Retrieved 2006-08-07.\n3. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-3)** [\"Food Allergies\"](http:\/\/www.aafa.org\/display.cfm?id=9&sub=20&cont=286) [Archived](https:\/\/web.archive.org\/web\/20121006052320\/http:\/\/www.aafa.org\/display.cfm?id=9&sub=20&cont=286) 2012-10-06 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\") Asthma and Allergy Foundation of America\n4. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-NHS_4-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-NHS_4-1)\n   [\"Food allergy\"](http:\/\/www.nhs.uk\/conditions\/food-allergy\/Pages\/Intro1.aspx). [National Health Service (England)](https:\/\/en.wikipedia.org\/wiki\/National_Health_Service_\\(England\\) \"National Health Service (England)\"). 16 May 2016. [Archived](https:\/\/web.archive.org\/web\/20170720023406\/http:\/\/www.nhs.uk\/Conditions\/food-allergy\/Pages\/Intro1.aspx) from the original on 20 July 2017. Retrieved 27 December 2020.\n5. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Urisu2014_5-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Urisu2014_5-1)\n   Urisu A, Ebisawa M, Ito K, Aihara Y, Ito S, Mayumi M, Kohno Y, Kondo N (September 2014). [\"Japanese Guideline for Food Allergy 2014\"](https:\/\/doi.org\/10.2332%2Fallergolint.14-RAI-0770). *Allergol Int*. **63** (3): 399–419\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.2332\/allergolint.14-RAI-0770](https:\/\/doi.org\/10.2332%2Fallergolint.14-RAI-0770). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [25178179](https:\/\/pubmed.ncbi.nlm.nih.gov\/25178179).\n6. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Thal2015_6-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Thal2015_6-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Thal2015_6-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Thal2015_6-3)\n   Thalayasingam M, Lee BW (May 2015). \"Fish and shellfish allergy\". *Chem Immunol Allergy*. Chemical Immunology and Allergy. **101**: 152–61\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1159\/000375508](https:\/\/doi.org\/10.1159%2F000375508). [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-3-318-02340-4](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-3-318-02340-4 \"Special:BookSources\/978-3-318-02340-4\")\n   \n   . [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [26022875](https:\/\/pubmed.ncbi.nlm.nih.gov\/26022875).\n7. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2013_7-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2013_7-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2013_7-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2013_7-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2013_7-4)\n   Lopata AL, Jeebhay MF (June 2013). \"Airborne seafood allergens as a cause of occupational allergy and asthma\". *Curr Allergy Asthma Rep*. **13** (3): 288–97\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1007\/s11882-013-0347-y](https:\/\/doi.org\/10.1007%2Fs11882-013-0347-y). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [23575656](https:\/\/pubmed.ncbi.nlm.nih.gov\/23575656). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [1276304](https:\/\/api.semanticscholar.org\/CorpusID:1276304).\n8. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Jeebhay2001_8-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Jeebhay2001_8-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Jeebhay2001_8-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Jeebhay2001_8-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Jeebhay2001_8-4) [***f***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Jeebhay2001_8-5)\n   Jeebhay MF, Robins TG, Lehrer SB, Lopata AL (September 2001). [\"Occupational seafood allergy: a review\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1740192). *Occup Environ Med*. **58** (9): 553–62\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1136\/oem.58.9.553](https:\/\/doi.org\/10.1136%2Foem.58.9.553). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [1740192](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1740192). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [11511741](https:\/\/pubmed.ncbi.nlm.nih.gov\/11511741).\n9. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-medlineplus_9-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-medlineplus_9-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-medlineplus_9-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-medlineplus_9-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-medlineplus_9-4) *[MedlinePlus Encyclopedia](https:\/\/en.wikipedia.org\/wiki\/MedlinePlus \"MedlinePlus\")*: [Food allergy](https:\/\/medlineplus.gov\/ency\/article\/000817.htm)\n10. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-10)**\n    Reber LL, Hernandez JD, Galli SJ (August 2017). [\"The pathophysiology of anaphylaxis\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5657389). *The Journal of Allergy and Clinical Immunology*. **140** (2): 335–348\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.jaci.2017.06.003](https:\/\/doi.org\/10.1016%2Fj.jaci.2017.06.003). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [0091-6749](https:\/\/search.worldcat.org\/issn\/0091-6749). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5657389](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5657389). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [28780941](https:\/\/pubmed.ncbi.nlm.nih.gov\/28780941).\n11. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Sicherer2014_11-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Sicherer2014_11-1)\n    Sicherer SH, Sampson HA (February 2014). \"Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment\". *J Allergy Clin Immunol*. **133** (2): 291–307\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.jaci.2013.11.020](https:\/\/doi.org\/10.1016%2Fj.jaci.2013.11.020). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24388012](https:\/\/pubmed.ncbi.nlm.nih.gov\/24388012).\n12. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Wai2020_12-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Wai2020_12-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Wai2020_12-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Wai2020_12-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Wai2020_12-4)\n    Wai CY, Leung NY, Chu KH, Leung PS, Leung AS, Wong GW, Leung TF (March 2020). [\"Overcoming Shellfish Allergy: How Far Have We Come?\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7139905). *Int J Mol Sci*. **21** (6): 2234. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.3390\/ijms21062234](https:\/\/doi.org\/10.3390%2Fijms21062234). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [7139905](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7139905). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [32210187](https:\/\/pubmed.ncbi.nlm.nih.gov\/32210187).\n13. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Prester2016_13-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Prester2016_13-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Prester2016_13-2)\n    Prester L (August 2016). \"Seafood Allergy, Toxicity, and Intolerance: A Review\". *J Am Coll Nutr*. **35** (3): 271–83\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1080\/07315724.2015.1014120](https:\/\/doi.org\/10.1080%2F07315724.2015.1014120). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [26252073](https:\/\/pubmed.ncbi.nlm.nih.gov\/26252073). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [1154235](https:\/\/api.semanticscholar.org\/CorpusID:1154235).\n14. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Gelis2020_14-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Gelis2020_14-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Gelis2020_14-2)\n    Gelis S, Rueda M, Valero A, Fernández EA, Moran M, Fernández-Caldas E (July 2020). [\"Shellfish Allergy: Unmet Needs in Diagnosis and Treatment\"](https:\/\/doi.org\/10.18176%2Fjiaci.0565). *J Investig Allergol Clin Immunol*. **30** (6): 409–20\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.18176\/jiaci.0565](https:\/\/doi.org\/10.18176%2Fjiaci.0565). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [32694101](https:\/\/pubmed.ncbi.nlm.nih.gov\/32694101).\n15. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2016_15-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2016_15-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2016_15-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2016_15-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2016_15-4) [***f***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Lopata2016_15-5)\n    Lopata AL, Kleine-Tebbe J, Kamath SD (November 2016). [\"Allergens and molecular diagnostics of shellfish allergy: Part 22 of the Series Molecular Allergology\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5306157). *Allergo J Int*. **25** (7): 210–18\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1007\/s40629-016-0124-2](https:\/\/doi.org\/10.1007%2Fs40629-016-0124-2). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5306157](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5306157). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [28239537](https:\/\/pubmed.ncbi.nlm.nih.gov\/28239537).\n16. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Pedrosa2015_16-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Pedrosa2015_16-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Pedrosa2015_16-2)\n    Pedrosa M, Boyano-Martínez T, García-Ara C, Quirce S (October 2015). \"Shellfish Allergy: a Comprehensive Review\". *Clin Rev Allergy Immunol*. **49** (2): 203–16\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1007\/s12016-014-8429-8](https:\/\/doi.org\/10.1007%2Fs12016-014-8429-8). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24870065](https:\/\/pubmed.ncbi.nlm.nih.gov\/24870065). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [7306395](https:\/\/api.semanticscholar.org\/CorpusID:7306395).\n17. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Tong2018_17-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Tong2018_17-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Tong2018_17-2)\n    Tong WS, Yuen AW, Wai CY, Leung NY, Chu KH, Leung PS (October 2018). [\"Diagnosis of fish and shellfish allergies\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6181092). *J Asthma Allergy*. **11**: 247–60\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.2147\/JAA.S142476](https:\/\/doi.org\/10.2147%2FJAA.S142476). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [6181092](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6181092). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [30323632](https:\/\/pubmed.ncbi.nlm.nih.gov\/30323632).\n18. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Ruethers2018_18-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Ruethers2018_18-1)\n    Ruethers T, Taki AC, Johnston EB, Nugraha R, Le TT, Kalic T, McLean TR, Kamath SD, Lopata AL (August 2018). \"Seafood allergy: A comprehensive review of fish and shellfish allergens\". *Mol. Immunol*. **100**: 28–57\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.molimm.2018.04.008](https:\/\/doi.org\/10.1016%2Fj.molimm.2018.04.008). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [29858102](https:\/\/pubmed.ncbi.nlm.nih.gov\/29858102). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [46921072](https:\/\/api.semanticscholar.org\/CorpusID:46921072).\n19. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-19)**\n    [\"Avoiding Cross-Contact\"](https:\/\/www.foodallergy.org\/resources\/avoiding-cross-contact#:~:text=Cross-contact%20occurs%20when%20an,reaction%20to%20the%20food%20eaten.). *FARE: Food Allergy Research & Education*. [Archived](https:\/\/web.archive.org\/web\/20201123215541\/https:\/\/www.foodallergy.org\/resources\/avoiding-cross-contact#:~:text=Cross-contact%20occurs%20when%20an,reaction%20to%20the%20food%20eaten.) from the original on 23 November 2020. Retrieved 5 December 2020.\n20. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Morozin2019_20-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Morozin2019_20-1)\n    Morozińska-Gogol J (December 2019). \"Anisakis spp. as etiological agent of zoonotic disease and allergy in European region – an overview\". *Ann Parasitol*. **65** (4): 303–14\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.17420\/ap6504.214](https:\/\/doi.org\/10.17420%2Fap6504.214) (inactive 1 November 2024). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [32191412](https:\/\/pubmed.ncbi.nlm.nih.gov\/32191412).\n    \n    `{{cite journal}}`: CS1 maint: DOI inactive as of November 2024 ([link](https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_DOI_inactive_as_of_November_2024 \"Category:CS1 maint: DOI inactive as of November 2024\"))\n21. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Aibinu2019_21-0)**\n    Aibinu IE, Smooker PM, Lopata AL (August 2019). [\"Anisakis Nematodes in Fish and Shellfish- from infection to allergies\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6626974). *Int J Parasitol Parasites Wildl*. **9**: 384–93\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.ijppaw.2019.04.007](https:\/\/doi.org\/10.1016%2Fj.ijppaw.2019.04.007). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [6626974](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6626974). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [31338296](https:\/\/pubmed.ncbi.nlm.nih.gov\/31338296).\n22. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Audicana_22-0)**\n    Audicana MT, Kennedy MW (April 2008). [\"Anisakis Simplex: From Obscure Infectious Worm to Inducer of Immune Hypersensitivity\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2292572). *Clinical Microbiology Reviews*. **21** (2): 360–79\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1128\/CMR.00012-07](https:\/\/doi.org\/10.1128%2FCMR.00012-07). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [2292572](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2292572). 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[doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1007\/s40629-014-0029-x](https:\/\/doi.org\/10.1007%2Fs40629-014-0029-x). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [4479473](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4479473). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [26120535](https:\/\/pubmed.ncbi.nlm.nih.gov\/26120535).\n55. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Velde2013_55-0)**\n    van der Velde JL, Dubois AE, Flokstra-de Blok BM (December 2013). \"Food allergy and quality of life: what have we learned?\". *Curr Allergy Asthma Rep*. **13** (6): 651–61\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1007\/s11882-013-0391-7](https:\/\/doi.org\/10.1007%2Fs11882-013-0391-7). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24122150](https:\/\/pubmed.ncbi.nlm.nih.gov\/24122150). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [326837](https:\/\/api.semanticscholar.org\/CorpusID:326837).\n56. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-FDA2004_56-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-FDA2004_56-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-FDA2004_56-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-FDA2004_56-3)\n    [\"Food Allergen Labeling and Consumer Protection Act of 2004\"](https:\/\/web.archive.org\/web\/20191214032633\/https:\/\/www.fda.gov\/media\/77570\/download). US Food and Drug Administration. 2 August 2004. Archived from [the original](https:\/\/www.fda.gov\/media\/77570\/download) on December 14, 2019. Retrieved 7 March 2022.\n57. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-57)** [Culinary Institute of America](https:\/\/www.ciachef.edu\/cia-allergen-free-dining-oasis-release\/) [Archived](https:\/\/web.archive.org\/web\/20171110172606\/https:\/\/www.ciachef.edu\/cia-allergen-free-dining-oasis-release\/) 2017-11-10 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\") Allergen-free oasis comes to the CIA (2017)\n58. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Shah2008_58-0)**\n    Shah E, Pongracic J (August 2008). \"Food-induced anaphylaxis: who, what, why, and where?\". *Pediatr Ann*. **37** (8): 536–41\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.3928\/00904481-20080801-06](https:\/\/doi.org\/10.3928%2F00904481-20080801-06). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [18751571](https:\/\/pubmed.ncbi.nlm.nih.gov\/18751571).\n59. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-EU2015_59-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-EU2015_59-1)\n    [\"Food allergen labelling and information requirements under the EU Food Information for Consumers Regulation No. 1169\/2011: Technical Guidance\"](https:\/\/web.archive.org\/web\/20210430190511\/https:\/\/webarchive.nationalarchives.gov.uk\/20180411165936\/https:\/\/www.food.gov.uk\/sites\/default\/files\/food-allergen-labelling-technical-guidance.pdf) (PDF). *Food Standards Agency food.gov.uk*. April 2015. Archived from [the original](https:\/\/www.food.gov.uk\/sites\/default\/files\/food-allergen-labelling-technical-guidance.pdf) (PDF) on 2021-04-30. Retrieved 2021-04-30.\n60. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-FDAreadlabel2017_60-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-FDAreadlabel2017_60-1)\n    FDA (December 2017). [\"Have Food Allergies? Read the Label\"](https:\/\/web.archive.org\/web\/20201112015900\/https:\/\/www.fda.gov\/consumers\/consumer-updates\/have-food-allergies-read-label). *[Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\")*. Archived from [the original](https:\/\/www.fda.gov\/ForConsumers\/ConsumerUpdates\/ucm254504.htm) on 12 November 2020. Retrieved 14 January 2018.\n61. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-Allen2014_61-0)**\n    Allen KJ, Turner PJ, Pawankar R, Taylor S, Sicherer S, Lack G, et al. (April 2014). [\"Precautionary labelling of foods for allergen content: are we ready for a global framework?\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4005619). *World Allergy Organ J*. **7** (1): 10. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1186\/1939-4551-7-10](https:\/\/doi.org\/10.1186%2F1939-4551-7-10). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [4005619](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4005619). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24791183](https:\/\/pubmed.ncbi.nlm.nih.gov\/24791183).\n62. **[^](https:\/\/en.wikipedia.org\/wiki\/Shellfish_allergy#cite_ref-62)**\n    Akiyama H, Imai T, Ebisawa M (2011). [\"Chapter 4: Japan Food Allergen Labeling Regulation—History and Evaluation\"](https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9780123859891000041). *Advances in Food and Nutrition Research*. **62**: 139–71\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/B978-0-12-385989-1.00004-1](https:\/\/doi.org\/10.1016%2FB978-0-12-385989-1.00004-1). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [21504823](https:\/\/pubmed.ncbi.nlm.nih.gov\/21504823). [Archived](https:\/\/web.archive.org\/web\/20210504111332\/https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9780123859891000041?via%3Dihub) from the original on 2021-05-04. Retrieved 2021-05-03.\n\n## External links\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&action=edit&section=22 \"Edit section: External links\")\\]\n\n|   |   |\n|---|---|\n| Classification | [D](https:\/\/www.wikidata.org\/wiki\/Q23037743 \"d:Q23037743\") **[ICD](https:\/\/en.wikipedia.org\/wiki\/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems \"International Statistical Classification of Diseases and Related Health Problems\")\\-[10](https:\/\/en.wikipedia.org\/wiki\/ICD-10 \"ICD-10\")**: [T78.0](https:\/\/icd.who.int\/browse10\/2019\/en#\/T78.0), [T78.1](https:\/\/icd.who.int\/browse10\/2019\/en#\/T78.1), [L23.6](https:\/\/icd.who.int\/browse10\/2019\/en#\/L23.6), [L27.2](https:\/\/icd.who.int\/browse10\/2019\/en#\/L27.2), [Z91.0](https:\/\/icd.who.int\/browse10\/2019\/en#\/Z91.0) **[MeSH](https:\/\/en.wikipedia.org\/wiki\/Medical_Subject_Headings \"Medical Subject Headings\")**: [D000067208](https:\/\/meshb.nlm.nih.gov\/record\/ui?ui=D000067208) |\n\n| [v](https:\/\/en.wikipedia.org\/wiki\/Template:Hypersensitivity_disease_by_system \"Template:Hypersensitivity disease by system\") [t](https:\/\/en.wikipedia.org\/wiki\/Template_talk:Hypersensitivity_disease_by_system \"Template talk:Hypersensitivity disease by system\") [e](https:\/\/en.wikipedia.org\/wiki\/Special:EditPage\/Template:Hypersensitivity_disease_by_system \"Special:EditPage\/Template:Hypersensitivity disease by system\")[Allergies](https:\/\/en.wikipedia.org\/wiki\/Allergies \"Allergies\"), allergy-like conditions and symptoms |   |\n|---|---|\n| [Respiratory system](https:\/\/en.wikipedia.org\/wiki\/Respiratory_system \"Respiratory system\") | [Allergic rhinitis](https:\/\/en.wikipedia.org\/wiki\/Allergic_rhinitis \"Allergic rhinitis\") (hay fever) [Asthma](https:\/\/en.wikipedia.org\/wiki\/Asthma \"Asthma\") [Hypersensitivity pneumonitis](https:\/\/en.wikipedia.org\/wiki\/Hypersensitivity_pneumonitis \"Hypersensitivity pneumonitis\") [Eosinophilic pneumonia](https:\/\/en.wikipedia.org\/wiki\/Eosinophilic_pneumonia \"Eosinophilic pneumonia\") [Eosinophilic granulomatosis with polyangiitis](https:\/\/en.wikipedia.org\/wiki\/Eosinophilic_granulomatosis_with_polyangiitis \"Eosinophilic granulomatosis with polyangiitis\") [Allergic bronchopulmonary aspergillosis](https:\/\/en.wikipedia.org\/wiki\/Allergic_bronchopulmonary_aspergillosis \"Allergic bronchopulmonary aspergillosis\") [Farmer's lung](https:\/\/en.wikipedia.org\/wiki\/Farmer%27s_lung \"Farmer's lung\") [Laboratory animal allergy](https:\/\/en.wikipedia.org\/wiki\/Laboratory_animal_allergy \"Laboratory animal allergy\") |\n| [Skin](https:\/\/en.wikipedia.org\/wiki\/Integumentary_system \"Integumentary system\") | [Angioedema](https:\/\/en.wikipedia.org\/wiki\/Angioedema \"Angioedema\") [Urticaria](https:\/\/en.wikipedia.org\/wiki\/Urticaria \"Urticaria\") [Atopic dermatitis](https:\/\/en.wikipedia.org\/wiki\/Atopic_dermatitis \"Atopic dermatitis\") [Allergic contact dermatitis](https:\/\/en.wikipedia.org\/wiki\/Contact_dermatitis \"Contact dermatitis\") [Hypersensitivity vasculitis](https:\/\/en.wikipedia.org\/wiki\/Hypersensitivity_vasculitis \"Hypersensitivity vasculitis\") |\n| [Blood and immune system](https:\/\/en.wikipedia.org\/wiki\/Hematology \"Hematology\") | [Serum sickness](https:\/\/en.wikipedia.org\/wiki\/Serum_sickness \"Serum sickness\") |\n| [Circulatory system](https:\/\/en.wikipedia.org\/wiki\/Circulatory_system \"Circulatory system\") | [Anaphylaxis](https:\/\/en.wikipedia.org\/wiki\/Anaphylaxis \"Anaphylaxis\") |\n| [Digestive system](https:\/\/en.wikipedia.org\/wiki\/Human_digestive_system \"Human digestive system\") | [Coeliac disease](https:\/\/en.wikipedia.org\/wiki\/Coeliac_disease \"Coeliac disease\") [Eosinophilic gastroenteritis](https:\/\/en.wikipedia.org\/wiki\/Eosinophilic_gastroenteritis \"Eosinophilic gastroenteritis\") [Eosinophilic esophagitis](https:\/\/en.wikipedia.org\/wiki\/Eosinophilic_esophagitis \"Eosinophilic esophagitis\") [Food allergy](https:\/\/en.wikipedia.org\/wiki\/Food_allergy \"Food allergy\") [corn](https:\/\/en.wikipedia.org\/wiki\/Corn_allergy \"Corn allergy\") [eggs](https:\/\/en.wikipedia.org\/wiki\/Egg_allergy \"Egg allergy\") [fish](https:\/\/en.wikipedia.org\/wiki\/Fish_allergy \"Fish allergy\") [fruits](https:\/\/en.wikipedia.org\/wiki\/Fruit_allergy \"Fruit allergy\") [garlic](https:\/\/en.wikipedia.org\/wiki\/Garlic_allergy \"Garlic allergy\") meat [poultry](https:\/\/en.wikipedia.org\/wiki\/Poultry_allergy \"Poultry allergy\") [red meat](https:\/\/en.wikipedia.org\/wiki\/Alpha-gal_allergy \"Alpha-gal allergy\") [milk](https:\/\/en.wikipedia.org\/wiki\/Milk_allergy \"Milk allergy\") [peanuts](https:\/\/en.wikipedia.org\/wiki\/Peanut_allergy \"Peanut allergy\") [rice](https:\/\/en.wikipedia.org\/wiki\/Rice_allergy \"Rice allergy\") [sesame](https:\/\/en.wikipedia.org\/wiki\/Sesame_allergy \"Sesame allergy\") [shellfish]() [soy](https:\/\/en.wikipedia.org\/wiki\/Soy_allergy \"Soy allergy\") [tree nuts](https:\/\/en.wikipedia.org\/wiki\/Tree_nut_allergy \"Tree nut allergy\") [wheat](https:\/\/en.wikipedia.org\/wiki\/Wheat_allergy \"Wheat allergy\") |\n| [Nervous system](https:\/\/en.wikipedia.org\/wiki\/Nervous_system \"Nervous system\") | [Eosinophilic meningitis](https:\/\/en.wikipedia.org\/wiki\/Eosinophilic_meningitis \"Eosinophilic meningitis\") |\n| [Genitourinary system](https:\/\/en.wikipedia.org\/wiki\/Urinary_system \"Urinary system\") | [Acute interstitial nephritis](https:\/\/en.wikipedia.org\/wiki\/Interstitial_nephritis \"Interstitial nephritis\") |\n| Other conditions | [Drug allergy](https:\/\/en.wikipedia.org\/wiki\/Drug_allergy \"Drug allergy\") [Allergic conjunctivitis](https:\/\/en.wikipedia.org\/wiki\/Allergic_conjunctivitis \"Allergic conjunctivitis\") [Latex allergy](https:\/\/en.wikipedia.org\/wiki\/Latex_allergy \"Latex allergy\") [Dust mite allergy](https:\/\/en.wikipedia.org\/wiki\/Dust_mite_allergy \"Dust mite allergy\") |\n\n| [v](https:\/\/en.wikipedia.org\/wiki\/Template:Hypersensitivity_disease_by_cause \"Template:Hypersensitivity disease by cause\") [t](https:\/\/en.wikipedia.org\/wiki\/Template_talk:Hypersensitivity_disease_by_cause \"Template talk:Hypersensitivity disease by cause\") [e](https:\/\/en.wikipedia.org\/wiki\/Special:EditPage\/Template:Hypersensitivity_disease_by_cause \"Special:EditPage\/Template:Hypersensitivity disease by cause\")[Hypersensitivity](https:\/\/en.wikipedia.org\/wiki\/Hypersensitivity \"Hypersensitivity\") and [autoimmune diseases](https:\/\/en.wikipedia.org\/wiki\/Autoimmune_disease \"Autoimmune disease\") |   |\n|---|---|\n| [Type I](https:\/\/en.wikipedia.org\/wiki\/Type_I_hypersensitivity \"Type I hypersensitivity\")\/[allergy](https:\/\/en.wikipedia.org\/wiki\/Allergy \"Allergy\")\/[atopy](https:\/\/en.wikipedia.org\/wiki\/Atopy \"Atopy\") ([IgE](https:\/\/en.wikipedia.org\/wiki\/Immunoglobulin_E \"Immunoglobulin E\")) |   |\n|   |   |\n| Foreign | [Allergic asthma](https:\/\/en.wikipedia.org\/wiki\/Allergic_asthma \"Allergic asthma\") [Allergic urticaria](https:\/\/en.wikipedia.org\/wiki\/Allergic_urticaria \"Allergic urticaria\") [Allergic rhinitis](https:\/\/en.wikipedia.org\/wiki\/Allergic_rhinitis \"Allergic rhinitis\") (Hay fever) [Anaphylaxis](https:\/\/en.wikipedia.org\/wiki\/Anaphylaxis \"Anaphylaxis\") [Atopic dermatitis](https:\/\/en.wikipedia.org\/wiki\/Atopic_dermatitis \"Atopic dermatitis\") [Food allergy](https:\/\/en.wikipedia.org\/wiki\/Food_allergy \"Food allergy\") common allergies include: [Egg](https:\/\/en.wikipedia.org\/wiki\/Egg_allergy \"Egg allergy\") [Milk](https:\/\/en.wikipedia.org\/wiki\/Milk_allergy \"Milk allergy\") [Peanut](https:\/\/en.wikipedia.org\/wiki\/Peanut_allergy \"Peanut allergy\") [Seafood](https:\/\/en.wikipedia.org\/wiki\/Seafood_allergy \"Seafood allergy\") [Soy](https:\/\/en.wikipedia.org\/wiki\/Soy_allergy \"Soy allergy\") [Tree nut](https:\/\/en.wikipedia.org\/wiki\/Tree_nut_allergy \"Tree nut allergy\") [Wheat](https:\/\/en.wikipedia.org\/wiki\/Wheat_allergy \"Wheat allergy\") [Penicillin allergy](https:\/\/en.wikipedia.org\/wiki\/Side_effects_of_penicillin \"Side effects of penicillin\") |\n| Autoimmune | [Autoimmune urticaria](https:\/\/en.wikipedia.org\/wiki\/Autoimmune_urticaria \"Autoimmune urticaria\") [Eosinophilic esophagitis](https:\/\/en.wikipedia.org\/wiki\/Eosinophilic_esophagitis \"Eosinophilic esophagitis\") |\n| [Type II](https:\/\/en.wikipedia.org\/wiki\/Type_II_hypersensitivity \"Type II hypersensitivity\")\/[ADCC](https:\/\/en.wikipedia.org\/wiki\/Antibody-dependent_cellular_cytotoxicity \"Antibody-dependent cellular cytotoxicity\")  [IgG](https:\/\/en.wikipedia.org\/wiki\/Immunoglobulin_G \"Immunoglobulin G\") [IgM](https:\/\/en.wikipedia.org\/wiki\/Immunoglobulin_M \"Immunoglobulin M\") |   |\n|   |   |\n| Foreign | [Hemolytic disease of the newborn](https:\/\/en.wikipedia.org\/wiki\/Hemolytic_disease_of_the_newborn \"Hemolytic disease of the newborn\") |\n| Autoimmune |   |\n|   |   |\n| [Cytotoxic](https:\/\/en.wikipedia.org\/wiki\/Cytotoxicity \"Cytotoxicity\") | [Autoimmune hemolytic anemia](https:\/\/en.wikipedia.org\/wiki\/Autoimmune_hemolytic_anemia \"Autoimmune hemolytic anemia\") [Bullous pemphigoid](https:\/\/en.wikipedia.org\/wiki\/Bullous_pemphigoid \"Bullous pemphigoid\") [Goodpasture syndrome](https:\/\/en.wikipedia.org\/wiki\/Goodpasture_syndrome \"Goodpasture syndrome\") [Guillain–Barré syndrome](https:\/\/en.wikipedia.org\/wiki\/Guillain%E2%80%93Barr%C3%A9_syndrome \"Guillain–Barré syndrome\") [Immune thrombocytopenic purpura](https:\/\/en.wikipedia.org\/wiki\/Immune_thrombocytopenic_purpura \"Immune thrombocytopenic purpura\") [Pemphigus vulgaris](https:\/\/en.wikipedia.org\/wiki\/Pemphigus_vulgaris \"Pemphigus vulgaris\") [Rheumatic fever](https:\/\/en.wikipedia.org\/wiki\/Rheumatic_fever \"Rheumatic fever\") |\n| \"[Type V](https:\/\/en.wikipedia.org\/wiki\/Hypersensitivity#Type_V \"Hypersensitivity\")\"\/[receptor](https:\/\/en.wikipedia.org\/wiki\/Receptor_\\(biochemistry\\) \"Receptor (biochemistry)\") | [Graves' disease](https:\/\/en.wikipedia.org\/wiki\/Graves%27_disease \"Graves' disease\") [Myasthenia gravis](https:\/\/en.wikipedia.org\/wiki\/Myasthenia_gravis \"Myasthenia gravis\") [Pernicious anemia](https:\/\/en.wikipedia.org\/wiki\/Pernicious_anemia \"Pernicious anemia\") |\n| [Type III](https:\/\/en.wikipedia.org\/wiki\/Type_III_hypersensitivity \"Type III hypersensitivity\") ([Immune complex](https:\/\/en.wikipedia.org\/wiki\/Immune_complex \"Immune complex\")) |   |\n|   |   |\n| Foreign | [Arthus reaction](https:\/\/en.wikipedia.org\/wiki\/Arthus_reaction \"Arthus reaction\") [Farmer's lung](https:\/\/en.wikipedia.org\/wiki\/Farmer%27s_lung \"Farmer's lung\") [Henoch–Schönlein purpura](https:\/\/en.wikipedia.org\/wiki\/Henoch%E2%80%93Sch%C3%B6nlein_purpura \"Henoch–Schönlein purpura\") [Hypersensitivity vasculitis](https:\/\/en.wikipedia.org\/wiki\/Cutaneous_small-vessel_vasculitis \"Cutaneous small-vessel vasculitis\") [Post-streptococcal glomerulonephritis](https:\/\/en.wikipedia.org\/wiki\/Acute_proliferative_glomerulonephritis \"Acute proliferative glomerulonephritis\") [Reactive arthritis](https:\/\/en.wikipedia.org\/wiki\/Reactive_arthritis \"Reactive arthritis\") [Serum sickness](https:\/\/en.wikipedia.org\/wiki\/Serum_sickness \"Serum sickness\") |\n| Autoimmune | [Lupus](https:\/\/en.wikipedia.org\/wiki\/Lupus \"Lupus\") [Rheumatoid arthritis](https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis \"Rheumatoid arthritis\") [Subacute bacterial endocarditis](https:\/\/en.wikipedia.org\/wiki\/Subacute_bacterial_endocarditis \"Subacute bacterial endocarditis\") |\n| [Type IV](https:\/\/en.wikipedia.org\/wiki\/Type_IV_hypersensitivity \"Type IV hypersensitivity\")\/[cell-mediated](https:\/\/en.wikipedia.org\/wiki\/Cell-mediated_immunity \"Cell-mediated immunity\") ([T cells](https:\/\/en.wikipedia.org\/wiki\/T_cell \"T cell\")) |   |\n|   |   |\n| Foreign | [Allergic contact dermatitis](https:\/\/en.wikipedia.org\/wiki\/Allergic_contact_dermatitis \"Allergic contact dermatitis\") [Mantoux test](https:\/\/en.wikipedia.org\/wiki\/Mantoux_test \"Mantoux test\") |\n| Autoimmune | [Coeliac disease](https:\/\/en.wikipedia.org\/wiki\/Coeliac_disease \"Coeliac disease\") [Giant cell arteritis](https:\/\/en.wikipedia.org\/wiki\/Giant_cell_arteritis \"Giant cell arteritis\") [Hashimoto's thyroiditis](https:\/\/en.wikipedia.org\/wiki\/Hashimoto%27s_thyroiditis \"Hashimoto's thyroiditis\") [Multiple sclerosis](https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis \"Multiple sclerosis\") [Postorgasmic illness syndrome](https:\/\/en.wikipedia.org\/wiki\/Postorgasmic_illness_syndrome \"Postorgasmic illness syndrome\") [Reactive arthritis](https:\/\/en.wikipedia.org\/wiki\/Reactive_arthritis \"Reactive arthritis\") [Type 1 diabetes](https:\/\/en.wikipedia.org\/wiki\/Type_1_diabetes \"Type 1 diabetes\") |\n| [GVHD](https:\/\/en.wikipedia.org\/wiki\/Graft-versus-host_disease \"Graft-versus-host disease\") | [Transfusion-associated graft-versus-host disease](https:\/\/en.wikipedia.org\/wiki\/Transfusion-associated_graft-versus-host_disease \"Transfusion-associated graft-versus-host disease\") |\n| Unknown\/ multiple |   |\n|   |   |\n| Foreign | [Hypersensitivity pneumonitis](https:\/\/en.wikipedia.org\/wiki\/Hypersensitivity_pneumonitis \"Hypersensitivity pneumonitis\") [Allergic bronchopulmonary aspergillosis](https:\/\/en.wikipedia.org\/wiki\/Allergic_bronchopulmonary_aspergillosis \"Allergic bronchopulmonary aspergillosis\") [Latex allergy](https:\/\/en.wikipedia.org\/wiki\/Latex_allergy \"Latex allergy\") (I+IV) [Transplant rejection](https:\/\/en.wikipedia.org\/wiki\/Transplant_rejection \"Transplant rejection\") |\n| Autoimmune | [Autoimmune adrenalitis](https:\/\/en.wikipedia.org\/wiki\/Addison%27s_disease \"Addison's disease\") [Autoimmune hepatitis](https:\/\/en.wikipedia.org\/wiki\/Autoimmune_hepatitis \"Autoimmune hepatitis\") [Autoimmune polyendocrine syndrome](https:\/\/en.wikipedia.org\/wiki\/Autoimmune_polyendocrine_syndrome \"Autoimmune polyendocrine syndrome\") [APS1](https:\/\/en.wikipedia.org\/wiki\/Autoimmune_polyendocrine_syndrome_type_1 \"Autoimmune polyendocrine syndrome type 1\") [APS2](https:\/\/en.wikipedia.org\/wiki\/Autoimmune_polyendocrine_syndrome_type_2 \"Autoimmune polyendocrine syndrome type 2\") [Sjögren syndrome](https:\/\/en.wikipedia.org\/wiki\/Sj%C3%B6gren_syndrome \"Sjögren syndrome\") [Systemic autoimmune disease](https:\/\/en.wikipedia.org\/wiki\/Autoimmune_disease \"Autoimmune disease\") |\n\n![](https:\/\/en.wikipedia.org\/wiki\/Special:CentralAutoLogin\/start?type=1x1&usesul3=1)\n\nRetrieved from \"<https:\/\/en.wikipedia.org\/w\/index.php?title=Shellfish_allergy&oldid=1292971393>\"\n\n[Category](https:\/\/en.wikipedia.org\/wiki\/Help:Category \"Help:Category\"):\n\n- [Food allergies](https:\/\/en.wikipedia.org\/wiki\/Category:Food_allergies \"Category:Food allergies\")\n\nHidden categories:\n\n- [Webarchive template wayback links](https:\/\/en.wikipedia.org\/wiki\/Category:Webarchive_template_wayback_links \"Category:Webarchive template wayback links\")\n- [CS1 maint: DOI inactive as of November 2024](https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_DOI_inactive_as_of_November_2024 \"Category:CS1 maint: DOI inactive as of November 2024\")\n- [Articles with short description](https:\/\/en.wikipedia.org\/wiki\/Category:Articles_with_short_description \"Category:Articles with short description\")\n- [Short description is different from 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Boilerpipe Text	Type of food allergy caused by shellfish Shellfish allergy is among the most common food allergies . " Shellfish " is a colloquial and fisheries term for aquatic invertebrates used as food , including various species of molluscs such as clams , mussels , oysters and scallops , crustaceans such as shrimp , lobsters and crabs , and cephalopods such as squid and octopus . However, scientifically these groups are in completely different Phyla and some in different Classes. Clams, mussels, oysters, and scallops are in the Phylum Mollusca and Class Bivalvia, squid and octopus are in the Class Cephalopoda. Crustaceans are in the Phylum Arthropoda and Class Crustacea. Their chemistry is different and to understand the underlying mechanisms of various allergies to these animals requires an understanding of the diversity of the different proteins found and a knowledge of their proper scientific name and classification. Shellfish allergy is an immune hypersensitivity to proteins found in shellfish. Symptoms can be either rapid or gradual in onset. The latter can take hours to days to appear. The former may include anaphylaxis , a potentially life-threatening condition which requires treatment with epinephrine . Other presentations may include atopic dermatitis or inflammation of the esophagus . [ 2 ] Shellfish is one of the eight common food allergens, responsible for 90% of allergic reactions to foods: cow's milk , eggs , wheat , shellfish , peanuts , tree nuts , fish, and soy beans . [ 3 ] [ 4 ] Unlike early childhood allergic reactions to milk and eggs, which often lessen as the children age, [ 5 ] shellfish allergy tends to first appear in school-age children and older, and persist in adulthood. [ 6 ] Strong predictors for adult-persistence are anaphylaxis, high shellfish-specific serum immunoglobulin E (IgE) and robust response to the skin prick test. Adult onset of shellfish allergy is common in workers in the shellfish catching and processing industry. [ 7 ] [ 8 ] Signs and symptoms of anaphylaxis Food allergy symptoms usually occur within minutes after exposure but can be delayed to hours depending on the nature of the immune system response. [ 9 ] Symptoms may include rash, hives , itching of mouth, lips, tongue, throat, eyes, skin, or other areas, swelling of lips, tongue, eyelids, or the whole face, difficulty swallowing, runny or congested nose, hoarse voice, wheezing, shortness of breath, diarrhea, abdominal pain, lightheadedness, fainting, nausea, or vomiting. [ 9 ] Symptoms of allergies vary from person to person and may vary from incident to incident. [ 9 ] Serious danger regarding allergies can begin when the respiratory tract or blood circulation is affected. The former can be indicated by wheezing, a blocked airway and cyanosis , and the latter by weak pulse, pale skin, and fainting. When these symptoms occur the allergic reaction is called anaphylaxis . [ 9 ] Anaphylaxis occurs when IgE antibodies are involved, [ 10 ] and areas of the body that are not in direct contact with the food become affected and show severe symptoms. [ 9 ] [ 11 ] Untreated, this can proceed to vasodilation , a low blood pressure situation called anaphylactic shock . [ 11 ] The cause is typically the eating of shellfish or foods that contain shellfish. The shellfish types causing clinical allergy are, in decreasing incidence: Shrimp Crab Lobster Clam Oyster Mussel. [ 12 ] Once an allergic reaction has occurred it usually remains a lifelong sensitivity. [ 13 ] The immune system overreacts to proteins found in shellfish, most commonly to tropomyosin , but often to other proteins, such as arginine kinase , myosin light chain and sarcoplasmic calcium-binding protein. [ 14 ] [ 15 ] [ 16 ] The allergic reaction to fish is to a different protein, parvalbumin ; there is no cross-reactivity between fish and shellfish allergy. [ 6 ] [ 17 ] [ 18 ] Cross-contact, also referred to as cross-contamination, occurs when foods are being processed in factories or at food markets, or are being prepared for cooking in restaurants and home kitchens. The allergenic proteins are transferred from one food to another. [ 19 ] The food-borne parasite Anisakis is a genus of nematodes known to be present in squid . [ 20 ] Anisakis are directly infective to humans whenever infected squid (or marine fish) are consumed raw or slightly processed, causing a condition called anisakiasis . Symptoms from consuming live nematodes include severe abdominal pain, nausea , and vomiting. [ 21 ] In addition, there can be an allergic reaction to Anisakis proteins, even if the food in question was frozen or cooked before being consumed, killing the nematodes, as some of the nematode proteins are resistant to cold and heat. [ 20 ] Allergic reactions can include hives, asthma and true anaphylactic reactions. [ 13 ] [ 22 ] Occupational exposure [ edit ] An industry review conducted in 1990 estimated that 28.5 million people worldwide were engaged in some aspect of the seafood industry: fishing, aquaculture, processing and industrial cooking. [ 23 ] Men predominate in fishing, women in processing facilities. [ 7 ] Exposure to shellfish allergenic proteins includes inhalation of wet aerosols from fresh shellfish handling, and dermal contact through skin breaks and cuts. [ 7 ] [ 8 ] Prevalence of seafood-induced adult asthma is reported as in the range of 7% to 36% (higher for crustaceans and lower for bony fish). [ 8 ] Prevalence of skin allergy reactions, often characterized by itchy rash (hives), range from 3% to 11%. [ 8 ] The shellfish-induced health outcomes are mainly due to the protein tropomyosin causing an IgE mediated immune system response. [ 7 ] [ 8 ] Cross-reactivity to non-shellfish [ edit ] Tropomyosin , the major allergen in shellfish allergy, is also found in dust mites and cockroaches . [ 15 ] [ 16 ] Exposure to inhaled tropomyosins from dust mites is thought to be the primary sensitizer for shellfish allergy, an example of inhalant-to-food cross-reactivity. [ 24 ] Epidemiological surveys have confirmed correlation between shellfish and dust mite sensitizations. [ 25 ] An additional confirmation was seen in Orthodox Jews with no history of shellfish consumption, in that skin tests confirming dust mite allergy were also positive for shellfish tropomyosin. [ 15 ] [ 25 ] In addition to tropomyosin, arginine kinase and hemocyanin seem to have a role in cross-reactivity to dust mites. [ 14 ] Exercise as contributing factor [ edit ] Exercise can be a contributing factor to an allergic food response. There is a condition called food-dependent, exercise-induced anaphylaxis. [ 26 ] [ 27 ] For people with this condition, exercise alone is not sufficient, nor is consumption of a food to which they are mildly allergic, but when the food in question is consumed within a few hours before high-intensity exercise, the result can be anaphylaxis. Shellfish are specifically mentioned as a causative food. [ 26 ] [ 27 ] [ 28 ] One theory is that exercise is stimulating the release of mediators such as histamine from IgE-activated mast cells. [ 28 ] Two of the reviews postulate that exercise is not essential for the development of symptoms, but rather that it is one of several augmentation factors, citing evidence that the culprit food in combination with alcohol or aspirin will result in a respiratory anaphylactic reaction. [ 26 ] [ 28 ] Conditions caused by food allergies are classified into three groups according to the mechanism of the allergic response: [ 4 ] IgE-mediated (classic) – the most common type, manifesting acute changes that occur shortly after eating, and may progress to anaphylaxis Non-IgE mediated – characterized by an immune response not involving immunoglobulin E ; may occur hours to days after eating, complicating diagnosis IgE and non-IgE-mediated – a hybrid of the above two types Allergic reactions are hyperactive responses of the immune system to generally innocuous substances, such as food proteins. [ 29 ] Why some proteins trigger allergic reactions while others do not is not entirely clear. One theory holds that proteins which resist digestion in the stomach, therefore reaching the small intestine relatively intact, are more likely to be allergenic, but studies have shown that digestion may abolish, decrease, have no effect, or even increase the allergenicity of food allergens. [ 30 ] The heat of cooking structurally degrades protein molecules, potentially making them less allergenic. [ 31 ] [ 32 ] The pathophysiology of allergic responses can be divided into two time periods: The first is an acute response that occurs within minutes after exposure to an allergen. [ 33 ] This phase can either subside or progress into a "late-phase reaction" which can substantially prolong the symptoms of a response, and result in more tissue damage hours later. [ 34 ] In the early stages of acute allergic reaction, lymphocytes previously sensitized to a specific protein or protein fraction react by quickly producing a particular type of antibody known as secreted IgE (sIgE), which circulates in the blood and binds to IgE-specific receptors on the surface of other kinds of immune cells called mast cells and basophils . Both of these are involved in the acute inflammatory response. [ 33 ] Activated mast cells and basophils undergo a process called degranulation , during which they release histamine and other inflammatory chemical mediators called ( cytokines , interleukins , leukotrienes , and prostaglandins ) into the surrounding tissue causing several systemic effects, such as vasodilation, mucous secretion, nerve stimulation, and smooth-muscle contraction. [ 33 ] This results in runny nose , itchiness, shortness of breath , and potentially anaphylaxis . [ 33 ] Depending on the individual, the allergen, and the mode of introduction, the symptoms can be system-wide (classical anaphylaxis), or localized to particular body systems; asthma is localized to the respiratory system while hives and eczema are localized to the skin. [ 33 ] In addition to reacting to oral consumption, skin and asthma reactions can be triggered by inhallation or contact if there are skin abrasions or cuts. [ 7 ] [ 8 ] Hives allergic reaction on arm After the chemical mediators of the acute response subside, late-phase responses can often occur due to the migration of other white blood cells such as neutrophils , lymphocytes , eosinophils , and macrophages to the initial reaction sites. This is usually seen 2–24 hours after the original reaction. [ 34 ] Cytokines from mast cells may also play a role in the persistence of long-term effects. Late-phase responses seen in asthma are slightly different from those seen in other allergic responses, although they are still caused by release of mediators from eosinophils. [ 35 ] In addition to IgE-mediated responses, shellfish allergy can manifest as atopic dermatitis , especially in infants and young children. [ 36 ] Some will display both, so that a child could react to an oral food challenge with allergic symptoms, followed a day or two later with a flare up of atopic dermatitis and/or gastrointestinal symptoms, including allergic eosinophilic esophagitis . [ 37 ] Shellfish allergenic proteins [ edit ] Several proteins from shellfish are either clearly involved in allergenic reactions or suspected to be. Tropomyosin, arginine kinase, myosin light chain and sarcoplasmic calcium-binding protein are widely present across shellfish species. [ 14 ] [ 15 ] [ 16 ] [ 38 ] Troponin , actin , triosephosphate isomerase and hemocyanin are also identified as allergenic proteins. [ 1 ] [ 15 ] As of a 2016 review, only three (tropomyosin, arginine kinase and sarcoplasmic calcium-binding protein) were available for routine diagnostic skin testing. [ 15 ] Shellfish do not manifest the proteins β-parvalbumin (found in bony fishes) or α-parvalbumin (found in cartilaginous fishes such as sharks and rays), so there is not cross-reactivity of shellfish allergy to fish allergy. [ 6 ] [ 17 ] [ 18 ] Diagnosis of shellfish allergy is based on the person's history of allergic reactions, skin prick test and measurement of shellfish-specific serum immunoglobulin E (IgE or sIgE). Confirmation is by double-blind, placebo-controlled food challenges. [ 17 ] Self-reported shellfish allergy often fails to be confirmed by food challenge. [ 39 ] Reviews of food allergens in general stated that introducing solid foods at 4–6 months may result in the lowest subsequent allergy risks for eczema, allergic rhinitis and more severe reactions. [ 40 ] The evidence is best for peanuts, eggs and milk. [ 41 ] The literature is sparse for consequences of early introduction of shellfish. [ 41 ] Epinephrine autoinjectors are portable single-dose epinephrine-dispensing devices used to treat anaphylaxis. Treatment for accidental ingestion of shellfish products by allergic individuals varies depending on the sensitivity of the person. An antihistamine such as diphenhydramine may be prescribed. Sometimes prednisone will be prescribed to prevent a possible late phase Type I hypersensitivity reaction. [ 42 ] Severe allergic reactions (anaphalaxis) may require treatment with an epinephrine pen , which is an injection device designed to be used by a non-healthcare professional when emergency treatment is warranted. [ 43 ] Unlike for egg allergy, for which there is active research on trying oral immunotherapy (OIT) to desensitize people to egg allergens, [ 44 ] reviews mention that there are no published clinical trials evaluating oral immunotherapy for shellfish allergy. [ 6 ] [ 12 ] Unlike milk and egg allergies, [ 5 ] [ 45 ] shellfish allergy usually persists into adulthood. [ 12 ] [ 13 ] Incidence and prevalence are terms commonly used in describing disease epidemiology . Incidence is newly diagnosed cases, which can be expressed as new cases per year per million people. Prevalence is the number of cases alive, expressible as existing cases per million people during a period of time. [ 46 ] Worldwide, the prevalence of shellfish allergy is increasing because shellfish consumption is increasing, [ 47 ] and among adults shellfish is the most common anaphylaxis-eliciting food. [ 12 ] Reviews cite self-reported shellfish allergy in range of 0.5 to 2.5 percent in the general population. [ 1 ] [ 39 ] [ 48 ] Prevalence is higher in coastal southeast Asian countries, where shellfish consumption is more common. [ 1 ] [ 12 ] [ 49 ] [ 50 ] Self-reported allergy prevalence is always higher than food-challenge confirmed allergy, which one review put at 0% to 0.9% (the higher value in southeast Asia). [ 51 ] Whether food allergy prevalence is increasing or not, food allergy awareness has increased, with impacts on the quality of life for children, their parents and their immediate caregivers. [ 52 ] [ 53 ] [ 54 ] [ 55 ] In the United States, the Food Allergen Labeling and Consumer Protection Act (FALCPA), made law in August 2004, effective January 1, 2006, [ 56 ] causes people to be reminded of allergy problems every time they handle a food package. Although not regulated under FALCPA, restaurants have added allergen warnings to menus. The Culinary Institute of America , a premier school for chef training, has courses in allergen-free cooking and a separate teaching kitchen. [ 57 ] School systems have protocols about what foods can be brought into the school. Despite all these precautions, people with serious allergies are aware that accidental exposure can easily occur at other peoples' houses, at school or in restaurants. [ 58 ] Regulation of labeling [ edit ] An example of "MAY CONTAIN TRACES OF..." as a means of listing trace amounts of allergens in a food product due to cross-contamination during manufacture. In response to the risk that certain foods pose to those with food allergies, some countries have responded by instituting labeling laws that require food products to clearly inform consumers if their products contain major allergens or byproducts of major allergens among the ingredients intentionally added to foods. Laws and regulations passed in the US and by the European Union recommend labeling but do not require mandatory declaration of the presence of trace amounts in the final product as a consequence of unintentional cross-contamination. [ 56 ] [ 59 ] [ 60 ] Ingredients intentionally added [ edit ] FALCPA requires companies to disclose on the label whether a packaged food product contains any of these eight major food allergens, added intentionally: cow's milk, peanuts, eggs, shellfish, fish, tree nuts, soy and wheat. [ 56 ] This list originated in 1999 from the World Health Organisation Codex Alimentarius Commission. [ 61 ] To meet FALCPA labeling requirements, if an ingredient is derived from one of the required-label allergens, then it must either have its "food sourced name" in parentheses, for example "Casein (milk)," or as an alternative, there must be a statement separate but adjacent to the ingredients list: "Contains milk" (and any other of the allergens with mandatory labeling). [ 56 ] [ 60 ] The European Union requires listing for those eight major allergens plus molluscs, celery , mustard, lupin, sesame and sulfites . [ 59 ] In Japan, a food-labeling system for five specific allergenic ingredients (egg, milk, wheat, buckwheat, peanut) was mandated under law on April 1, 2002. Additional labeling of shrimp/prawn and crab became mandatory in 2008. This applies to packaged food, but not to restaurants. [ 62 ]
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From Wikipedia, the free encyclopedia Type of food allergy caused by shellfish Medical condition \| Shellfish allergy \| \| \|---\|---\| \| [![](https://upload.wikimedia.org/wikipedia/commons/thumb/9/9a/Seafood_on_platter.jpg/250px-Seafood_on_platter.jpg)](https://en.wikipedia.org/wiki/File:Seafood_on_platter.jpg) \| \| \| Shellfish (shrimp, crab legs, mussels) on platter \| \| \| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") \| [Immunology](https://en.wikipedia.org/wiki/Immunology "Immunology") [![Edit this on Wikidata](https://upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https://www.wikidata.org/wiki/Q23037743?uselang=en#P1995 "Edit this on Wikidata") \| \| Frequency \| Shellfish allergy frequency estimated at ~0.5-2.5% (self-reported)[\[1\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Khora2016-1) \| Shellfish allergy is among the most common [food allergies](https://en.wikipedia.org/wiki/Food_allergy "Food allergy"). "[Shellfish](https://en.wikipedia.org/wiki/Shellfish "Shellfish")" is a colloquial and [fisheries](https://en.wikipedia.org/wiki/Fisheries "Fisheries") term for [aquatic](https://en.wikipedia.org/wiki/Aquatic_animal "Aquatic animal") [invertebrates](https://en.wikipedia.org/wiki/Invertebrate "Invertebrate") used as [food](https://en.wikipedia.org/wiki/Food "Food"), including various species of [molluscs](https://en.wikipedia.org/wiki/Mollusca "Mollusca") such as [clams](https://en.wikipedia.org/wiki/Clam "Clam"), [mussels](https://en.wikipedia.org/wiki/Mussel "Mussel"), [oysters](https://en.wikipedia.org/wiki/Oyster "Oyster") and [scallops](https://en.wikipedia.org/wiki/Scallop "Scallop"), [crustaceans](https://en.wikipedia.org/wiki/Crustacean "Crustacean") such as [shrimp](https://en.wikipedia.org/wiki/Shrimp "Shrimp"), [lobsters](https://en.wikipedia.org/wiki/Lobster "Lobster") and [crabs](https://en.wikipedia.org/wiki/Crab "Crab"), and [cephalopods](https://en.wikipedia.org/wiki/Cephalopod "Cephalopod") such as [squid](https://en.wikipedia.org/wiki/Squid "Squid") and [octopus](https://en.wikipedia.org/wiki/Octopus "Octopus"). However, scientifically these groups are in completely different Phyla and some in different Classes. Clams, mussels, oysters, and scallops are in the Phylum Mollusca and Class Bivalvia, squid and octopus are in the Class Cephalopoda. Crustaceans are in the Phylum Arthropoda and Class Crustacea. Their chemistry is different and to understand the underlying mechanisms of various allergies to these animals requires an understanding of the diversity of the different proteins found and a knowledge of their proper scientific name and classification. Shellfish allergy is an [immune hypersensitivity](https://en.wikipedia.org/wiki/Immune_hypersensitivity "Immune hypersensitivity") to [proteins](https://en.wikipedia.org/wiki/Protein "Protein") found in shellfish. Symptoms can be either rapid or gradual in onset. The latter can take hours to days to appear. The former may include [anaphylaxis](https://en.wikipedia.org/wiki/Anaphylaxis "Anaphylaxis"), a potentially life-threatening condition which requires treatment with [epinephrine](https://en.wikipedia.org/wiki/Epinephrine_\(medication\) "Epinephrine (medication)"). Other presentations may include [atopic dermatitis](https://en.wikipedia.org/wiki/Atopic_dermatitis "Atopic dermatitis") or [inflammation of the esophagus](https://en.wikipedia.org/wiki/Allergic_eosinophilic_esophagitis "Allergic eosinophilic esophagitis").[\[2\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-2) Shellfish is one of the eight common food allergens, responsible for 90% of allergic reactions to foods: [cow's milk](https://en.wikipedia.org/wiki/Milk "Milk"), [eggs](https://en.wikipedia.org/wiki/Egg_\(food\) "Egg (food)"), [wheat](https://en.wikipedia.org/wiki/Wheat "Wheat"), [shellfish](https://en.wikipedia.org/wiki/Crustacea "Crustacea"), [peanuts](https://en.wikipedia.org/wiki/Peanut "Peanut"), [tree nuts](https://en.wikipedia.org/wiki/Tree_nuts "Tree nuts"), fish, and [soy beans](https://en.wikipedia.org/wiki/Soy "Soy").[\[3\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-3)[\[4\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-NHS-4) Unlike early childhood allergic reactions to milk and eggs, which often lessen as the children age,[\[5\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Urisu2014-5) shellfish allergy tends to first appear in school-age children and older, and persist in adulthood.[\[6\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Thal2015-6) Strong predictors for adult-persistence are anaphylaxis, high shellfish-specific serum [immunoglobulin E](https://en.wikipedia.org/wiki/Immunoglobulin_E "Immunoglobulin E") (IgE) and robust response to the skin prick test. Adult onset of shellfish allergy is common in workers in the shellfish catching and processing industry.[\[7\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2013-7)[\[8\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Jeebhay2001-8) ## Signs and symptoms \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=1 "Edit section: Signs and symptoms")\] [![Signs and symptoms of anaphylaxis](https://upload.wikimedia.org/wikipedia/commons/thumb/7/71/Signs_and_symptoms_of_anaphylaxis.png/500px-Signs_and_symptoms_of_anaphylaxis.png)](https://en.wikipedia.org/wiki/File:Signs_and_symptoms_of_anaphylaxis.png "Signs and symptoms of anaphylaxis") Signs and symptoms of anaphylaxis Food allergy symptoms usually occur within minutes after exposure but can be delayed to hours depending on the nature of the immune system response.[\[9\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-medlineplus-9) Symptoms may include rash, [hives](https://en.wikipedia.org/wiki/Hives "Hives"), itching of mouth, lips, tongue, throat, eyes, skin, or other areas, swelling of lips, tongue, eyelids, or the whole face, difficulty swallowing, runny or congested nose, hoarse voice, wheezing, shortness of breath, diarrhea, abdominal pain, lightheadedness, fainting, nausea, or vomiting.[\[9\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-medlineplus-9) Symptoms of allergies vary from person to person and may vary from incident to incident.[\[9\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-medlineplus-9) Serious danger regarding allergies can begin when the respiratory tract or blood circulation is affected. The former can be indicated by wheezing, a blocked airway and [cyanosis](https://en.wikipedia.org/wiki/Cyanosis "Cyanosis"), and the latter by weak pulse, pale skin, and fainting. When these symptoms occur the allergic reaction is called [anaphylaxis](https://en.wikipedia.org/wiki/Anaphylaxis "Anaphylaxis").[\[9\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-medlineplus-9) Anaphylaxis occurs when [IgE antibodies](https://en.wikipedia.org/wiki/IgE_antibodies "IgE antibodies") are involved,[\[10\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-10) and areas of the body that are not in direct contact with the food become affected and show severe symptoms.[\[9\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-medlineplus-9)[\[11\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Sicherer2014-11) Untreated, this can proceed to [vasodilation](https://en.wikipedia.org/wiki/Vasodilation "Vasodilation"), a low blood pressure situation called [anaphylactic shock](https://en.wikipedia.org/wiki/Anaphylactic_shock "Anaphylactic shock").[\[11\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Sicherer2014-11) ## Causes \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=2 "Edit section: Causes")\] ### Eating shellfish \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=3 "Edit section: Eating shellfish")\] The cause is typically the eating of shellfish or foods that contain shellfish. The shellfish types causing clinical allergy are, in decreasing incidence: - Shrimp - Crab - Lobster - Clam - Oyster - Mussel.[\[12\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Wai2020-12) Once an allergic reaction has occurred it usually remains a lifelong sensitivity.[\[13\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Prester2016-13) The immune system overreacts to proteins found in shellfish, most commonly to [tropomyosin](https://en.wikipedia.org/wiki/Tropomyosin "Tropomyosin"), but often to other proteins, such as [arginine kinase](https://en.wikipedia.org/wiki/Arginine_kinase "Arginine kinase"), [myosin light chain](https://en.wikipedia.org/wiki/Myosin_light_chain "Myosin light chain") and sarcoplasmic calcium-binding protein.[\[14\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Gelis2020-14)[\[15\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2016-15)[\[16\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Pedrosa2015-16) The allergic reaction to fish is to a different protein, [parvalbumin](https://en.wikipedia.org/wiki/Parvalbumin "Parvalbumin"); there is no cross-reactivity between fish and shellfish allergy.[\[6\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Thal2015-6)[\[17\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Tong2018-17)[\[18\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Ruethers2018-18) ### Cross-contact \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=4 "Edit section: Cross-contact")\] Cross-contact, also referred to as cross-contamination, occurs when foods are being processed in factories or at food markets, or are being prepared for cooking in restaurants and home kitchens. The allergenic proteins are transferred from one food to another.[\[19\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-19) ### Shellfish parasite \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=5 "Edit section: Shellfish parasite")\] The food-borne parasite [Anisakis](https://en.wikipedia.org/wiki/Anisakis "Anisakis") is a genus of [nematodes](https://en.wikipedia.org/wiki/Nematode "Nematode") known to be present in [squid](https://en.wikipedia.org/wiki/Squid "Squid").[\[20\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Morozin2019-20) Anisakis are directly infective to humans whenever infected squid (or marine fish) are consumed raw or slightly processed, causing a condition called [anisakiasis](https://en.wikipedia.org/wiki/Shellfish_allergy#Anisakiasis). Symptoms from consuming live nematodes include severe abdominal pain, [nausea](https://en.wikipedia.org/wiki/Nausea "Nausea"), and vomiting.[\[21\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Aibinu2019-21) In addition, there can be an allergic reaction to Anisakis proteins, even if the food in question was frozen or cooked before being consumed, killing the nematodes, as some of the nematode proteins are resistant to cold and heat.[\[20\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Morozin2019-20) Allergic reactions can include hives, asthma and true anaphylactic reactions.[\[13\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Prester2016-13)[\[22\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Audicana-22) ### Occupational exposure \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=6 "Edit section: Occupational exposure")\] An industry review conducted in 1990 estimated that 28.5 million people worldwide were engaged in some aspect of the seafood industry: fishing, aquaculture, processing and industrial cooking.[\[23\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-23) Men predominate in fishing, women in processing facilities.[\[7\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2013-7) Exposure to shellfish allergenic proteins includes inhalation of wet [aerosols](https://en.wikipedia.org/wiki/Aerosol "Aerosol") from fresh shellfish handling, and dermal contact through skin breaks and cuts.[\[7\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2013-7)[\[8\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Jeebhay2001-8) Prevalence of seafood-induced adult asthma is reported as in the range of 7% to 36% (higher for [crustaceans](https://en.wikipedia.org/wiki/Crustaceans "Crustaceans") and lower for bony fish).[\[8\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Jeebhay2001-8) Prevalence of skin allergy reactions, often characterized by itchy rash (hives), range from 3% to 11%.[\[8\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Jeebhay2001-8) The shellfish-induced health outcomes are mainly due to the protein [tropomyosin](https://en.wikipedia.org/wiki/Tropomyosin "Tropomyosin") causing an IgE mediated immune system response.[\[7\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2013-7)[\[8\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Jeebhay2001-8) ### Cross-reactivity to non-shellfish \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=7 "Edit section: Cross-reactivity to non-shellfish")\] [Tropomyosin](https://en.wikipedia.org/wiki/Tropomyosin "Tropomyosin"), the major allergen in shellfish allergy, is also found in [dust mites](https://en.wikipedia.org/wiki/House_dust_mites "House dust mites") and [cockroaches](https://en.wikipedia.org/wiki/Cockroach "Cockroach").[\[15\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2016-15)[\[16\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Pedrosa2015-16) Exposure to inhaled tropomyosins from dust mites is thought to be the primary sensitizer for shellfish allergy, an example of inhalant-to-food cross-reactivity.[\[24\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Wong2019-24) Epidemiological surveys have confirmed correlation between shellfish and dust mite sensitizations.[\[25\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Wong2016-25) An additional confirmation was seen in Orthodox Jews with no history of shellfish consumption, in that skin tests confirming [dust mite allergy](https://en.wikipedia.org/wiki/Dust_mite_allergy "Dust mite allergy") were also positive for shellfish tropomyosin.[\[15\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2016-15)[\[25\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Wong2016-25) In addition to tropomyosin, arginine kinase and [hemocyanin](https://en.wikipedia.org/wiki/Hemocyanin "Hemocyanin") seem to have a role in cross-reactivity to dust mites.[\[14\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Gelis2020-14) ### Exercise as contributing factor \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=8 "Edit section: Exercise as contributing factor")\] Exercise can be a contributing factor to an allergic food response. There is a condition called food-dependent, exercise-induced anaphylaxis.[\[26\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Feldweg2017-26)[\[27\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Pravettoni2016-27) For people with this condition, exercise alone is not sufficient, nor is consumption of a food to which they are mildly allergic, but when the food in question is consumed within a few hours before high-intensity exercise, the result can be anaphylaxis. Shellfish are specifically mentioned as a causative food.[\[26\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Feldweg2017-26)[\[27\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Pravettoni2016-27)[\[28\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Kim2013-28) One theory is that exercise is stimulating the release of mediators such as histamine from IgE-activated mast cells.[\[28\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Kim2013-28) Two of the reviews postulate that exercise is not essential for the development of symptoms, but rather that it is one of several augmentation factors, citing evidence that the culprit food in combination with alcohol or aspirin will result in a respiratory anaphylactic reaction.[\[26\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Feldweg2017-26)[\[28\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Kim2013-28) ## Mechanisms \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=9 "Edit section: Mechanisms")\] ### Allergic response \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=10 "Edit section: Allergic response")\] Conditions caused by food allergies are classified into three groups according to the mechanism of the allergic response:[\[4\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-NHS-4) 1. IgE-mediated (classic) – the most common type, manifesting acute changes that occur shortly after eating, and may progress to [anaphylaxis](https://en.wikipedia.org/wiki/Anaphylaxis "Anaphylaxis") 2. Non-IgE mediated – characterized by an immune response not involving [immunoglobulin E](https://en.wikipedia.org/wiki/Immunoglobulin_E "Immunoglobulin E"); may occur hours to days after eating, complicating diagnosis 3. IgE and non-IgE-mediated – a hybrid of the above two types [Allergic reactions](https://en.wikipedia.org/wiki/Allergic_reactions "Allergic reactions") are hyperactive responses of the immune system to generally innocuous substances, such as food proteins.[\[29\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Con2007-29) Why some proteins trigger allergic reactions while others do not is not entirely clear. One theory holds that proteins which resist digestion in the stomach, therefore reaching the small intestine relatively intact, are more likely to be allergenic, but studies have shown that digestion may abolish, decrease, have no effect, or even increase the allergenicity of food allergens.[\[30\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-30) The heat of cooking structurally degrades protein molecules, potentially making them less allergenic.[\[31\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-31)[\[32\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-32) The [pathophysiology](https://en.wikipedia.org/wiki/Pathophysiology "Pathophysiology") of allergic responses can be divided into two time periods: The first is an [acute response](https://en.wikipedia.org/wiki/Acute_\(medical\) "Acute (medical)") that occurs within minutes after exposure to an allergen.[\[33\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Janeway-33) This phase can either subside or progress into a "late-phase reaction" which can substantially prolong the symptoms of a response, and result in more tissue damage hours later.[\[34\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Grimbaldeston2006-34) In the early stages of acute allergic reaction, [lymphocytes](https://en.wikipedia.org/wiki/Lymphocyte "Lymphocyte") previously sensitized to a specific protein or protein fraction react by quickly producing a particular type of antibody known as secreted IgE (sIgE), which circulates in the blood and binds to IgE-specific receptors on the surface of other kinds of immune cells called [mast cells](https://en.wikipedia.org/wiki/Mast_cell "Mast cell") and [basophils](https://en.wikipedia.org/wiki/Basophil "Basophil"). Both of these are involved in the acute inflammatory response.[\[33\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Janeway-33) Activated mast cells and basophils undergo a process called [degranulation](https://en.wikipedia.org/wiki/Degranulation "Degranulation"), during which they release [histamine](https://en.wikipedia.org/wiki/Histamine "Histamine") and other inflammatory chemical mediators called ([cytokines](https://en.wikipedia.org/wiki/Cytokine "Cytokine"), [interleukins](https://en.wikipedia.org/wiki/Interleukin "Interleukin"), [leukotrienes](https://en.wikipedia.org/wiki/Leukotriene "Leukotriene"), and [prostaglandins](https://en.wikipedia.org/wiki/Prostaglandin "Prostaglandin")) into the surrounding tissue causing several systemic effects, such as vasodilation, [mucous](https://en.wikipedia.org/wiki/Mucous_membrane "Mucous membrane") secretion, [nerve](https://en.wikipedia.org/wiki/Nerve "Nerve") stimulation, and [smooth-muscle](https://en.wikipedia.org/wiki/Smooth_muscle "Smooth muscle") contraction.[\[33\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Janeway-33) This results in [runny nose](https://en.wikipedia.org/wiki/Rhinorrhea "Rhinorrhea"), itchiness, [shortness of breath](https://en.wikipedia.org/wiki/Dyspnea "Dyspnea"), and potentially [anaphylaxis](https://en.wikipedia.org/wiki/Anaphylaxis "Anaphylaxis").[\[33\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Janeway-33) Depending on the individual, the allergen, and the mode of introduction, the symptoms can be system-wide (classical anaphylaxis), or localized to particular body systems; [asthma](https://en.wikipedia.org/wiki/Asthma "Asthma") is localized to the respiratory system while hives and eczema are localized to the skin.[\[33\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Janeway-33) In addition to reacting to oral consumption, skin and asthma reactions can be triggered by inhallation or contact if there are skin abrasions or cuts.[\[7\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2013-7)[\[8\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Jeebhay2001-8) [![](https://upload.wikimedia.org/wikipedia/commons/thumb/6/63/EMminor2010.JPG/250px-EMminor2010.JPG)](https://en.wikipedia.org/wiki/File:EMminor2010.JPG) Hives allergic reaction on arm After the chemical mediators of the acute response subside, late-phase responses can often occur due to the migration of other [white blood cells](https://en.wikipedia.org/wiki/White_blood_cells "White blood cells") such as [neutrophils](https://en.wikipedia.org/wiki/Neutrophil "Neutrophil"), [lymphocytes](https://en.wikipedia.org/wiki/Lymphocyte "Lymphocyte"), [eosinophils](https://en.wikipedia.org/wiki/Eosinophil "Eosinophil"), and [macrophages](https://en.wikipedia.org/wiki/Macrophage "Macrophage") to the initial reaction sites. This is usually seen 2–24 hours after the original reaction.[\[34\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Grimbaldeston2006-34) Cytokines from mast cells may also play a role in the persistence of long-term effects. Late-phase responses seen in asthma are slightly different from those seen in other allergic responses, although they are still caused by release of mediators from eosinophils.[\[35\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-35) In addition to IgE-mediated responses, shellfish allergy can manifest as [atopic dermatitis](https://en.wikipedia.org/wiki/Atopic_dermatitis "Atopic dermatitis"), especially in infants and young children.[\[36\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-36) Some will display both, so that a child could react to an oral food challenge with allergic symptoms, followed a day or two later with a flare up of atopic dermatitis and/or gastrointestinal symptoms, including allergic [eosinophilic esophagitis](https://en.wikipedia.org/wiki/Eosinophilic_esophagitis "Eosinophilic esophagitis").[\[37\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-37) ### Shellfish allergenic proteins \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=11 "Edit section: Shellfish allergenic proteins")\] Several proteins from shellfish are either clearly involved in allergenic reactions or suspected to be. Tropomyosin, arginine kinase, myosin light chain and sarcoplasmic calcium-binding protein are widely present across shellfish species.[\[14\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Gelis2020-14)[\[15\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2016-15)[\[16\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Pedrosa2015-16)[\[38\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Faber2017-38) [Troponin](https://en.wikipedia.org/wiki/Troponin "Troponin"), [actin](https://en.wikipedia.org/wiki/Actin "Actin"), [triosephosphate isomerase](https://en.wikipedia.org/wiki/Triosephosphate_isomerase "Triosephosphate isomerase") and [hemocyanin](https://en.wikipedia.org/wiki/Hemocyanin "Hemocyanin") are also identified as allergenic proteins.[\[1\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Khora2016-1)[\[15\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2016-15) As of a 2016 review, only three (tropomyosin, arginine kinase and sarcoplasmic calcium-binding protein) were available for routine diagnostic skin testing.[\[15\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lopata2016-15) Shellfish do not manifest the proteins β-parvalbumin (found in bony fishes) or α-parvalbumin (found in cartilaginous fishes such as sharks and rays), so there is not cross-reactivity of shellfish allergy to fish allergy.[\[6\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Thal2015-6)[\[17\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Tong2018-17)[\[18\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Ruethers2018-18) ## Diagnosis \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=12 "Edit section: Diagnosis")\] Diagnosis of shellfish allergy is based on the person's history of allergic reactions, [skin prick test](https://en.wikipedia.org/wiki/Skin_prick_test "Skin prick test") and measurement of shellfish-specific serum [immunoglobulin E](https://en.wikipedia.org/wiki/Immunoglobulin_E "Immunoglobulin E") (IgE or sIgE). Confirmation is by double-blind, placebo-controlled food challenges.[\[17\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Tong2018-17) Self-reported shellfish allergy often fails to be confirmed by food challenge.[\[39\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Nwaru2014-39) ## Prevention \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=13 "Edit section: Prevention")\] Reviews of food allergens in general stated that introducing solid foods at 4–6 months may result in the lowest subsequent allergy risks for eczema, allergic rhinitis and more severe reactions.[\[40\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Ferraro2019-40) The evidence is best for peanuts, eggs and milk.[\[41\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Perkins2016-41) The literature is sparse for consequences of early introduction of shellfish.[\[41\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Perkins2016-41) ## Treatment \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=14 "Edit section: Treatment")\] [![](https://upload.wikimedia.org/wikipedia/commons/thumb/3/39/Epi-Pen_2016.jpg/250px-Epi-Pen_2016.jpg)](https://en.wikipedia.org/wiki/File:Epi-Pen_2016.jpg) Epinephrine autoinjectors are portable single-dose epinephrine-dispensing devices used to treat anaphylaxis. Treatment for accidental ingestion of shellfish products by allergic individuals varies depending on the sensitivity of the person. An [antihistamine](https://en.wikipedia.org/wiki/Antihistamine "Antihistamine") such as [diphenhydramine](https://en.wikipedia.org/wiki/Diphenhydramine "Diphenhydramine") may be prescribed. Sometimes [prednisone](https://en.wikipedia.org/wiki/Prednisone "Prednisone") will be prescribed to prevent a possible late phase [Type I hypersensitivity](https://en.wikipedia.org/wiki/Type_I_hypersensitivity "Type I hypersensitivity") reaction.[\[42\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-42) Severe allergic reactions (anaphalaxis) may require treatment with an [epinephrine pen](https://en.wikipedia.org/wiki/Epinephrine_pen "Epinephrine pen"), which is an injection device designed to be used by a non-healthcare professional when emergency treatment is warranted.[\[43\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-EAACI2014-43) Unlike for egg allergy, for which there is active research on trying [oral immunotherapy](https://en.wikipedia.org/wiki/Oral_immunotherapy "Oral immunotherapy") (OIT) to desensitize people to egg allergens,[\[44\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-44) reviews mention that there are no published clinical trials evaluating oral immunotherapy for shellfish allergy.[\[6\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Thal2015-6)[\[12\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Wai2020-12) ## Prognosis \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=15 "Edit section: Prognosis")\] Unlike milk and egg allergies,[\[5\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Urisu2014-5)[\[45\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-45) shellfish allergy usually persists into adulthood.[\[12\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Wai2020-12)[\[13\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Prester2016-13) ## Epidemiology \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=16 "Edit section: Epidemiology")\] Incidence and prevalence are terms commonly used in describing disease [epidemiology](https://en.wikipedia.org/wiki/Epidemiology "Epidemiology"). Incidence is newly diagnosed cases, which can be expressed as new cases per year per million people. Prevalence is the number of cases alive, expressible as existing cases per million people during a period of time.[\[46\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-46) Worldwide, the prevalence of shellfish allergy is increasing because shellfish consumption is increasing,[\[47\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Tsabouri2012-47) and among adults shellfish is the most common anaphylaxis-eliciting food.[\[12\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Wai2020-12) Reviews cite self-reported shellfish allergy in range of 0.5 to 2.5 percent in the general population.[\[1\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Khora2016-1)[\[39\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Nwaru2014-39)[\[48\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Rona2007-48) Prevalence is higher in coastal southeast Asian countries, where shellfish consumption is more common.[\[1\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Khora2016-1)[\[12\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Wai2020-12)[\[49\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Tham2018-49)[\[50\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lee2012-50) Self-reported allergy prevalence is always higher than food-challenge confirmed allergy, which one review put at 0% to 0.9% (the higher value in southeast Asia).[\[51\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Moone2016-51) ## Regulation \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=17 "Edit section: Regulation")\] Whether food allergy prevalence is increasing or not, food allergy awareness has increased, with impacts on the quality of life for children, their parents and their immediate caregivers.[\[52\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Ravid2015-52)[\[53\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Morou2014-53)[\[54\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Lange2014-54)[\[55\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Velde2013-55) In the United States, the [Food Allergen Labeling and Consumer Protection Act](https://en.wikipedia.org/wiki/Food_Allergen_Labeling_and_Consumer_Protection_Act "Food Allergen Labeling and Consumer Protection Act") (FALCPA), made law in August 2004, effective January 1, 2006,[\[56\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-FDA2004-56) causes people to be reminded of allergy problems every time they handle a food package. Although not regulated under FALCPA, restaurants have added allergen warnings to menus. The [Culinary Institute of America](https://en.wikipedia.org/wiki/Culinary_Institute_of_America "Culinary Institute of America"), a premier school for chef training, has courses in allergen-free cooking and a separate teaching kitchen.[\[57\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-57) School systems have protocols about what foods can be brought into the school. Despite all these precautions, people with serious allergies are aware that accidental exposure can easily occur at other peoples' houses, at school or in restaurants.[\[58\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Shah2008-58) ### Regulation of labeling \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=18 "Edit section: Regulation of labeling")\] [![](https://upload.wikimedia.org/wikipedia/commons/thumb/4/42/US_Allergen_Information_Example.jpg/330px-US_Allergen_Information_Example.jpg)](https://en.wikipedia.org/wiki/File:US_Allergen_Information_Example.jpg) An example of "MAY CONTAIN TRACES OF..." as a means of listing trace amounts of allergens in a food product due to cross-contamination during manufacture. In response to the risk that certain foods pose to those with food allergies, some countries have responded by instituting labeling laws that require food products to clearly inform consumers if their products contain major allergens or byproducts of major allergens among the ingredients intentionally added to foods. Laws and regulations passed in the US and by the European Union recommend labeling but do not require mandatory declaration of the presence of trace amounts in the final product as a consequence of unintentional cross-contamination.[\[56\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-FDA2004-56)[\[59\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-EU2015-59)[\[60\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-FDAreadlabel2017-60) #### Ingredients intentionally added \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=19 "Edit section: Ingredients intentionally added")\] FALCPA requires companies to disclose on the label whether a packaged food product contains any of these eight major food allergens, added intentionally: cow's milk, peanuts, eggs, shellfish, fish, tree nuts, soy and wheat.[\[56\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-FDA2004-56) This list originated in 1999 from the World Health Organisation Codex Alimentarius Commission.[\[61\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-Allen2014-61) To meet FALCPA labeling requirements, if an ingredient is derived from one of the required-label allergens, then it must either have its "food sourced name" in parentheses, for example "Casein (milk)," or as an alternative, there must be a statement separate but adjacent to the ingredients list: "Contains milk" (and any other of the allergens with mandatory labeling).[\[56\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-FDA2004-56)[\[60\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-FDAreadlabel2017-60) The European Union requires listing for those eight major allergens plus molluscs, [celery](https://en.wikipedia.org/wiki/Celery "Celery"), mustard, lupin, sesame and [sulfites](https://en.wikipedia.org/wiki/Sulfite "Sulfite").[\[59\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-EU2015-59) In Japan, a food-labeling system for five specific allergenic ingredients (egg, milk, wheat, buckwheat, peanut) was mandated under law on April 1, 2002. Additional labeling of shrimp/prawn and crab became mandatory in 2008. This applies to packaged food, but not to restaurants.[\[62\]](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_note-62) ## See also \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=20 "Edit section: See also")\] - [List of allergens](https://en.wikipedia.org/wiki/List_of_allergens "List of allergens") (food and non-food) ## References \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=21 "Edit section: References")\] 1. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Khora2016_1-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Khora2016_1-1) [c](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Khora2016_1-2) [d](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Khora2016_1-3) Khora SS (August 2016). "Seafood-Associated Shellfish Allergy: A Comprehensive Review". Immunol Invest. 45* (6): 504–30\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1080/08820139.2016.1180301](https://doi.org/10.1080%2F08820139.2016.1180301). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27404324](https://pubmed.ncbi.nlm.nih.gov/27404324). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [23368221](https://api.semanticscholar.org/CorpusID:23368221). 2. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-2) National Report of the Expert Panel on Food Allergy Research, NIH-NIAID 2003 ["National Report of the Expert Panel on Food Allergy Research"](https://web.archive.org/web/20061004001123/http://www3.niaid.nih.gov/about/organization/dait/PDF/june30_2003.pdf) (PDF). 30 June 2003. Archived from [the original](http://www3.niaid.nih.gov/about/organization/dait/PDF/june30_2003.pdf) (PDF) on 2006-10-04. Retrieved 2006-08-07. 3. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-3) ["Food Allergies"](http://www.aafa.org/display.cfm?id=9&sub=20&cont=286) [Archived](https://web.archive.org/web/20121006052320/http://www.aafa.org/display.cfm?id=9&sub=20&cont=286) 2012-10-06 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") Asthma and Allergy Foundation of America 4. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-NHS_4-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-NHS_4-1) ["Food allergy"](http://www.nhs.uk/conditions/food-allergy/Pages/Intro1.aspx). [National Health Service (England)](https://en.wikipedia.org/wiki/National_Health_Service_\(England\) "National Health Service (England)"). 16 May 2016. [Archived](https://web.archive.org/web/20170720023406/http://www.nhs.uk/Conditions/food-allergy/Pages/Intro1.aspx) from the original on 20 July 2017. Retrieved 27 December 2020. 5. ^ [a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Urisu2014_5-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Urisu2014_5-1) Urisu A, Ebisawa M, Ito K, Aihara Y, Ito S, Mayumi M, Kohno Y, Kondo N (September 2014). ["Japanese Guideline for Food Allergy 2014"](https://doi.org/10.2332%2Fallergolint.14-RAI-0770). Allergol Int. 63* (3): 399–419\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2332/allergolint.14-RAI-0770](https://doi.org/10.2332%2Fallergolint.14-RAI-0770). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25178179](https://pubmed.ncbi.nlm.nih.gov/25178179). 6. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Thal2015_6-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Thal2015_6-1) [c](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Thal2015_6-2) [d](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Thal2015_6-3) Thalayasingam M, Lee BW (May 2015). "Fish and shellfish allergy". Chem Immunol Allergy. Chemical Immunology and Allergy. 101: 152–61\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1159/000375508](https://doi.org/10.1159%2F000375508). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-318-02340-4](https://en.wikipedia.org/wiki/Special:BookSources/978-3-318-02340-4 "Special:BookSources/978-3-318-02340-4") . [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26022875](https://pubmed.ncbi.nlm.nih.gov/26022875). 7. ^ [a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Lopata2013_7-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Lopata2013_7-1) [c](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Lopata2013_7-2) [d](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Lopata2013_7-3) [e](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Lopata2013_7-4) Lopata AL, Jeebhay MF (June 2013). "Airborne seafood allergens as a cause of occupational allergy and asthma". Curr Allergy Asthma Rep. 13* (3): 288–97\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s11882-013-0347-y](https://doi.org/10.1007%2Fs11882-013-0347-y). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23575656](https://pubmed.ncbi.nlm.nih.gov/23575656). 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[PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1740192](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740192). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [11511741](https://pubmed.ncbi.nlm.nih.gov/11511741). 9. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-medlineplus_9-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-medlineplus_9-1) [c](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-medlineplus_9-2) [d](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-medlineplus_9-3) [e](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-medlineplus_9-4) [MedlinePlus Encyclopedia](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus"): [Food allergy](https://medlineplus.gov/ency/article/000817.htm) 10. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-10)* Reber LL, Hernandez JD, Galli SJ (August 2017). ["The pathophysiology of anaphylaxis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657389). The Journal of Allergy and Clinical Immunology. 140 (2): 335–348\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jaci.2017.06.003](https://doi.org/10.1016%2Fj.jaci.2017.06.003). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [0091-6749](https://search.worldcat.org/issn/0091-6749). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5657389](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657389). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28780941](https://pubmed.ncbi.nlm.nih.gov/28780941). 11. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Sicherer2014_11-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Sicherer2014_11-1) Sicherer SH, Sampson HA (February 2014). "Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment". J Allergy Clin Immunol. 133* (2): 291–307\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jaci.2013.11.020](https://doi.org/10.1016%2Fj.jaci.2013.11.020). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24388012](https://pubmed.ncbi.nlm.nih.gov/24388012). 12. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Wai2020_12-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Wai2020_12-1) [c](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Wai2020_12-2) [d](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Wai2020_12-3) [e](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Wai2020_12-4) Wai CY, Leung NY, Chu KH, Leung PS, Leung AS, Wong GW, Leung TF (March 2020). ["Overcoming Shellfish Allergy: How Far Have We Come?"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139905). Int J Mol Sci. 21* (6): 2234. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3390/ijms21062234](https://doi.org/10.3390%2Fijms21062234). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7139905](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139905). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32210187](https://pubmed.ncbi.nlm.nih.gov/32210187). 13. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Prester2016_13-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Prester2016_13-1) [c](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Prester2016_13-2) Prester L (August 2016). "Seafood Allergy, Toxicity, and Intolerance: A Review". J Am Coll Nutr. 35* (3): 271–83\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1080/07315724.2015.1014120](https://doi.org/10.1080%2F07315724.2015.1014120). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26252073](https://pubmed.ncbi.nlm.nih.gov/26252073). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [1154235](https://api.semanticscholar.org/CorpusID:1154235). 14. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Gelis2020_14-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Gelis2020_14-1) [c](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Gelis2020_14-2) Gelis S, Rueda M, Valero A, Fernández EA, Moran M, Fernández-Caldas E (July 2020). ["Shellfish Allergy: Unmet Needs in Diagnosis and Treatment"](https://doi.org/10.18176%2Fjiaci.0565). J Investig Allergol Clin Immunol. 30* (6): 409–20\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.18176/jiaci.0565](https://doi.org/10.18176%2Fjiaci.0565). 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[doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s40629-016-0124-2](https://doi.org/10.1007%2Fs40629-016-0124-2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5306157](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5306157). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28239537](https://pubmed.ncbi.nlm.nih.gov/28239537). 16. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Pedrosa2015_16-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Pedrosa2015_16-1) [c](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Pedrosa2015_16-2) Pedrosa M, Boyano-Martínez T, García-Ara C, Quirce S (October 2015). "Shellfish Allergy: a Comprehensive Review". Clin Rev Allergy Immunol. 49* (2): 203–16\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s12016-014-8429-8](https://doi.org/10.1007%2Fs12016-014-8429-8). 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[S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [27294622](https://api.semanticscholar.org/CorpusID:27294622). 48. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Rona2007_48-0) Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, Sigurdardottir ST, Lindner T, Goldhahn K, Dahlstrom J, McBride D, Madsen C (September 2007). "The prevalence of food allergy: a meta-analysis". J. Allergy Clin. Immunol. 120 (3): 638–46\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jaci.2007.05.026](https://doi.org/10.1016%2Fj.jaci.2007.05.026). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17628647](https://pubmed.ncbi.nlm.nih.gov/17628647). 49. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Tham2018_49-0) Tham EH, Shek LP, Van Bever HP, Vichyanond P, Ebisawa M, Wong GW, Lee BW (February 2018). "Early introduction of allergenic foods for the prevention of food allergy from an Asian perspective-An Asia Pacific Association of Pediatric Allergy, Respirology & Immunology (APAPARI) consensus statement". Pediatr Allergy Immunol. 29 (1): 18–27\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/pai.12820](https://doi.org/10.1111%2Fpai.12820). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29068090](https://pubmed.ncbi.nlm.nih.gov/29068090). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [21200411](https://api.semanticscholar.org/CorpusID:21200411). 50. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Lee2012_50-0) Lee AJ, Gerez I, Shek LP, Lee BW (March 2012). "Shellfish allergy--an Asia-Pacific perspective". Asian Pac J Allergy Immunol. 30 (1): 3–10\. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22523902](https://pubmed.ncbi.nlm.nih.gov/22523902). 51. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Moone2016_51-0) Moonesinghe H, Mackenzie H, Venter C, Kilburn S, Turner P, Weir K, Dean T (September 2016). "Prevalence of fish and shellfish allergy: A systematic review". Ann Allergy Asthma Immunol. 117 (3): 264–72.e4. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.anai.2016.07.015](https://doi.org/10.1016%2Fj.anai.2016.07.015). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[10044/1/45844](https://hdl.handle.net/10044%2F1%2F45844). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27613460](https://pubmed.ncbi.nlm.nih.gov/27613460). 52. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Ravid2015_52-0) Ravid NL, Annunziato RA, Ambrose MA, Chuang K, Mullarkey C, Sicherer SH, Shemesh E, Cox AL (March 2015). "Mental health and quality-of-life concerns related to the burden of food allergy". Psychiatr. Clin. North Am. 38 (1): 77–89\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.psc.2014.11.004](https://doi.org/10.1016%2Fj.psc.2014.11.004). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25725570](https://pubmed.ncbi.nlm.nih.gov/25725570). 53. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Morou2014_53-0) Morou Z, Tatsioni A, Dimoliatis ID, Papadopoulos NG (June 2014). "Health-related quality of life in children with food allergy and their parents: a systematic review of the literature". J Investig Allergol Clin Immunol. 24 (6): 382–95\. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25668890](https://pubmed.ncbi.nlm.nih.gov/25668890). 54. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Lange2014_54-0) Lange L (November 2014). ["Quality of life in the setting of anaphylaxis and food allergy"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479473). Allergo J Int. 23 (7): 252–60\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s40629-014-0029-x](https://doi.org/10.1007%2Fs40629-014-0029-x). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4479473](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479473). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26120535](https://pubmed.ncbi.nlm.nih.gov/26120535). 55. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Velde2013_55-0) van der Velde JL, Dubois AE, Flokstra-de Blok BM (December 2013). "Food allergy and quality of life: what have we learned?". Curr Allergy Asthma Rep. 13 (6): 651–61\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s11882-013-0391-7](https://doi.org/10.1007%2Fs11882-013-0391-7). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24122150](https://pubmed.ncbi.nlm.nih.gov/24122150). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [326837](https://api.semanticscholar.org/CorpusID:326837). 56. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-FDA2004_56-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-FDA2004_56-1) [c](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-FDA2004_56-2) [d](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-FDA2004_56-3) ["Food Allergen Labeling and Consumer Protection Act of 2004"](https://web.archive.org/web/20191214032633/https://www.fda.gov/media/77570/download). US Food and Drug Administration. 2 August 2004. Archived from [the original](https://www.fda.gov/media/77570/download) on December 14, 2019. Retrieved 7 March 2022. 57. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-57)* [Culinary Institute of America](https://www.ciachef.edu/cia-allergen-free-dining-oasis-release/) [Archived](https://web.archive.org/web/20171110172606/https://www.ciachef.edu/cia-allergen-free-dining-oasis-release/) 2017-11-10 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") Allergen-free oasis comes to the CIA (2017) 58. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Shah2008_58-0) Shah E, Pongracic J (August 2008). "Food-induced anaphylaxis: who, what, why, and where?". Pediatr Ann. 37 (8): 536–41\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3928/00904481-20080801-06](https://doi.org/10.3928%2F00904481-20080801-06). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18751571](https://pubmed.ncbi.nlm.nih.gov/18751571). 59. ^ [*a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-EU2015_59-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-EU2015_59-1) ["Food allergen labelling and information requirements under the EU Food Information for Consumers Regulation No. 1169/2011: Technical Guidance"](https://web.archive.org/web/20210430190511/https://webarchive.nationalarchives.gov.uk/20180411165936/https://www.food.gov.uk/sites/default/files/food-allergen-labelling-technical-guidance.pdf) (PDF). Food Standards Agency food.gov.uk. April 2015. Archived from [the original](https://www.food.gov.uk/sites/default/files/food-allergen-labelling-technical-guidance.pdf) (PDF) on 2021-04-30. Retrieved 2021-04-30. 60. ^ [a](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-FDAreadlabel2017_60-0) [b](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-FDAreadlabel2017_60-1) FDA (December 2017). ["Have Food Allergies? Read the Label"](https://web.archive.org/web/20201112015900/https://www.fda.gov/consumers/consumer-updates/have-food-allergies-read-label). [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration"). Archived from [the original](https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm254504.htm) on 12 November 2020. Retrieved 14 January 2018. 61. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-Allen2014_61-0)* Allen KJ, Turner PJ, Pawankar R, Taylor S, Sicherer S, Lack G, et al. (April 2014). ["Precautionary labelling of foods for allergen content: are we ready for a global framework?"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005619). World Allergy Organ J. 7 (1): 10. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1186/1939-4551-7-10](https://doi.org/10.1186%2F1939-4551-7-10). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4005619](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005619). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24791183](https://pubmed.ncbi.nlm.nih.gov/24791183). 62. [^](https://en.wikipedia.org/wiki/Shellfish_allergy#cite_ref-62) Akiyama H, Imai T, Ebisawa M (2011). ["Chapter 4: Japan Food Allergen Labeling Regulation—History and Evaluation"](https://www.sciencedirect.com/science/article/pii/B9780123859891000041). Advances in Food and Nutrition Research. 62: 139–71\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/B978-0-12-385989-1.00004-1](https://doi.org/10.1016%2FB978-0-12-385989-1.00004-1). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21504823](https://pubmed.ncbi.nlm.nih.gov/21504823). [Archived](https://web.archive.org/web/20210504111332/https://www.sciencedirect.com/science/article/pii/B9780123859891000041?via%3Dihub) from the original on 2021-05-04. Retrieved 2021-05-03. ## External links \[[edit](https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&action=edit&section=22 "Edit section: External links")\] \| \| \| \|---\|---\| \| Classification \| [D](https://www.wikidata.org/wiki/Q23037743 "d:Q23037743") [ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10"): [T78.0](https://icd.who.int/browse10/2019/en#/T78.0), [T78.1](https://icd.who.int/browse10/2019/en#/T78.1), [L23.6](https://icd.who.int/browse10/2019/en#/L23.6), [L27.2](https://icd.who.int/browse10/2019/en#/L27.2), [Z91.0](https://icd.who.int/browse10/2019/en#/Z91.0) [MeSH](https://en.wikipedia.org/wiki/Medical_Subject_Headings "Medical Subject Headings"): [D000067208](https://meshb.nlm.nih.gov/record/ui?ui=D000067208) \| \| [v](https://en.wikipedia.org/wiki/Template:Hypersensitivity_disease_by_system "Template:Hypersensitivity disease by system") [t](https://en.wikipedia.org/wiki/Template_talk:Hypersensitivity_disease_by_system "Template talk:Hypersensitivity disease by system") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Hypersensitivity_disease_by_system "Special:EditPage/Template:Hypersensitivity disease by system")[Allergies](https://en.wikipedia.org/wiki/Allergies "Allergies"), allergy-like conditions and symptoms \| \| \|---\|---\| \| [Respiratory system](https://en.wikipedia.org/wiki/Respiratory_system "Respiratory system") \| [Allergic rhinitis](https://en.wikipedia.org/wiki/Allergic_rhinitis "Allergic rhinitis") (hay fever) [Asthma](https://en.wikipedia.org/wiki/Asthma "Asthma") [Hypersensitivity pneumonitis](https://en.wikipedia.org/wiki/Hypersensitivity_pneumonitis "Hypersensitivity pneumonitis") [Eosinophilic pneumonia](https://en.wikipedia.org/wiki/Eosinophilic_pneumonia "Eosinophilic pneumonia") [Eosinophilic granulomatosis with polyangiitis](https://en.wikipedia.org/wiki/Eosinophilic_granulomatosis_with_polyangiitis "Eosinophilic granulomatosis with polyangiitis") [Allergic bronchopulmonary aspergillosis](https://en.wikipedia.org/wiki/Allergic_bronchopulmonary_aspergillosis "Allergic bronchopulmonary aspergillosis") [Farmer's lung](https://en.wikipedia.org/wiki/Farmer%27s_lung "Farmer's lung") [Laboratory animal allergy](https://en.wikipedia.org/wiki/Laboratory_animal_allergy "Laboratory animal allergy") \| \| [Skin](https://en.wikipedia.org/wiki/Integumentary_system "Integumentary system") \| [Angioedema](https://en.wikipedia.org/wiki/Angioedema "Angioedema") [Urticaria](https://en.wikipedia.org/wiki/Urticaria "Urticaria") [Atopic dermatitis](https://en.wikipedia.org/wiki/Atopic_dermatitis "Atopic dermatitis") [Allergic contact dermatitis](https://en.wikipedia.org/wiki/Contact_dermatitis "Contact dermatitis") [Hypersensitivity vasculitis](https://en.wikipedia.org/wiki/Hypersensitivity_vasculitis "Hypersensitivity vasculitis") \| \| [Blood and immune system](https://en.wikipedia.org/wiki/Hematology "Hematology") \| [Serum sickness](https://en.wikipedia.org/wiki/Serum_sickness "Serum sickness") \| \| [Circulatory system](https://en.wikipedia.org/wiki/Circulatory_system "Circulatory system") \| [Anaphylaxis](https://en.wikipedia.org/wiki/Anaphylaxis "Anaphylaxis") \| \| [Digestive system](https://en.wikipedia.org/wiki/Human_digestive_system "Human digestive system") \| [Coeliac disease](https://en.wikipedia.org/wiki/Coeliac_disease "Coeliac disease") [Eosinophilic gastroenteritis](https://en.wikipedia.org/wiki/Eosinophilic_gastroenteritis "Eosinophilic gastroenteritis") [Eosinophilic esophagitis](https://en.wikipedia.org/wiki/Eosinophilic_esophagitis "Eosinophilic esophagitis") [Food allergy](https://en.wikipedia.org/wiki/Food_allergy "Food allergy") [corn](https://en.wikipedia.org/wiki/Corn_allergy "Corn allergy") [eggs](https://en.wikipedia.org/wiki/Egg_allergy "Egg allergy") [fish](https://en.wikipedia.org/wiki/Fish_allergy "Fish allergy") [fruits](https://en.wikipedia.org/wiki/Fruit_allergy "Fruit allergy") [garlic](https://en.wikipedia.org/wiki/Garlic_allergy "Garlic allergy") meat [poultry](https://en.wikipedia.org/wiki/Poultry_allergy "Poultry allergy") [red meat](https://en.wikipedia.org/wiki/Alpha-gal_allergy "Alpha-gal allergy") [milk](https://en.wikipedia.org/wiki/Milk_allergy "Milk allergy") [peanuts](https://en.wikipedia.org/wiki/Peanut_allergy "Peanut allergy") [rice](https://en.wikipedia.org/wiki/Rice_allergy "Rice allergy") [sesame](https://en.wikipedia.org/wiki/Sesame_allergy "Sesame allergy") [shellfish]() [soy](https://en.wikipedia.org/wiki/Soy_allergy "Soy allergy") [tree nuts](https://en.wikipedia.org/wiki/Tree_nut_allergy "Tree nut allergy") [wheat](https://en.wikipedia.org/wiki/Wheat_allergy "Wheat allergy") \| \| [Nervous system](https://en.wikipedia.org/wiki/Nervous_system "Nervous system") \| [Eosinophilic meningitis](https://en.wikipedia.org/wiki/Eosinophilic_meningitis "Eosinophilic meningitis") \| \| [Genitourinary system](https://en.wikipedia.org/wiki/Urinary_system "Urinary system") \| [Acute interstitial nephritis](https://en.wikipedia.org/wiki/Interstitial_nephritis "Interstitial nephritis") \| \| Other conditions \| [Drug allergy](https://en.wikipedia.org/wiki/Drug_allergy "Drug allergy") [Allergic conjunctivitis](https://en.wikipedia.org/wiki/Allergic_conjunctivitis "Allergic conjunctivitis") [Latex allergy](https://en.wikipedia.org/wiki/Latex_allergy "Latex allergy") [Dust mite allergy](https://en.wikipedia.org/wiki/Dust_mite_allergy "Dust mite allergy") \| \| [v](https://en.wikipedia.org/wiki/Template:Hypersensitivity_disease_by_cause "Template:Hypersensitivity disease by cause") [t](https://en.wikipedia.org/wiki/Template_talk:Hypersensitivity_disease_by_cause "Template talk:Hypersensitivity disease by cause") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Hypersensitivity_disease_by_cause "Special:EditPage/Template:Hypersensitivity disease by cause")[Hypersensitivity](https://en.wikipedia.org/wiki/Hypersensitivity "Hypersensitivity") and [autoimmune diseases](https://en.wikipedia.org/wiki/Autoimmune_disease "Autoimmune disease") \| \| \|---\|---\| \| [Type I](https://en.wikipedia.org/wiki/Type_I_hypersensitivity "Type I hypersensitivity")/[allergy](https://en.wikipedia.org/wiki/Allergy "Allergy")/[atopy](https://en.wikipedia.org/wiki/Atopy "Atopy") ([IgE](https://en.wikipedia.org/wiki/Immunoglobulin_E "Immunoglobulin E")) \| \| \| \| \| \| Foreign \| [Allergic asthma](https://en.wikipedia.org/wiki/Allergic_asthma "Allergic asthma") [Allergic urticaria](https://en.wikipedia.org/wiki/Allergic_urticaria "Allergic urticaria") [Allergic rhinitis](https://en.wikipedia.org/wiki/Allergic_rhinitis "Allergic rhinitis") (Hay fever) [Anaphylaxis](https://en.wikipedia.org/wiki/Anaphylaxis "Anaphylaxis") [Atopic dermatitis](https://en.wikipedia.org/wiki/Atopic_dermatitis "Atopic dermatitis") [Food allergy](https://en.wikipedia.org/wiki/Food_allergy "Food allergy") common allergies include: [Egg](https://en.wikipedia.org/wiki/Egg_allergy "Egg allergy") [Milk](https://en.wikipedia.org/wiki/Milk_allergy "Milk allergy") [Peanut](https://en.wikipedia.org/wiki/Peanut_allergy "Peanut allergy") [Seafood](https://en.wikipedia.org/wiki/Seafood_allergy "Seafood allergy") [Soy](https://en.wikipedia.org/wiki/Soy_allergy "Soy allergy") [Tree nut](https://en.wikipedia.org/wiki/Tree_nut_allergy "Tree nut allergy") [Wheat](https://en.wikipedia.org/wiki/Wheat_allergy "Wheat allergy") [Penicillin allergy](https://en.wikipedia.org/wiki/Side_effects_of_penicillin "Side effects of penicillin") \| \| Autoimmune \| [Autoimmune urticaria](https://en.wikipedia.org/wiki/Autoimmune_urticaria "Autoimmune urticaria") [Eosinophilic esophagitis](https://en.wikipedia.org/wiki/Eosinophilic_esophagitis "Eosinophilic esophagitis") \| \| [Type II](https://en.wikipedia.org/wiki/Type_II_hypersensitivity "Type II hypersensitivity")/[ADCC](https://en.wikipedia.org/wiki/Antibody-dependent_cellular_cytotoxicity "Antibody-dependent cellular cytotoxicity") [IgG](https://en.wikipedia.org/wiki/Immunoglobulin_G "Immunoglobulin G") [IgM](https://en.wikipedia.org/wiki/Immunoglobulin_M "Immunoglobulin M") \| \| \| \| \| \| Foreign \| [Hemolytic disease of the newborn](https://en.wikipedia.org/wiki/Hemolytic_disease_of_the_newborn "Hemolytic disease of the newborn") \| \| Autoimmune \| \| \| \| \| \| [Cytotoxic](https://en.wikipedia.org/wiki/Cytotoxicity "Cytotoxicity") \| [Autoimmune hemolytic anemia](https://en.wikipedia.org/wiki/Autoimmune_hemolytic_anemia "Autoimmune hemolytic anemia") [Bullous pemphigoid](https://en.wikipedia.org/wiki/Bullous_pemphigoid "Bullous pemphigoid") [Goodpasture syndrome](https://en.wikipedia.org/wiki/Goodpasture_syndrome "Goodpasture syndrome") [Guillain–Barré syndrome](https://en.wikipedia.org/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome "Guillain–Barré syndrome") [Immune thrombocytopenic purpura](https://en.wikipedia.org/wiki/Immune_thrombocytopenic_purpura "Immune thrombocytopenic purpura") [Pemphigus vulgaris](https://en.wikipedia.org/wiki/Pemphigus_vulgaris "Pemphigus vulgaris") [Rheumatic fever](https://en.wikipedia.org/wiki/Rheumatic_fever "Rheumatic fever") \| \| "[Type V](https://en.wikipedia.org/wiki/Hypersensitivity#Type_V "Hypersensitivity")"/[receptor](https://en.wikipedia.org/wiki/Receptor_\(biochemistry\) "Receptor (biochemistry)") \| [Graves' disease](https://en.wikipedia.org/wiki/Graves%27_disease "Graves' disease") [Myasthenia gravis](https://en.wikipedia.org/wiki/Myasthenia_gravis "Myasthenia gravis") [Pernicious anemia](https://en.wikipedia.org/wiki/Pernicious_anemia "Pernicious anemia") \| \| [Type III](https://en.wikipedia.org/wiki/Type_III_hypersensitivity "Type III hypersensitivity") ([Immune complex](https://en.wikipedia.org/wiki/Immune_complex "Immune complex")) \| \| \| \| \| \| Foreign \| [Arthus reaction](https://en.wikipedia.org/wiki/Arthus_reaction "Arthus reaction") [Farmer's lung](https://en.wikipedia.org/wiki/Farmer%27s_lung "Farmer's lung") [Henoch–Schönlein purpura](https://en.wikipedia.org/wiki/Henoch%E2%80%93Sch%C3%B6nlein_purpura "Henoch–Schönlein purpura") [Hypersensitivity vasculitis](https://en.wikipedia.org/wiki/Cutaneous_small-vessel_vasculitis "Cutaneous small-vessel vasculitis") [Post-streptococcal glomerulonephritis](https://en.wikipedia.org/wiki/Acute_proliferative_glomerulonephritis "Acute proliferative glomerulonephritis") [Reactive arthritis](https://en.wikipedia.org/wiki/Reactive_arthritis "Reactive arthritis") [Serum sickness](https://en.wikipedia.org/wiki/Serum_sickness "Serum sickness") \| \| Autoimmune \| [Lupus](https://en.wikipedia.org/wiki/Lupus "Lupus") [Rheumatoid arthritis](https://en.wikipedia.org/wiki/Rheumatoid_arthritis "Rheumatoid arthritis") [Subacute bacterial endocarditis](https://en.wikipedia.org/wiki/Subacute_bacterial_endocarditis "Subacute bacterial endocarditis") \| \| [Type IV](https://en.wikipedia.org/wiki/Type_IV_hypersensitivity "Type IV hypersensitivity")/[cell-mediated](https://en.wikipedia.org/wiki/Cell-mediated_immunity "Cell-mediated immunity") ([T cells](https://en.wikipedia.org/wiki/T_cell "T cell")) \| \| \| \| \| \| Foreign \| [Allergic contact dermatitis](https://en.wikipedia.org/wiki/Allergic_contact_dermatitis "Allergic contact dermatitis") [Mantoux test](https://en.wikipedia.org/wiki/Mantoux_test "Mantoux test") \| \| Autoimmune \| [Coeliac disease](https://en.wikipedia.org/wiki/Coeliac_disease "Coeliac disease") [Giant cell arteritis](https://en.wikipedia.org/wiki/Giant_cell_arteritis "Giant cell arteritis") [Hashimoto's thyroiditis](https://en.wikipedia.org/wiki/Hashimoto%27s_thyroiditis "Hashimoto's thyroiditis") [Multiple sclerosis](https://en.wikipedia.org/wiki/Multiple_sclerosis "Multiple sclerosis") [Postorgasmic illness syndrome](https://en.wikipedia.org/wiki/Postorgasmic_illness_syndrome "Postorgasmic illness syndrome") [Reactive arthritis](https://en.wikipedia.org/wiki/Reactive_arthritis "Reactive arthritis") [Type 1 diabetes](https://en.wikipedia.org/wiki/Type_1_diabetes "Type 1 diabetes") \| \| [GVHD](https://en.wikipedia.org/wiki/Graft-versus-host_disease "Graft-versus-host disease") \| [Transfusion-associated graft-versus-host disease](https://en.wikipedia.org/wiki/Transfusion-associated_graft-versus-host_disease "Transfusion-associated graft-versus-host disease") \| \| Unknown/ multiple \| \| \| \| \| \| Foreign \| [Hypersensitivity pneumonitis](https://en.wikipedia.org/wiki/Hypersensitivity_pneumonitis "Hypersensitivity pneumonitis") [Allergic bronchopulmonary aspergillosis](https://en.wikipedia.org/wiki/Allergic_bronchopulmonary_aspergillosis "Allergic bronchopulmonary aspergillosis") [Latex allergy](https://en.wikipedia.org/wiki/Latex_allergy "Latex allergy") (I+IV) [Transplant rejection](https://en.wikipedia.org/wiki/Transplant_rejection "Transplant rejection") \| \| Autoimmune \| [Autoimmune adrenalitis](https://en.wikipedia.org/wiki/Addison%27s_disease "Addison's disease") [Autoimmune hepatitis](https://en.wikipedia.org/wiki/Autoimmune_hepatitis "Autoimmune hepatitis") [Autoimmune polyendocrine syndrome](https://en.wikipedia.org/wiki/Autoimmune_polyendocrine_syndrome "Autoimmune polyendocrine syndrome") [APS1](https://en.wikipedia.org/wiki/Autoimmune_polyendocrine_syndrome_type_1 "Autoimmune polyendocrine syndrome type 1") [APS2](https://en.wikipedia.org/wiki/Autoimmune_polyendocrine_syndrome_type_2 "Autoimmune polyendocrine syndrome type 2") [Sjögren syndrome](https://en.wikipedia.org/wiki/Sj%C3%B6gren_syndrome "Sjögren syndrome") [Systemic autoimmune disease](https://en.wikipedia.org/wiki/Autoimmune_disease "Autoimmune disease") \| ![](https://en.wikipedia.org/wiki/Special:CentralAutoLogin/start?type=1x1&usesul3=1) Retrieved from "<https://en.wikipedia.org/w/index.php?title=Shellfish_allergy&oldid=1292971393>" [Category](https://en.wikipedia.org/wiki/Help:Category "Help:Category"): - [Food allergies](https://en.wikipedia.org/wiki/Category:Food_allergies "Category:Food allergies") Hidden categories: - [Webarchive template wayback links](https://en.wikipedia.org/wiki/Category:Webarchive_template_wayback_links "Category:Webarchive template wayback links") - [CS1 maint: DOI inactive as of November 2024](https://en.wikipedia.org/wiki/Category:CS1_maint:_DOI_inactive_as_of_November_2024 "Category:CS1 maint: DOI inactive as of November 2024") - [Articles with short description](https://en.wikipedia.org/wiki/Category:Articles_with_short_description "Category:Articles with short description") - [Short description is 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