Allergy Unit, Meyer Children's Hospital IRCCS, 50139 Florence, Italy.
Department of Health Sciences, University of Florence, 50139 Florence, Italy.
Nutrients. 2023 Jun 11;15(12):2714. doi: 10.3390/nu15122714.
Shellfish, including various species of mollusks (e.g., mussels, clams, and oysters) and crustaceans (e.g., shrimp, prawn, lobster, and crab), have been a keystone of healthy dietary recommendations due to their valuable protein content. In parallel with their consumption, allergic reactions related to shellfish may be increasing. Adverse reactions to shellfish are classified into different groups: (1) Immunological reactions, including IgE and non-IgE allergic reactions; (2) non-immunological reactions, including toxic reactions and food intolerance. The IgE-mediated reactions occur within about two hours after ingestion of the shellfish and range from urticaria, angioedema, nausea, and vomiting to respiratory signs and symptoms such as bronchospasm, laryngeal oedema, and anaphylaxis. The most common allergenic proteins involved in IgE-mediated allergic reactions to shellfish include tropomyosin, arginine kinase, myosin light chain, sarcoplasmic calcium-binding protein, troponin c, and triosephosphate isomerase. Over the past decades, the knowledge gained on the identification of the molecular features of different shellfish allergens improved the diagnosis and the potential design of allergen immunotherapy for shellfish allergy. Unfortunately, immunotherapeutic studies and some diagnostic tools are still restricted in a research context and need to be validated before being implemented into clinical practice. However, they seem promising for improving management strategies for shellfish allergy. In this review, epidemiology, pathogenesis, clinical features, diagnosis, and management of shellfish allergies in children are presented. The cross-reactivity among different forms of shellfish and immunotherapeutic approaches, including unmodified allergens, hypoallergens, peptide-based, and DNA-based vaccines, are also addressed.
贝类包括各种软体动物（如贻贝、蛤和牡蛎）和甲壳类动物（如虾、对虾、龙虾和螃蟹），由于其富含蛋白质，一直是健康饮食建议的基石。随着贝类的食用，与贝类相关的过敏反应可能在增加。贝类过敏反应可分为不同类别：（1）免疫反应，包括 IgE 和非 IgE 过敏反应；（2）非免疫反应，包括毒性反应和食物不耐受。IgE 介导的反应发生在摄入贝类后约两小时内，从荨麻疹、血管性水肿、恶心和呕吐到呼吸道症状，如支气管痉挛、喉头水肿和过敏反应。涉及 IgE 介导的贝类过敏反应的最常见变应原蛋白包括原肌球蛋白、精氨酸激酶、肌球蛋白轻链、肌浆钙结合蛋白、肌钙蛋白 C 和磷酸丙糖异构酶。在过去几十年中，对不同贝类过敏原分子特征的认识提高了贝类过敏的诊断和潜在变应原免疫治疗的设计。不幸的是，免疫治疗研究和一些诊断工具仍然局限于研究背景，需要在临床实践中验证之前进行验证。然而，它们似乎为改善贝类过敏的管理策略提供了希望。本文综述了儿童贝类过敏的流行病学、发病机制、临床特征、诊断和管理。还讨论了不同形式贝类之间的交叉反应和免疫治疗方法，包括未修饰的过敏原、低变应原、基于肽和基于 DNA 的疫苗。
