Nakonechna Alla, van Bergen Ard, Anantharachagan Ariharan, Arnold Dilani, Johnston Nicole, Nadeau Kari, Rutkowski Krzysztof, Sindher Sayantani B, Sriaroon Panida, Thomas Iason, Vijayadurai Pavaladurai, Wagner Annette, Davis Carla M
University of Liverpool, Liverpool, United Kingdom.
Department of Immunology and Allergy, Hull University Teaching Hospitals NHS Foundation Trust, Hull, United Kingdom.
J Allergy Clin Immunol Glob. 2024 Jul 22;3(4):100309. doi: 10.1016/j.jacig.2024.100309. eCollection 2024 Nov.
Seafood allergy (SA), including allergy to shellfish (crustacean and mollusks) and fish, is among the 4 most common food allergies causing anaphylaxis, but there are limited data showing SA clinical management in different countries.
We sought to characterize a large cohort of patients with fish and shellfish allergy and to facilitate standardization of future care for this increasingly common allergic disease.
We performed a retrospective, observational, noninterventional study from 945 patients from 2015 to 2019 in 7 hospitals in the United States and the United Kingdom to evaluate SA. A chi-square test was used to detect differences in family history, medical history, and current symptoms between patients in 2 countries.
Underdiagnosed anaphylaxis in patients with SA was associated with underuse of epinephrine (adrenaline) autoinjectors in both countries. Oral food challenge was used only when skin or serologic test results were negative. Asthma and allergic rhinitis were more common in the US patients with SA, but eczema was more common in UK patients with SA ( < .001). Respiratory, gastrointestinal, and neurological symptoms were higher in UK patients with SA than in US patients with SA ( < .001).
In international multicenter cohorts of patients with fish and shellfish allergy, there are opportunities for improvement in management. Physician identification of anaphylaxis, use of diagnostic oral food challenges, and anaphylaxis treatment with epinephrine are areas with significant knowledge gaps in need of improvement in the United Kingdom and the United States. There is an opportunity for the development of unified, standardized diagnostic protocols for SA with distribution for allergists and trainees.
海鲜过敏（SA），包括对贝类（甲壳类和软体动物）和鱼类的过敏，是导致过敏反应的4种最常见食物过敏之一，但在不同国家，关于SA临床管理的数据有限。
我们试图对一大群鱼类和贝类过敏患者进行特征描述，并促进对这种日益常见的过敏性疾病未来护理的标准化。
我们于2015年至2019年在美国和英国的7家医院对945例患者进行了一项回顾性、观察性、非干预性研究，以评估SA。采用卡方检验来检测两国患者在家族史、病史和当前症状方面的差异。
SA患者中未被诊断出的过敏反应与两国肾上腺素自动注射器使用不足有关。仅在皮肤或血清学检测结果为阴性时才使用口服食物激发试验。在美国SA患者中，哮喘和过敏性鼻炎更为常见，但在英国SA患者中，湿疹更为常见（P<0.001）。英国SA患者的呼吸道、胃肠道和神经症状高于美国SA患者（P<0.001）。
在国际多中心鱼类和贝类过敏患者队列中，管理方面仍有改进空间。在英国和美国，医生对过敏反应的识别、诊断性口服食物激发试验的使用以及肾上腺素过敏反应治疗方面存在重大知识差距，需要改进。有机会制定统一、标准化的SA诊断方案，并分发给过敏症专科医生和实习医生。
