Heidari Sahel, Ruethers Thimo, Karnaneedi Shaymaviswanathan, Yin Lydia Wong Su, Lopata Andreas Ludwig
Molecular Allergy Research Laboratory, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.
Centre for Food and Allergy Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Clin Rev Allergy Immunol. 2025 Jul 16;68(1):65. doi: 10.1007/s12016-025-09077-8.
Shellfish allergy, triggered by immune reactions to crustacean and mollusk proteins upon consumption/inhalation, is one of the most severe and persistent food allergies, affecting approximately 1%-3% of the general population worldwide. Shellfish is among the "big nine" food allergens responsible for over 90% of food allergy cases worldwide. Its diagnosis poses major challenges due to regional species diversity and a lack of reliable diagnostic tools. Management strategies generally emphasize strict avoidance and provision of emergency adrenaline autoinjectors; however, these approaches are inconvenient and insufficient for both patients and healthcare providers. Given the rising prevalence of shellfish allergy, there is an urgent need for targeted therapies that focus on key allergens, particularly tropomyosin-a major pan-allergen. As the primary target in current immunotherapy approaches, tropomyosin plays a central role in driving shellfish-induced immune responses. Recent advancements in immunotherapy are exploring alternatives beyond avoidance, aiming for long-term desensitization. This review discusses progress with allergen-specific immunotherapy, hypoallergenic allergen variants, DNA-based vaccines, and innovative approaches involving immunoregulatory peptides and probiotics. These strategies collectively strive to desensitize patients, reduce allergic symptoms, and enhance quality of life. Although some therapies are in active trials, most are in the investigational stages and offer promising directions for effective, patient-centered long-term management of shellfish allergy.
贝类过敏是由食用/吸入甲壳类和软体动物蛋白质引发的免疫反应所导致，是最严重且持续存在的食物过敏之一，影响着全球约1%-3%的普通人群。贝类是导致全球90%以上食物过敏病例的“九大”食物过敏原之一。由于区域物种多样性以及缺乏可靠的诊断工具，其诊断面临重大挑战。管理策略通常强调严格避免接触并提供肾上腺素自动注射器用于急救；然而，这些方法对患者和医疗服务提供者来说既不方便也不充分。鉴于贝类过敏的患病率不断上升，迫切需要针对关键过敏原，特别是原肌球蛋白（一种主要的泛过敏原）的靶向治疗方法。作为当前免疫疗法的主要靶点，原肌球蛋白在引发贝类诱导的免疫反应中起核心作用。免疫疗法的最新进展正在探索除避免接触之外的其他方法，目标是实现长期脱敏。本综述讨论了过敏原特异性免疫疗法、低敏性过敏原变体、基于DNA的疫苗以及涉及免疫调节肽和益生菌的创新方法的进展。这些策略共同努力使患者脱敏、减轻过敏症状并提高生活质量。尽管一些疗法正在积极试验中，但大多数仍处于研究阶段，为以患者为中心的贝类过敏有效长期管理提供了有前景的方向。
