SAGB2013 Harriet Moonesinghe (University of Portsmouth)

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SAGB2013 Harriet Moonesinghe (University of Portsmouth)

  1. 1. THE SPECTRUM OF FISH AND SHELLFISH ALLERGIES Harriet Moonesinghe PhD Research Student harriet.moonesinghe@port.ac.uk
  2. 2. OVERVIEW
  3. 3. OVERVIEW o Epidemiology and Prevalence
  4. 4. OVERVIEW o Epidemiology and Prevalence o Cross-reactivity
  5. 5. OVERVIEW o Epidemiology and Prevalence o Cross-reactivity o Symptoms
  6. 6. OVERVIEW o Epidemiology and Prevalence o Cross-reactivity o Symptoms o Differential Diagnosis
  7. 7. OVERVIEW o Epidemiology and Prevalence o Cross-reactivity o Symptoms o Differential Diagnosis o Management
  8. 8. OVERVIEW o Epidemiology and Prevalence o Cross-reactivity o Symptoms o Differential Diagnosis o Management o Introduction of Seafood into the Infant Diet
  9. 9. OVERVIEW o Epidemiology and Prevalence o Cross-reactivity o Symptoms o Differential Diagnosis o Management o Introduction of Seafood into the Infant Diet o PhD Research Project
  10. 10. European Academy of Allergy and Clinical Immunology Food Hypersensitivity Food Allergy IgE mediated food allergy Non-IgE mediated food allergy Non-allergic FHS 1 0 Immune system involved Does not involve immune system
  11. 11. Milk
  12. 12. EPIDEMIOLOGY
  13. 13. EPIDEMIOLOGY • Seafood allergies are caused by the bodies immune response to proteins found in seafood.
  14. 14. EPIDEMIOLOGY • Seafood allergies are caused by the bodies immune response to proteins found in seafood. • Seafood allergies are distinct from adverse reactions due to toxins or infectious contaminants, which are not immune-based.
  15. 15. EPIDEMIOLOGY • Seafood allergies are caused by the bodies immune response to proteins found in seafood. • Seafood allergies are distinct from adverse reactions due to toxins or infectious contaminants, which are not immune-based. • Fish and crustacean allergy is more common than mollusc.
  16. 16. EPIDEMIOLOGY • Seafood allergies are caused by the bodies immune response to proteins found in seafood. • Seafood allergies are distinct from adverse reactions due to toxins or infectious contaminants, which are not immune-based. • Fish and crustacean allergy is more common than mollusc. • Seafood allergy is more common in adults than children.
  17. 17. EPIDEMIOLOGY • Seafood allergies are caused by the bodies immune response to proteins found in seafood. • Seafood allergies are distinct from adverse reactions due to toxins or infectious contaminants, which are not immune-based. • Fish and crustacean allergy is more common than mollusc. • Seafood allergy is more common in adults than children. • The types of seafood causing a reaction varies depending on the local diet.
  18. 18. EPIDEMIOLOGY • Seafood allergies are caused by the bodies immune response to proteins found in seafood. • Seafood allergies are distinct from adverse reactions due to toxins or infectious contaminants, which are not immune-based. • Fish and crustacean allergy is more common than mollusc. • Seafood allergy is more common in adults than children. • The types of seafood causing a reaction varies depending on the local diet.
  19. 19. EPIDEMIOLOGY • Seafood allergies are caused by the bodies immune response to proteins found in seafood. • Seafood allergies are distinct from adverse reactions due to toxins or infectious contaminants, which are not immune-based. • Fish and crustacean allergy is more common than mollusc. • Seafood allergy is more common in adults than children. • The types of seafood causing a reaction varies depending on the local diet.
  20. 20. EPIDEMIOLOGY CONT
  21. 21. EPIDEMIOLOGY CONT • The prevalence of seafood allergy varies worldwide.
  22. 22. EPIDEMIOLOGY CONT • The prevalence of seafood allergy varies worldwide. • A UK birth cohort looking at 11 and 15 year olds showed 0.9-1.8% for fish and 0.3-0.7% for shellfish allergy (Pereira et al, 2005)
  23. 23. EPIDEMIOLOGY CONT • The prevalence of seafood allergy varies worldwide. • A UK birth cohort looking at 11 and 15 year olds showed 0.9-1.8% for fish and 0.3-0.7% for shellfish allergy (Pereira et al, 2005) • In Canada, self-reported rates of fish and crustacean allergy in adults are 0.6% and 1.9 % (Ben-Shoshan, 2010)
  24. 24. EPIDEMIOLOGY CONT • The prevalence of seafood allergy varies worldwide. • A UK birth cohort looking at 11 and 15 year olds showed 0.9-1.8% for fish and 0.3-0.7% for shellfish allergy (Pereira et al, 2005) • In Canada, self-reported rates of fish and crustacean allergy in adults are 0.6% and 1.9 % (Ben-Shoshan, 2010) • In South-East Asia the prevalence of fish allergy is higher, at 1.1% (Connett, 2012)
  25. 25. EPIDEMIOLOGY CONT • The prevalence of seafood allergy varies worldwide. • A UK birth cohort looking at 11 and 15 year olds showed 0.9-1.8% for fish and 0.3-0.7% for shellfish allergy (Pereira et al, 2005) • In Canada, self-reported rates of fish and crustacean allergy in adults are 0.6% and 1.9 % (Ben-Shoshan, 2010) • In South-East Asia the prevalence of fish allergy is higher, at 1.1% (Connett, 2012) • 0.5% prevalence rate of Mollusc allergy in Portugal (Falcao, 2004)
  26. 26. EPIDEMIOLOGY CONT • The prevalence of seafood allergy varies worldwide. • A UK birth cohort looking at 11 and 15 year olds showed 0.9-1.8% for fish and 0.3-0.7% for shellfish allergy (Pereira et al, 2005) • In Canada, self-reported rates of fish and crustacean allergy in adults are 0.6% and 1.9 % (Ben-Shoshan, 2010) • In South-East Asia the prevalence of fish allergy is higher, at 1.1% (Connett, 2012) • 0.5% prevalence rate of Mollusc allergy in Portugal (Falcao, 2004) • It has been suggested that allergic reactions to fish are common in countries where fish constitutes a major source of protein in the diet (Chiang et al, 2007)
  27. 27. CROSS REACTIVITY OF ALLERGENS
  28. 28. CROSS REACTIVITY OF ALLERGENS • Grass: wheat
  29. 29. CROSS REACTIVITY OF ALLERGENS • Grass: wheat • Birch pollen: apple, carrot, celery, pear, tomato, cherry, tree nuts
  30. 30. CROSS REACTIVITY OF ALLERGENS • Grass: wheat • Birch pollen: apple, carrot, celery, pear, tomato, cherry, tree nuts • Latex: bananas, avocado, chestnut, apple, kiwi, potato, tomato, melon, papaya.
  31. 31. CROSS REACTIVITY OF ALLERGENS • Grass: wheat • Birch pollen: apple, carrot, celery, pear, tomato, cherry, tree nuts • Latex: bananas, avocado, chestnut, apple, kiwi, potato, tomato, melon, papaya. Peanut: lupine, other legumes
  32. 32. CROSS-REACTIVITY IN SEAFOOD
  33. 33. CROSS-REACTIVITY IN SEAFOOD • Fish: Parvalbumin is the dominant allergen in finned fish, distributed universally in the white muscle of fish.
  34. 34. CROSS-REACTIVITY IN SEAFOOD • Fish: Parvalbumin is the dominant allergen in finned fish, distributed universally in the white muscle of fish. • Crustacean: Tropmyosin, higher homologies of up to 98% across species.
  35. 35. CROSS-REACTIVITY IN SEAFOOD • Fish: Parvalbumin is the dominant allergen in finned fish, distributed universally in the white muscle of fish. • Crustacean: Tropmyosin, higher homologies of up to 98% across species. • NO cross-reaction between fish allergens and shellfish allergens have to date been demonstrated (Lopata & Lehrer, 2009).
  36. 36. CROSS-REACTIVITY IN SEAFOOD • Fish: Parvalbumin is the dominant allergen in finned fish, distributed universally in the white muscle of fish. • Crustacean: Tropmyosin, higher homologies of up to 98% across species. • NO cross-reaction between fish allergens and shellfish allergens have to date been demonstrated (Lopata & Lehrer, 2009). • However 21-43% of fish-allergic individuals are also allergic to shellfish (Venter & Arshad, 2011).
  37. 37. SEAFOOD CROSS-REACTING SPECIES COD TUNA, MACKEREL, HERRING, PLAICE, SOLE, BASS, EEL TUNA COD, TROUT, SALMON SALMON SARDINE, MACKEREL, TUNA MACKEREL ANCHOVY, COD, SALMON, HERRING, SARDINE, PLAICE PRAWNS LOBSTER, CRAB, CRAYFISH MUSSELS OCTOPUS, SQUID SHELLFISH COCKROACH, HOUSE DUST MITE, SNAILS Cross reactivity of fish and shellfish (Skypala & Venter, 2009)
  38. 38. SYMPTOMS
  39. 39. SYMPTOMS • Seafood allergy is associated with immediate symptoms related to an IgE-mediated food hypersensitivity.
  40. 40. SYMPTOMS • Seafood allergy is associated with immediate symptoms related to an IgE-mediated food hypersensitivity. • Fish: vomitting; Mollusc: gastro-intestinal symptoms with a delay in onset; Crustacean: oral symptoms of swelling and itching.
  41. 41. SYMPTOMS • Seafood allergy is associated with immediate symptoms related to an IgE-mediated food hypersensitivity. • Fish: vomitting; Mollusc: gastro-intestinal symptoms with a delay in onset; Crustacean: oral symptoms of swelling and itching. • Seafood is often involved in the most severe food allergic reactions.
  42. 42. SYMPTOMS • Seafood allergy is associated with immediate symptoms related to an IgE-mediated food hypersensitivity. • Fish: vomitting; Mollusc: gastro-intestinal symptoms with a delay in onset; Crustacean: oral symptoms of swelling and itching. • Seafood is often involved in the most severe food allergic reactions. • Food-dependent exercise induced anaphylaxis to seafood.
  43. 43. SYMPTOMS • Seafood allergy is associated with immediate symptoms related to an IgE-mediated food hypersensitivity. • Fish: vomitting; Mollusc: gastro-intestinal symptoms with a delay in onset; Crustacean: oral symptoms of swelling and itching. • Seafood is often involved in the most severe food allergic reactions. • Food-dependent exercise induced anaphylaxis to seafood.
  44. 44. SYMPTOMS CONT.    
  45. 45. SYMPTOMS CONT.     Non IgE-mediated food allergies include:
  46. 46. SYMPTOMS CONT.  Food protein-induced enterocolitis in children    Non IgE-mediated food allergies include:
  47. 47. SYMPTOMS CONT.  Food protein-induced enterocolitis in children  Enterocolitis-like reaction in adults  children   Non IgE-mediated food allergies include:
  48. 48. SYMPTOMS CONT.  Food protein-induced enterocolitis in children  Enterocolitis-like reaction in adults  Contact dermatitis in those with occupational and household skin exposure   Non IgE-mediated food allergies include:
  49. 49. SYMPTOMS CONT.  Food protein-induced enterocolitis in children  Enterocolitis-like reaction in adults  Contact dermatitis in those with occupational and household skin exposure  Occupational allergies i.e. asthma and dermatitis in workers exposed to crustaceans, molluscs and bony fish  Non IgE-mediated food allergies include:
  50. 50. SYMPTOMS CONT.  Food protein-induced enterocolitis in children  Enterocolitis-like reaction in adults  Contact dermatitis in those with occupational and household skin exposure  Occupational allergies i.e. asthma and dermatitis in workers exposed to crustaceans, molluscs and bony fish  Non IgE-mediated food allergies include:
  51. 51. DIFFERENTIAL DIAGNOSIS
  52. 52. DIFFERENTIAL DIAGNOSIS • Anisakis simplex allergy
  53. 53. DIFFERENTIAL DIAGNOSIS • Anisakis simplex allergy • Diarrhetic shellfish poisoning (DSP)
  54. 54. DIFFERENTIAL DIAGNOSIS • Anisakis simplex allergy • Diarrhetic shellfish poisoning (DSP) • Scombroid poisoning easily confused with fish allergy due to the typical symptoms which include: flushing, sweating, urticaria, gastrointestinal symptoms, palpitations and in severe cases bronchospasm
  55. 55. MANAGEMENT OF SEAFOOD ALLERGY
  56. 56. MANAGEMENT OF SEAFOOD ALLERGY • Unlike some food allergies, seafood allergy does not in general resolve with age and therefore correct life-long dietary avoidance is essential (Lopata & Lehrer, 2009).
  57. 57. MANAGEMENT OF SEAFOOD ALLERGY • Unlike some food allergies, seafood allergy does not in general resolve with age and therefore correct life-long dietary avoidance is essential (Lopata & Lehrer, 2009). • Fish, crustacean and mollusc are all required by EU labelling laws to be declared on all products, however some products considered to be a very low risk for reactions do not have to.
  58. 58. MANAGEMENT OF SEAFOOD ALLERGY • Unlike some food allergies, seafood allergy does not in general resolve with age and therefore correct life-long dietary avoidance is essential (Lopata & Lehrer, 2009). • Fish, crustacean and mollusc are all required by EU labelling laws to be declared on all products, however some products considered to be a very low risk for reactions do not have to. • Fish: cross-contamination, wine & beer
  59. 59. MANAGEMENT OF SEAFOOD ALLERGY • Unlike some food allergies, seafood allergy does not in general resolve with age and therefore correct life-long dietary avoidance is essential (Lopata & Lehrer, 2009). • Fish, crustacean and mollusc are all required by EU labelling laws to be declared on all products, however some products considered to be a very low risk for reactions do not have to. • Fish: cross-contamination, wine & beer • Crustacean: cross-contamination, cooking vapours
  60. 60. MANAGEMENT OF SEAFOOD ALLERGY • Unlike some food allergies, seafood allergy does not in general resolve with age and therefore correct life-long dietary avoidance is essential (Lopata & Lehrer, 2009). • Fish, crustacean and mollusc are all required by EU labelling laws to be declared on all products, however some products considered to be a very low risk for reactions do not have to. • Fish: cross-contamination, wine & beer • Crustacean: cross-contamination, cooking vapours
  61. 61. MANAGEMENT OF SEAFOOD ALLERGY • Unlike some food allergies, seafood allergy does not in general resolve with age and therefore correct life-long dietary avoidance is essential (Lopata & Lehrer, 2009). • Fish, crustacean and mollusc are all required by EU labelling laws to be declared on all products, however some products considered to be a very low risk for reactions do not have to. • Fish: cross-contamination, wine & beer • Crustacean: cross-contamination, cooking vapours
  62. 62. INTRODUCTION OF SEAFOOD INTO THE INFANT DIET
  63. 63. INTRODUCTION OF SEAFOOD INTO THE INFANT DIET • ‘window of tolerance’
  64. 64. INTRODUCTION OF SEAFOOD INTO THE INFANT DIET • ‘window of tolerance’ • The AAP recommended no solids be given to an infant until the age of 6months, with a further delay in the introduction of known allergens (cows milk until 1, hens eggs until 2 and peanuts, tree nuts and fish until 3years).
  65. 65. INTRODUCTION OF SEAFOOD INTO THE INFANT DIET • ‘window of tolerance’ • The AAP recommended no solids be given to an infant until the age of 6months, with a further delay in the introduction of known allergens (cows milk until 1, hens eggs until 2 and peanuts, tree nuts and fish until 3years). • However these recommendations have now been revised based on the lack of empirical evidence of the effectiveness in preventing food allergy, and it is no longer advised to delay the introduction of allergenic foods beyond 4-6months.
  66. 66. MY PHD RESEARCH PROJECT
  67. 67. MY PHD RESEARCH PROJECT 1. To determine the prevalence and natural history of fish and shellfish allergy in different regions of the world.
  68. 68. MY PHD RESEARCH PROJECT 1. To determine the prevalence and natural history of fish and shellfish allergy in different regions of the world. 2. To characterise fish allergic adults in the UK with regards to the types of fish involved and other co- existing allergies such as crustacean and molluscs, as well as the presence of atopic disease and their health- related quality of life.
  69. 69. MY PHD RESEARCH PROJECT 1. To determine the prevalence and natural history of fish and shellfish allergy in different regions of the world. 2. To characterise fish allergic adults in the UK with regards to the types of fish involved and other co- existing allergies such as crustacean and molluscs, as well as the presence of atopic disease and their health- related quality of life. 3. To correlate fish intake in pregnancy, the timing of introduction of fish in the first 3 years of life, and frequency of fish consumption with the development of fish allergy and other allergic diseases in the first 10 years of life.
  70. 70. CONCLUSIONS     
  71. 71. CONCLUSIONS  Further prevalence research needed to identify global patterns of allergy.    
  72. 72. CONCLUSIONS  Further prevalence research needed to identify global patterns of allergy.  Key allergenic proteins in seafood identified as Parvalbumin and Tropmyosin   
  73. 73. CONCLUSIONS  Further prevalence research needed to identify global patterns of allergy.  Key allergenic proteins in seafood identified as Parvalbumin and Tropmyosin  Symptoms of allergic reactions as well as non-allergic reactions described.  
  74. 74. CONCLUSIONS  Further prevalence research needed to identify global patterns of allergy.  Key allergenic proteins in seafood identified as Parvalbumin and Tropmyosin  Symptoms of allergic reactions as well as non-allergic reactions described.  Currently the only effective management is avoidance and treatment of adverse symptoms. 
  75. 75. CONCLUSIONS  Further prevalence research needed to identify global patterns of allergy.  Key allergenic proteins in seafood identified as Parvalbumin and Tropmyosin  Symptoms of allergic reactions as well as non-allergic reactions described.  Currently the only effective management is avoidance and treatment of adverse symptoms.  Further clarification is needed on the impact of early introduction of foods and the impact on the childs allergic march.
  76. 76. CONCLUSIONS  Further prevalence research needed to identify global patterns of allergy.  Key allergenic proteins in seafood identified as Parvalbumin and Tropmyosin  Symptoms of allergic reactions as well as non-allergic reactions described.  Currently the only effective management is avoidance and treatment of adverse symptoms.  Further clarification is needed on the impact of early introduction of foods and the impact on the childs allergic march. MANY THANKS

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