Trends in seafood-induced anaphylaxis: Data from the European Anaphylaxis Registry

Faust, L. et al. The Journal of Allergy and Clinical Immunology: In Practice, Volume 0, Issue 0 Articles in Press

HIGHLIGHT BOX

• What is already known about this topic? Shellfish and fish are common triggers of food-induced anaphylaxis. Real-world studies investigating the age-dependent clinical characteristics of anaphylaxis caused by fish and shellfish are limited.
• What does this article add to our knowledge? Shellfish, particularly shrimp, are a leading and rising trigger of food-induced anaphylaxis in adults, with high eliciting doses; high recurrence rates characterize fish anaphylaxis in children. Adrenaline is underused in seafood-induced anaphylaxis.
• How does this study impact current management guidelines? This study emphasizes improving adrenaline use, raising cofactor awareness, dietary prevention regarding eliciting amounts and allergen disclosure in food settings to enhance seafood anaphylaxis management across age groups and clinical presentations.

ABSTRACT

Background

Shellfish and fish are increasingly consumed worldwide and are common triggers of food-induced anaphylaxis.

Objective

To characterize seafood-induced anaphylaxis using data from the European Anaphylaxis Registry.

Methods

Seafood-induced cases were selected from the registry (2007-2022) and analysed regarding age and geographical distribution, elicitors, clinical features and time trends.

Results

(A) Flow diagram of case selection.
(B) Density plot showing estimated age distribution among
patients experiencing anaphylaxis induced by fish (n = 146),
shellfish (n = 316) or other food triggers (n = 4,776).
(C) Time trend of registered shellfish cases among all food
induced cases in adults (n = 240) over time (2007-2022).
(D) Frequency of reported seafood 666 anaphylaxis
from the European Anaphylaxis Registry.

We identified 462 patients, including 316 (68%) with shellfish- and 146 (32%) with fish-induced anaphylaxis. In Europe, shellfish showed geographical differences, being the main elicitor of food-induced anaphylaxis in Italy and Spain. Shrimps accounted for 76% of shellfish reactions, while fish-induced anaphylaxis involved a broader range of species (e.g., cod 41%, salmon 18%, tuna 8.2%). Shellfish anaphylaxis was more common in adults (76%), particularly females, was not life-threatening and presented with an atopy-independent phenotype. Reactions were frequently related to larger portion sizes (48%) and suspected cofactors. An increase in adult shellfish-induced anaphylaxis was observed over time. In contrast, fish anaphylaxis was more frequent in children and adolescents (59%) with mild severity, occurred more often in boys and was often triggered by small allergen amounts. A prior reaction to the same allergen was reported in 57% of cases. Adrenaline was administered in 33% of adult shellfish and 24% of fish anaphylaxis cases in children.

Conclusion

Fish- and shellfish-induced anaphylaxis show distinct patterns regarding age, sex and clinical manifestation, but also geographical distribution. Shellfish reactions in adults are on rise in Europe. The underuse of adrenaline highlights the need for improved management strategies across all age groups.

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