+
For Patients & Caregivers
For Lab Professionals
Welcome! Click here for Patient or Laboratory Professional content
Are you a healthcare professional?

The information in this website is intended only for healthcare professionals. By entering this site, you are confirming that you are a healthcare professional.

Are you a laboratory professional?

The information in this website is intended only for laboratory professionals. By entering this site, you are confirming that you are a laboratory professional.

f24 Shrimp

Code f24
Family Pandalidae/Penaeidae
Genus Pandalus/Penaeus
Species Pandalus borealis, Penaeus monodon, Metapenaeus spp.
Route of Exposure Ingestion
Source Material Boiled, frozen Atlantic shrimp and raw, frozen prawns from the Indo-West-Pacific
Latin Name Pandalus borealis, Penaeus monodon, Metapenaeopsis barbata, Metapenaus joyneri
Other Names Black tiger shrimp, Giant tiger prawn, Northern shrimp, pink shrimp
Categories Food Of Animal Origin, Shellfish

Summary

Shrimp is a commercially important decapod crustacean species and is considered to be a highly allergenic food, causing severe reactions, such as anaphylaxis. The shrimp allergen is present in its abdominal and tail muscle regions. Asians are reported to have higher prevalence of shellfish allergy compared to Western countries. Moreover, children are found to have a lower incidence of shellfish allergy than adults. Shrimp allergy is primarily caused due to consumption of shrimp meat and secondarily due to handling of shrimp, and its products in sea food industry and inhalation of aeroallergens produced during shrimp processing. Exposure of shrimp in sensitized individual can induce anaphylaxis, skin symptoms, urticaria, and angioedema, gastrointestinal symptoms, respiratory symptoms (rhinitis and occupational asthma). The major shrimp allergens reported are tropomyosin and arginine kinase. Shrimp tropomyosin is a pan-allergen, which is cross-reactive with the tropomyosin of other crustaceans, mollusks, house dust mite, cockroach, and parasites. In sensitized individual, it is advised to avoid shrimp meat intake and exposure to shrimp meat (handling) to prevent allergic reactions.

Allergen

Nature

Shrimp is a decapod crustacean, which is considered to be the major cause of allergic reactions (1). Penaeus monodon (giant tiger shrimp) is the commercially most important shrimp species because of its large size, faster growth, higher survival and successful breeding in captivity (2). Velvet shrimps (Metapenaeopsis spp.) are a group of small penaeid species (R. Watson 1990). Giant tiger shrimp has a smooth and polished shell. The rostrum is sigmoidal with 6 or 8 dorsal and 2 or 4 ventral teeth. Carapace and abdomen are transverse with the red and white band, antennas are greyish brown (2). Pink shrimp (Pandalus borealis) is characterized by the presence of prominent median dorsal spines on the third abdominal somite and the color varies from pink to bright red (3). 

Habitat

The juvenile and adolescents of giant tiger prawns are found inshore areas or in mangrove estuaries, while adults live in deeper water (up to 162 m) (2). Velvet shrimps are distributed in tropical and temperate climates (4). Pink shrimps are abundant and commercially important species in the northeast Atlantic (3).

Taxonomy

Taxonomic tree of Shrimp  (1-3,5)  
Domain Eukaryota
Kingdom Animalia
Phylum Arthropoda
Subphylum Crustacea
Class Malacostraca
Order Decapoda
Family Pandalidae/Penaeoidae
Genus Pandalus/Penaeus/ Metapenaeopsis
Species  Pandalus borealis, Penaeus monodon 

Tissue

Most of the allergens characterized in shellfish are found in the edible muscle regions of different species of shellfish. Major allergen tropomyosin is found in the abdominal part of prawn/shrimp (6). Allergens such as  (Met e 1, Pan s 1, Hom a 1) are found in shrimp tail muscles (7). Shrimp products including dried shrimp or shrimp paste are added as a flavoring agents in processed and packaged food (instant soup or noodles), which on accidental consumption can lead to shrimp allergic reactions in sensitized individuals and thus considered as a hidden allergen (8). 

Epidemiology

Worldwide distribution

Shellfish allergy is one of the most common food allergies, which may continue for a long time, usually persisting till adulthood. Among different crustacean species, shrimp is majorly responsible for allergy in adults and children. The prevalence of shellfish allergy ranges from 1.3 - 5.2%, based on the different dietary habits of various countries (9). Asians are reported to have a higher prevalence of shellfish allergy compared to the people in Western countries due to higher consumption of shellfish in this region (10). In the Philippines and Singapore shellfish allergy in teenagers was reported to be 5.12% and 5.23% respectively (11). A study conducted on children residing in Singapore showed more prevalence of shellfish allergy in native children as compared to non-native children. In the age group of 4-6years, the prevalence rate was 1.19% for native children and 0.55% for non-native children. Similarly, in the age group of 14-16 years, the prevalence rate was 5.23% for native children and 0.96% was for non-native children (12).

In another study conducted in Singapore by Thong et al. (2018) on 120 participants (of mean age 19.1± 1.5 years) with 64.2% having a food allergy, shellfish (78%) was the most commonly reported food and among different shellfish, shrimp was mostly responsible for causing oral allergy syndrome (OAS) in 30.3 % cases (13).

A study by Hao et al. (2018) reported a 12.4% prevalence of shrimp in 459 children and adults, based on a survey conducted in Hebei Province of China (14).  Li et al. (2019) conducted a multicenter epidemiological survey in 35,549 schoolchildren (between 6 to 11 years) from rural and urban areas of India, China and Russia. Results stated that, in Hong Kong, shrimp was the most common food associated with sensitization besides egg and milk. In India and rural Shaoguan (China) sensitization against shrimp was quite high, about 10.3% and 13.1% respectively (15).

A population-based cross-sectional survey by Gupta et al. (2019) included 40,443 adults from the US. The results reported a 1.9% prevalence of shrimp allergy (16). A telephonic survey of 14,948 individuals in the US reported that 2-3% of individuals claimed to have a seafood allergy, out of which 2.2 % was due to shellfish. Children (0.5%) estimated to have a lower allergy rate as compared to adults (2.5%). Shrimp was found to be the most common cause of allergy followed by crab, lobster, clam, oyster, and mussel in the same decreasing order (12). In line with this survey, another study in the USA detected adults have a higher incidence of shellfish allergy (2.8%) as compared to children (0.6%) and women had more incidence (3.6%) as compared to men (2%) (11).

A multi-center survey conducted in Europe showed IgE sensitization to shrimp was 4.8% among adults (10).

Shrimp allergy is highly prevalent in the Canarian Islands, due to the higher regional prevalence of house dust mite (HDM) allergy (17). A study evaluated parents (of Mexican school children aged 5-13 years) reported the prevalence of food allergy involving 1049 participants. Among all surveyed food in school children from Mexico, shrimp (1.3%) was found to be the major food for inducing hypersensitivity (18).

Risk factors

Individuals who are in the vicinity of cooking shellfish by boiling, steaming or frying are prone to develop allergic reactions by inhalation of vapors (12). Fishermen, processing workers, shell grinders, cooks, and even restaurant workers are at risk of developing allergic reactions to shellfish (19).

Pediatric issues

Adults are known to be more commonly affected compared with shellfish allergy compared to children (20). Moreover, in children, the anaphylaxis rate caused by shrimp was found to be lower compared to adults in a study. The precise reason for this mechanism was not clear. However, the probable reasons may be anaphylaxis rate has been artificially raised in the adult population as adults with less-severe allergic reactions would avoid causative food and won’t take medical attention. Secondly underreporting of anaphylaxis in children may occur because of risky behavior. Finally, some drugs taken by adults may lead to food-induced anaphylaxis (21).  

Environmental Characteristics

Worldwide distribution

Giant tiger prawns are widely distributed in the Indo-Pacific region, and fishing grounds are located in tropical countries like Indonesia, Malaysia, and the Philippines (2). Pink shrimp are widely distributed in the northeast of the Atlantic (3). Velvet shrimps are distributed in central Japan, Indonesia, Philippines, Thailand and Australia. Penaeus monodon (giant tiger prawn, black tiger prawn, leader prawn, grass prawn) is the most important species of farmed crustacean worldwide. The natural distribution is in the Indo-West–Pacific region. (4).

Route of Exposure

Main

The main route for shrimp exposure is through oral ingestion (10).

Secondary

Inhalation is another route of exposure. Workers working in the sea-food industry are exposed to air-borne shellfish particulate matter formed because of different processing activities such as filleting, freezing, cooking, smoking, drying which get suspended in the air as aerosols and can be inhaled (22).

Detection

Oral allergy symptoms and Anaphylaxis

On exposure to shellfish, IgE-mediated allergic reactions may take place. The reactions can involve single or multiple organs and also allergic reactions may vary from immediate or late-phase (up to 8 hrs. after shellfish intake) reactions. Most frequently reported symptoms are oral allergic symptoms such as itching in the mouth and throat and lip swelling. In allergic patients, these reactions can induce further skin reactions such as urticaria, periorbital angioedema and skin redness and also gastrointestinal symptoms (10, 21).  

 A study conducted by Chokshi et al. (2015) in the USA evaluated the rate of anaphylaxis with shrimp allergy, clinical presentation, and cross-reactive sensitization among children (< 18 years) allergic to shrimp. Results showed 68 patients were allergic to shrimp with a 12% rate of anaphylaxis. The most common clinical manifestation was mucocutaneous symptoms including skin symptoms (70%), urticaria (58%) and angioedema (58%). The patients more likely affected were males of African American or Asian ancestry with house dust mite or cockroach allergy. Also, a higher rate of eczema was observed in non-anaphylactic patients compared to the anaphylactic patient (21).

A case of a 16-year-old female was reported. She had a history of anaphylaxis to shellfish and allergic rhinitis (AR) to dust mite and cat. Her first allergic symptoms after eating shrimp (<20 mins) were swelling of the tongue and lips with pruritus, which resolved within 24 hours. However, the second reaction after eating shrimp rice (after 30 mins), was more severe, with allergic symptoms such as swelling of the periorbital area, lip, and tongue with hives. Further, tongue swelling increased which led to shortness of breath and required immediate medical attention. Her specific IgE (sIgE) level for shrimp was found to be high (20).  

Shellfish is known to induce food-dependent exercise-induced anaphylaxis. It is important to consider if exercise was performed before an allergic response. Shellfish allergy has also proved to be the leading cause of food anaphylaxis in Hong Kong and Taiwan (11). One study in Singapore detected OAS and anaphylaxis symptoms due to different types of shellfish ingestion in 120 patients and compared the rate of OAS and anaphylaxis. The skin prick test was found to be positive for shrimp with symptoms of OAS in 87.1% and anaphylaxis in 100% positive cases (13).

Exposure of skin to the shellfish allergens takes place in occupational settings while handling and leads to urticaria or allergic contact dermatitis. There is a 3 to 11% prevalence of occupational contact dermatitis due to shellfish (12).

Allergic rhinitis

Lobster, shrimp, and crab are also known to cause occupational dermatitis, rhinitis, and conjunctivitis in fishermen and processing workers, cooks, restaurant workers (19).

Asthma

Shellfish are known to induce occupational asthma among workers, working in seafood processing plants and an estimated prevalence is about 2-36% (23). A case study by Goetz and colleagues (2000) found cross-reactivity of shrimp and scallops in a restaurant worker handling seafood. He developed IgE-mediated occupational asthma and contact urticaria. The allergen identified was a heat-stable protein with molecular masses ranging between 35 to 39 kD which may be tropomyosin. Also, boiling shellfish in an open containers may be a potential source of allergen which can induce respiratory allergic symptoms in cooks (24). 

Prevention and Therapy

Prevention strategies

Avoidance

Avoidance of food responsible for causing allergy is the basic measure to control food allergies. Patients should be educated of possible exposure to hidden allergens in restaurants in terms of cooking equipment or serving utensils. Educating patient and family members about the diet intake, allergic symptoms its consequences and self-administration of anti-allergic medication (in an emergency) (17). Also, shrimp (dried or paste) is present in instant noodles or soup, which can lead to accidental exposure (8). Patients that are allergic to shellfish like shrimp and lobster have to avoid the entire group of shellfish due to high cross-reactivity rates (25). Also, it is important to protect the consumer by accurate labeling of the food products to prevent a potentially life-threatening condition for allergic persons (26). 

Molecular Aspects

Allergenic molecules

Name of allergen

Molecular weight

Common name

Tissue present

Remarks

Pen a 1

Pen m 1

38-41 kDa

Tropomyosin

Muscle

Ingestion/ Inhalation; major allergen from shrimp

Pen m 2

40 kDa

Arginine kinase

Muscle

Ingestion

Lit v 3,Cra c 5

20 kDa

Myosin light chain

Muscle

Ingestion

Pen m 4, Lit v 4

20-22 kDa

Calcium-binding sarcoplasmic protein

Muscle

Ingestion

Other allergens identified are;

  • Cra c 6 (Troponin C) with molecular weight 21 kDa.
  • Cra c 8 (Triosephosphate isomerase) with molecular weight 28 kDa.                
  • Myosin heavy chain with a molecular mass of 225 kDa.
  • α-actin (molecular weight 31–42 kDa).
  • Glyceraldehyde phosphate dehydrogenase (molecular weight 37 kDa).
  • Paramyosin (myofibrillar protein) specific to invertebrate is a thermo-labile allergen (molecular mass 100 kDa) identified in various shellfish (5, 17).

Pen a 1 is identical (up to 98%) with tropomyosin of other crustacean species such as crab and lobster (17). In Solenocera melantho (red shrimp), α- and β-actin, fructose biphosphate aldolase and ubiquitin are identified as allergens in few shrimp allergic patients (17).  Another study by Li et al. (2020) evaluated IgE and IgG4 response to tropomyosin in 92 shrimp allergic patients. Results identified that 71.4% of shrimp allergic patients are sensitized to Pen a 1 and IgG4 antibodies to Pen a 1 were present in 62.9% of patients (27).

Cross-reactivity

Pen a 1 (tropomyosin) is responsible for cross-reactivity among the members of the shellfish family, especially the crustaceans (such as prawns, crab and lobsters). Moreover, tropomyosin is an invertebrate pan allergen and reported to cross-react with the members of the class Arthropoda e.g. HDM (Der p1 10, Der f 10) (17), with mollusks, and nematodes (28). According to a study finding, shrimp allergic patients are thought to show about 70% probability of positive skin prick test to crab and 78% probability with lobster (5).

In one occupational asthma patient, oysters and shrimps were found to be cross-reactive (5). Some recent case reports mentioned, ubiquitin, α -actin, and Pen m 2 (arginine kinase) may be associated with mite-seafood cross-reactivity. HDM allergens are the leading sensitizers for shrimp allergen in children and adults due to cross-reactivity as shown in a study (29).

Moreover, cockroach allergen Bla g 8 has 62.6 % similarity and 48.5% identity with shrimp myosin light chain allergen (9).

Compiled By

Author: Turacoz Healthcare Solutions

Reviewer: Dr. Christian Fischer

 

Last reviewed: November 2020

References
  1. Faber MA, Pascal M, El Kharbouchi O, Sabato V, Hagendorens MM, Decuyper, II, et al. Shellfish allergens: tropomyosin and beyond. Allergy. 2017;72(6):842-8.
  2. Solis NB. Biology and Culture of Penaeus Monodon: Brackishwater Aquaculture Information System; 1988.
  3. Shumway S, Perkins HC, Schick DF, Stickney AP, Fi. Synopsis of biological data on the pink shrimp, Pandalus borealis Krøyer, 1838. NOAA Technical Report NMFS 30. XF2006254177. 1985;144.
  4. R. Watson AK. Velvet Prawns (Metapenaeopsis Spp) of Torres Strait1990.
  5. Pedrosa M, Boyano-Martinez T, Garcia-Ara C, Quirce S. Shellfish Allergy: a Comprehensive Review. Clin Rev Allergy Immunol. 2015;49(2):203-16.
  6. Lopata AL, Kleine-Tebbe J, Kamath SD. Allergens and molecular diagnostics of shellfish allergy: Part 22 of the Series Molecular Allergology. Allergo J Int. 2016;25(7):210-8.
  7. Leung PS, Chen YC, Gershwin ME, Wong SH, Kwan HS, Chu KH. Identification and molecular characterization of Charybdis feriatus tropomyosin, the major crab allergen. J Allergy Clin Immunol. 1998;102(5):847-52.
  8. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, et al. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol. 2016;27 Suppl 23:1-250.
  9. Pascal M, Grishina G, Yang AC, Sanchez-Garcia S, Lin J, Towle D, et al. Molecular Diagnosis of Shrimp Allergy: Efficiency of Several Allergens to Predict Clinical Reactivity. J Allergy Clin Immunol Pract. 2015;3(4):521-9 e10.
  10. Wai CYY, Leung NYH, Chu KH, Leung PSC, Leung ASY, Wong GWK, et al. Overcoming Shellfish Allergy: How Far Have We Come? Int J Mol Sci. 2020;21(6).
  11. Tong WS, Yuen AW, Wai CY, Leung NY, Chu KH, Leung PS. Diagnosis of fish and shellfish allergies. J Asthma Allergy. 2018;11:247-60.
  12. Woo CK, Bahna SL. Not all shellfish "allergy" is allergy! Clinical and Translational Allergy. 2011;1(1):3.
  13. Thong BY, Arulanandam S, Tan SC, Tan TC, Chan GY, Tan JW, et al. Shellfish/crustacean oral allergy syndrome among national service pre-enlistees in Singapore. Asia Pac Allergy. 2018;8(2):e18.
  14. Hao G, Lai X, Song Z, Wang Z, Kong XA, Zhong H, et al. Self-reported questionnaire survey on the prevalence and symptoms of adverse food reactions in patients with chronic inhalant diseases in Tangshan city, China. Allergy Asthma Clin Immunol. 2018;14:3.
  15. Li J, Ogorodova LM, Mahesh PA, Wang MH, Fedorova OS, Leung TF, et al. Comparative Study of Food Allergies in Children from China, India, and Russia: The EuroPrevall-INCO Surveys. J Allergy Clin Immunol Pract. 2020;8(4):1349-58 e16.
  16. Gupta RS, Warren CM, Smith BM, Jiang J, Blumenstock JA, Davis MM, et al. Prevalence and Severity of Food Allergies Among US Adults. JAMA Netw Open. 2019;2(1):e185630.
  17. El-Qutob D. Shrimp allergy: beyond avoidance diet. Eur Ann Allergy Clin Immunol. 2017;49(6):252-6.
  18. Ontiveros N, Valdez-Meza EE, Vergara-Jimenez MJ, Canizalez-Roman A, Borzutzky A, Cabrera-Chavez F. Parent-reported prevalence of food allergy in Mexican schoolchildren: A population-based study. Allergol Immunopathol (Madr). 2016;44(6):563-70.
  19. Leung PS, Chu KH. Molecular and immunological characterization of shellfish allergens. Front Biosci. 1998;3:d306-12.
  20. Davis CM, Gupta RS, Aktas ON, Diaz V, Kamath SD, Lopata AL. Clinical Management of Seafood Allergy. J Allergy Clin Immunol Pract. 2020;8(1):37-44.
  21. Chokshi NY, Maskatia Z, Miller S, Guffey D, Minard CG, Davis CM. Risk factors in pediatric shrimp allergy. Allergy Asthma Proc. 2015;36(4):65-71.
  22. Kamath SD, Thomassen MR, Saptarshi SR, Nguyen HM, Aasmoe L, Bang BE, et al. Molecular and immunological approaches in quantifying the air-borne food allergen tropomyosin in crab processing facilities. Int J Hyg Environ Health. 2014;217(7):740-50.
  23. Khora SS. Seafood-Associated Shellfish Allergy: A Comprehensive Review. Immunol Invest. 2016;45(6):504-30.
  24. Goetz DW, Whisman BA. Occupational asthma in a seafood restaurant worker: cross-reactivity of shrimp and scallops. Ann Allergy Asthma Immunol. 2000;85(6 Pt 1):461-6.
  25. Abrams EM, Sicherer SH. Diagnosis and management of food allergy. CMAJ. 2016;188(15):1087-93.
  26. Fernandes TJR, Costa J, Oliveira MBPP, Mafra I. An overview on fish and shellfish allergens and current methods of detection. Food and Agricultural Immunology. 2015;26(6):848-69.
  27. Li J, Li Z, Kong D, Li S, Yu Y, Li H. IgE and IgG4 responses to shrimp allergen tropomyosin and its epitopes in patients from coastal areas of northern China. Mol Med Rep. 2020;22(1):371-9.
  28. Ayuso R, Reese G, Leong-Kee S, Plante M, Lehrer SB. Molecular basis of arthropod cross-reactivity: IgE-binding cross-reactive epitopes of shrimp, house dust mite and cockroach tropomyosins. Int Arch Allergy Immunol. 2002;129(1):38-48.
  29. Shen CY, Tsai JJ, Liao EC. Cross-reactivity of sIgE to mite and shrimp induced allergies in different age groups and clinical profiles of shrimp sIgE in vegetarians. Sci Rep. 2019;9(1):12548.