Asthma caused by seafood


Occupations
  • Animal foodstuffs industry
  • Conserved food industry
  • Cook, Fishermen
  • Fishmonger
  • Food industry
  • Oyster sheller
  • Shellfish workers
Agents
Anisakis simplex, Ascidie, Caviar, Clam, Coral, Crab, Daphnia, Fish, Lobster, Prawn, Salmon, Sea squirt, shrimp, Scallops.
 
Incidence
Incidence: very high in certain areas e.g. 15.6% of exposed subjects in Canada. It is equally linked with work and the causative allergen: fish, prawn, crab.
 
Control of occupational exposure is important: epidermics of asthma caused by prawns have been described.
 
IgE-dependent mechanism with type III reactions in the case of alveolitis. Sensitisation may also occur due to inhalation of cooking vapours containing particles of the allergen.
 
Conditions
The expansion of aquaculture has increased the risk and number of cases of this occupational disease. Sensitisations may occur independently to one or more sea-food. Recently, the demonstration that a single common stable antigen exists in both prawns and scallops has increased the problem, since this allergen is a tropomyosin, identical to that which is found in squid, dust mites and snails. The antigen is a protein of 35–39 kDa. Anisakis simplex is a parasitic nematode found in fish and crustaceans, whose pathogenic role is well known amongst fish eaters. Inhalation of cooking vapours from contaminated fish may make Anisakis simplex into an occupational allergen. Fishers of Japanese langoustines develop urticaria, asthma and conjunctivitis to the coral (Dendronepthya nipponica) which they encounter during their work.
 
Symptoms
Typical allergic asthma, associated with rhinitis, conjunctivitis and work. Cases of alveolitis have been reported. Food allergies may develop to these products.
Anisakis may cause generalized urticaria.
 
Diagnostic methods
Skin tests: IDR and skin prick tests for those allergens which are commercially available.
 
Immunological assay: RAST/CAP RAST fish, crab, prawn, lobster and RAST for daphnia.
 
Bronchial provocation test (in hospital).
 
Due to the tropomyosin, cross-reactivities exist between Anisakis, other nematodes and dust mites. Coral allergens have been described, and skin tests and IgE measurements have been performed on an experimental basis.
 

References

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As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.