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Shrimp allergy: analysis of commercially available extracts for in-vivo diagnosis

Asero R1, Scala E2, Villalta D3, Pravettoni V4, Arena A5, Billeri L6, Colombo G7, Cortellini8, Cucinelli F9, De Cristofaro ML10, Farioli L11, Iemoli E12, Lodi Rizzini F13, Longo R14, Losappio L15, Macchia D16, Maietta G17, Minale P18, Murzilli F9, Nebiolo F19, Pastorello EA15, Ventura MT20, Voltolini18, Amato S21, Mistrello G21

1Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy
2Istituto Dermopatico dell'Immacolata – IRCCS, Roma, Italy
3SSD di Allergologia e Immunologia Clinica, Azienda Ospedaliera S. Maria degli Angeli, Pordenone, Italy
4UOC Clinical Allergy and Immunology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
5Ambulatorio Allergologia, Azienda Usl 5 di Messina, Italy
6Department of Laboratory Medicine, University Hospital, Padova, Italy
7Allergy and Clinical Immunology Unit, IRCCS San Raffaele Hospital, Milan, Italy
8UO di Medicina Interna e Reumatologia, Azienda Sanitaria della Romagna, Rimini, ItalY
9U.O.S.D. di Allergologia, Ospedale SS. Filippo e Nicola di Avezzano (AQ), Italy
10Ambulatorio di Allergologia, Ospedale San Timoteo, Termoli (CB), Italy
11Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
12Allergy and Clinical Immunology Unit, ASST Fatebenefratelli/Sacco, Milano, Italy
13S.S.V.D. Allergologia, A.O. Spedali Civili di Brescia, Italy
14Ambulatorio Territoriale di Allergologia, ASP Vibo Valentia, Italy
15Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
16Allergologia Immunologia Clinica, P.O. S. Giovanni di Dio, Firenze, Italy
17Ambulatorio di Allergologia Accreditato ASL, Lecce, Italy
18U.O.C. Allergologia IRCCS San Martino-IST, Genova, Italy
19Ambulatorio di Allergologia e Immunologia, AO Ordine Mauriziano, Torino, Italy
20Dipartimento di Medicina Interna, Immunologia e Malattie Infettive, Università di Bari, Policlinico, Bari, Italy
21R & D, Lofarma, Milano, Italy

J Investig Allergol Clin Immunol 2017; Vol. 27(3)
doi: 10.18176/jiaci.0127

Background: SPT with commercial extracts represent the first step of the diagnosis of shrimp allergy but their clinical efficiency is undefined.
Objective: To analyze the clinical usefulness of all commercial extracts of crustaceans for SPT available in Italy.
Methods: One hundred fifty-seven shrimp-allergic patients underwent SPT with five commercial extracts of crustaceans and with house dust mite (HDM) extract in a multicenter study. Commercial extracts were analyzed by SDS-PAGE and compared with a freshly prepared in house shrimp extract. IgE to Pen a 1/Pen m 1; Pen m 2, and Pen m 4 were detected and immunoblot analysis was carried on a large number of sera.
Results: Commercial crustaceans extracts gave extremely inhomogeneous skin reactions resulting in 32 different clinical profiles, showed marked differences in protein content, and sometimes lacked proteins at molecular weights corresponding to those of major shrimp allergens. Only strong Pen a 1/Pen m 1 reactors reacted to both HDM and all 5 commercial extracts on SPT. Most patients, including tropomyosin-negative ones, reacted to HDM. Patients reacted to a variable and large array of proteins and IgE reactivity at high molecular weights (> 50 kDa) was frequently detected.
Conclusions: The in-vivo diagnosis of shrimp allergy must be still based on SPT with fresh material. Shrimp-allergic patients frequently react to a numberof ill-defined high molecular weight allergens which makes currently available molecules for the component-resolved diagnosis largely insufficient. Mites and crustaceans probably share several allergens other than tropomyosin. 

Key words: Allergens, Allergy diagnosis, Food allergy, Shrimp allergy, Skin testing.