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Vol 23. no 2
June 2018

Anaphylactic reaction in patient allergic to shrimp (summary)
Ewa Gawrońska-Ukleja, Natalia Ukleja-Sokołowska, Magdalena Żbikowska-Gotz, Kinga Lis, Łukasz Sokołowski, Zbigniew Bartuzi
Introduction. The prevalence of shellfish allergy depends on the climate zone and the population. It is assumed that about 0.5-2.5% of the general population is allergic to shrimps. The best-characterized allergens are tropomyosin, arginine kinase, sarcoplasmic calcium-binding protein and hemocyanin. Case report. The patient, 28 year old male, was admitted in July 2017 to the Department of Allergology to diagnose the cause of anaphylactic reaction which occurred 3 months prior to the hospitalization after consumption of king prawns. Immediately after the meal the patient developed pruritus and generalized urticaria as well as swelling of the hands and face. Next the patient developed vast urticaria on limbs and trunk, followed by tachycardia and hypotension. During the diagnosis, the patient underwentskin prick tests with extracts of food and inhalant allergens, including standardized shrimp allergen extract - with a positive result for D. pteronyssinus and D. farinae, grass, weeds, cat dander, hazel, birch and alder, but negative for all food allergens tested, including shrimp. The prick by prick tests performed with fresh royal shrimp (both raw and cooked) yielded strongly positive results. The concentration of IgE specific to shrimp allergen was elevated - 5.25 kU/l, while the concentration of IgE of shrimp tropomiosin was negative (ImmunoCap). In addition, elevated concentrations of IgE specific for D. pteronyssinus were found 9.86 kU/l, D. farinae 7.90 kU/l, grass 19.09 kU/l, cat's dander 2.94 kU/l. We also established the level of IgE specific to allergen components using the ImmunoCap ISAC method. Allergen-specific IgE was not elevated to any shrimp allergens available in ImmunoCap ISAC: n Pen m1 (tropomyosin), n Pen m2 (arginine kinase) and n Pen m4 (calcium binding sarcoplasmic protein). Conclusions. On the basis of conducted examinations the patient was diagnosed with a shrimp allergy. The applied molecular diagnostics did not explain which allergen component the patient is allergic to. It is possible that the patient is allergic to hemocyanin, which can also cross-react with house dust mite allergens, but confirmation of this diagnosis requires further investigation. Keywords: allergy, shrimp, allergen components
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