results of the search · web viewthe prevalence of fish allergy ranged from 0-7% and shellfish...
TRANSCRIPT
The prevalence of fish and shellfish allergy: A systematic review
Harriet Moonesinghe, Sally Kilburn, Kellyn Lee, Heather Mackenzie, Paul Turner, Carina
Venter and Tara Dean.
Corresponding Author: Dr Heather Mackenzie, Graduate School, University of
Portsmouth, Portsmouth,
Funding sources:
Clinical implications:
Capsule summary:
Key words: prevalence, fish, shellfish, food allergy, food hypersensitivity, systematic
review
ABSTRACT
Background: Accurate information on the prevalence of food allergy facilitates a more
evidence-based approach to planning of allergy services, and can establish important
geographical variations which may exist.
Objective: To perform a systematic review to assess the prevalence, by age, of fish,
crustacean and mollusc allergy worldwide.
Methods: Searches were conducted using two databases; Web of Science and PubMed.
Data was presented by method of diagnosis; questionnaire-based, sensitisation rates and
food challenge proven prevalence.
Results: A total of 7333 articles were identified but only 61 studies met the inclusion
criteria and were included in this review. The prevalence of fish allergy ranged from 0-7%
and shellfish allergy from 0-10.3%, depending on the method of diagnosis.
Conclusions: Very few studies have established the prevalence of fish/shellfish allergy
using the gold standard challenge criteria, with the majority instead relying on self-
reported, questionnaire-based methods. Where food challenges were used, the prevalence
for fish allergy was found to be 0-0.3% and for shellfish allergy was 0-0.9%.
INTRODUCTION
1
Fish and shellfish (crustacea) are major allergens as defined by the European Community,
and are a leading cause of anaphylaxis (1). Allergic reactions to seafood are usually
immediate i.e. related to an IgE response, although non-IgE mediated reactions (including
Food Protein Induced Enterocolitis syndrome) can also be triggered (2). Reactions can be
triggered by direct ingestion or skin contact, or (in some cases) through ingestion or
contact with cooking vapours (3). In contrast to allergens such as egg and cow’s milk,
seafood allergy does not in general resolve with age and therefore life-long dietary
avoidance is necessary (4). Evidence suggests that there is an increased prevalence of fish
and shellfish allergy in countries with high seafood consumption such as Australia, Asia
and parts of Europe (5).
Accurate information about the prevalence of allergies to specific foods facilitates an
evidence-based approach to the planning and provision of allergy services both nationally
and internationally (2). Prevalence data can be used to identify which are the most
common food allergens and their natural history within countries. At an international level,
geographical variations can be explored and greater understanding of trends and
mechanisms in the development of food allergy reached. Existing policy and legislation in
the field of food allergy (e.g. manufacturing and labelling practices, care guidelines,
catering practices) is largely informed by self-reported prevalence, which is widely
recognised to overestimate true prevalence (6).
A systematic review enables the totality of the evidence base to be reviewed. This would
provide an accurate description of what we currently know about the prevalence of
allergies to specific foods and identifies gaps in our understanding (e.g. where data is
lacking for countries, diagnostic method and/or allergen). It allows us to understand the
degree to which current knowledge is based on self-report, sensitisation and/or challenge-
proven food allergy.
There are currently four existing systematic reviews looking at prevalence of food allergy
(7). However no systematic review has yet to describe the prevalence of allergy to the 14
food allergens as listed under EU food labelling legislation (which is the most
comprehensive list in current use) by region of the world. Therefore we conducted a
systematic review to meet the above aims, and this paper is part of a series presenting data
from this. This paper will report the prevalence of fish and shellfish allergy.
METHODS
2
Search strategy and reference management
We searched Web of Science, PubMed and the Conference Proceedings Citations Index
(Online repository 1). No language, date or study type restrictions were employed. Grey
literature was sought via direct contact with a list of topic experts and relevant research
funders. Search results were managed using EndNote and duplicates removed. English
language versions of articles were obtained where necessary.
Screening
The titles and abstracts of all identified articles were screened by one review author and
excluded if, for example, they were obviously unrelated to the topic of the review, the
sample was inappropriate for the scope of the review, or because they did not present
primary research. If the review author was unsure about the eligibility of the paper for
inclusion in the review, the paper was discussed with another author. Reasons for
exclusion were recorded. The full-text of all potentially eligible studies was assessed
against the following criteria:
Types of studies
Population-based cross-sectional studies and cohort studies examining the prevalence of
food allergy (IgE-mediated and non-IgE mediated) at an identifiable point (or period) in
time.
Types of participants
Participants of all age groups from any country. Studies that did not present region or
country-specific data were excluded from the review. Studies must have been population
based, using either a fixed cohort or an appropriate sampling strategy. Studies conducted in
a clinical setting or in selected patient groups were excluded.
Types of outcome measure
Prevalence of allergies (or sensitisation) to one or more of the following food allergens
(milk/dairy, eggs, cereals, peanuts, nuts, celery, crustaceans, fish, molluscs, soy, lupin,
mustard and sesame) were eligible for inclusion as diagnosed by:
Self-report
Positive SPT
3
Positive serum-specific IgE
Clinical history of adverse reactions to foods and:
; positive SPT (for IgE-mediated food allergy)
; or positive serum-specific IgE (for IgE-mediated food allergy)
; or positive food challenge (open or double-blind placebo-controlled: for IgE and
non-IgE mediated food allergy, allowing for delayed reactions in the case of non-
IgE mediated food allergy)
Studies that did not present separate prevalence data for individual allergens were excluded
from the review. In addition, studies employing atopy patch tests or other diagnostic tests
e.g. IgG measures were excluded as these are not recommended for the routine diagnosis
of food allergy (8).
Data extraction and analysis
The following was extracted for all included studies (using EPPI Reviewer software; EPPI
Centre, 2011):
1. General information: Authors’ contact details, research funder, year(s) study
conducted, country/countries in which conducted.
2. Methods: Study design, type of food allergy considered, food(s) assessed, method
of diagnosis (including additional information with regard to the procedure),
sampling strategy and sample characteristics.
3. Outcomes: Percentage prevalence, raw data and confidence intervals.
Where there was ambiguity in the reporting of results, all efforts were made to contact the
study authors to provide additional information.
Assessing the quality of included studies
Studies were assessed as being at low, medium or high risk of bias on the basis of two
quality criteria: risk of bias of the diagnostic method (in studies utilising more than one
method of diagnosis, the risk of bias of the highest quality method was judged) and method
of sampling.
Data synthesis and presentation
4
For each allergen we have presented a forest plot which maps the data (percentage
prevalence and 95% confidence intervals, where possible) according to region and country
and then by age (this has been grouped however is meaningful dependent upon the
approach taken by the included studies). The prevalence data has been presented by
method of diagnosis, and information has also been included on the year and age group for
which data is being presented. Data has additionally been narratively reported for the
prevalence of allergy to fish and shellfish both across Europe and for countries outside of
Europe. Meta-analysis was not conducted due to the high heterogeneity between studies
and so a pooled estimate would have been misleading.
RESULTS
Results of the search
Of the 7333 papers identified by the search 7145 were excluded during the title and
abstract screening. Hence, the full-text was obtained for 216 papers, of which 116 were
excluded after screening (further details of the process and reasons for exclusion are
outlined in Figure 1). There were 100 studies that were included in the systematic review,
of which there were 61 studies identified which presented data on the prevalence of fish
and/or shellfish allergy.
5
Figure 1 Flowchart of search results and screening for all studies
Description of included studies
The majority of studies (48) employed a cross-sectional design and 13 studies used a
cohort design. Forty-one studies were based in a paediatric population (< 18 years old), 11
in adults (> 18 years old), and in nine studies all ages were presented collectively. Figure 2
illustrates where the included studies were conducted. The key characteristics as well as
further information about the method of diagnosis of these studies are shown for each
country in alphabetical order (online repository). Questionnaire-based methods for
6
OF WHICH PRESENTED DATA ON
FISH/SHELLFISH = 61
INCLUDED= 100
MAIN REASON
Study design= 23
Topic= 16 Unidentifiable
time point= 4 Sample= 24 Unidentifiable
allergen= 1 Method of
diagnosis= 2 Data not
presented by individual allergen= 15
Linked records (i.e. data presented elsewhere= 26
Cannot obtain study record= 5
EXCLUDED= 116SCREENED ON FULL TEXT= 216
EXCLUDED= 7117SCREENED ON TITLE AND ABSTRACT= 7333
ADDITIONAL PAPERS IDENTIFIED (e.g. from
contact with expert panel)= 10
DUPLICATES REMOVED= 2484
RESULTS FROM DATABASE SEARCH= 9807
assessing suspected fish and/or shellfish allergy were presented in 44 studies, 25 studies
measured sensitisation rates, and ten studies carried out food challenges to confirm fish
and/or shellfish allergy.
7
Figure 2 A map of the world showing the countries from which prevalence data was found Online repository (purple pins= Europe, orange pins= rest of the world
8
Risk of bias in included studies
Table 2 presents the quality assessment for all included studies.
Table 1 Quality assessment of included studies
Study IDDiagnostic Methods: risk
of bias
Sampling Strategy
Method: risk of bias
Al-Hammadi (2010)
Arshad (2001)
Ben-Shoshan (2010)
Branum (2009)
Brugman (1998)
Burney (2010)
Chen (2011)
Connett (2012)
Dalal (2002)
Eggesbo (1999)
Emmett (1999) N/R
Falcao (2004)
Gelincik (2008)
Greenhawt (2009)
Gupta (2011)
Haahtela (1980)
Hu (2010)
Jansen (1994)
Johansson (2005)
9
Study IDDiagnostic Methods: risk
of bias
Sampling Strategy
Method: risk of bias
Kajosaari (1982)
Kavaliunas (2012)
Kim (2011) N/R
Krause (2002)
Kristjansson (1999)
Lao-araya (2012)
Leung (2009)
Liu (2010)
Marklund (2004)
Marrugo (2008)
Martinez-Gimeno
(2000)Mustafayev (2012) N/R
Obeng (2011) N/R
Oh (2004)
Orhan (2009)
Osborne (2011)
Ostblom (2008 a) N/R
Ostblom (2008 b) N/R
Osterballe (2005)
Osterballe (2009)
Penard-Morand
(2005)Pereira (2005)
10
Study IDDiagnostic Methods: risk
of bias
Sampling Strategy
Method: risk of bias
Pyrhonen (2009)
Rance (2005)
Ro (2012) N/R
Roberts (2005)
Sakellariou (2008)
Santadusit (2005)
Schafer (2001)
Shek (2010)
Sicherer (2004)
Touraine (2002)
Van Bockel-
Geelkerken (1992)
N/R
Venter (2006)
Venter (2008)
Vierk (2007)
Von Hertzen (2006)
Woods (1998)
Wu (2012)
Young (1994)
Zannikos (2008)
Zuberbier (2004)
11
High risk of
bias
Medium risk of
bias
Low risk of
bias
1) Low risk of bias= food challenges (open or double-blind) with or without clinical history; Medium
risk of bias= sensitisation (skin prick test and/or serum-specific IgE) with clinical history; High risk
of bias = Sensitisation (skin prick test and/or serum specific IgE) without clinical history,
questionnaire-based methods (self-report, clinical history or clinician diagnosed)
2) Low risk of bias = whole population; Medium risk of bias= random; High risk of bias = non-random
12
13
Figure 3 Fish allergy prevalence in Europe diagnosed by questionnaire-based methods
14
Figure 4 Fish allergy prevalence in other regions of the world diagnosed by questionnaire-based methods
15
Figure 5 Fish allergy prevalence in Europe diagnosed by sensitisation methods
Figure 6 Fish allergy prevalence in other regions of the world diagnosed by sensitisation methods
16
Figure 7 Fish allergy prevalence in Europe diagnosed by food-challenge methods
17
Figure 8 Fish allergy prevalence in other regions of the world diagnosed by food-challenge methods
18
Fish Allergy Prevalence
Assessed using questionnaire-based methods
In Europe, the highest reported prevalence in adults was found in Greece with 1.5%
(95% CI: 1.0-2.2) (9) of 20-54 year olds reporting an adverse reaction to fish and the
lowest reported prevalence was seen in Denmark, with only 0.2% (95% CI: 0.0-1.0)
(10) of 22 year olds reporting an adverse reaction to fish (cod specifically). With
regards to children, the prevalence ranged from 7.0% (95% CI: 5.4-9.0) (11) in one
year olds in Finland to 0.0% (95% CI: 0.0-0.1) (12) of 0-2 year olds in Israel.
In the African region one study reported fish prevalence data in Ghana and found the
reported prevalence of 5-16 year old children to be 0.3% (95% CI: N/R) (13).
In the Americas region, the highest reported fish allergy in adults was seen in the
United States (2.7%, 95% CI: 1.6-4.7) (14) and the lowest was 0.12% (95% CI: 0.08-
0.16) in Canada (15)1. The highest prevalence for children was 0.2% (95% CI: 0.1-
0.5) (16) in the United States and the lowest prevalence found in Canada was 0.0%
(95% CI: N/R) (15).
One study identified from the Eastern Mediterranean region of the world reported that
the clinician diagnosed prevalence of fish allergy in children (6-9 years old) was 2.8%
(95% CI: 1.5-5.1) (17).
In the South East Asia region, the highest reported prevalence seen in Thailand was
1.1% (95% CI: 0.4-2.7) (18) for 3-7 year olds, compared to the lowest which was
0.3% (95% CI: 0.1-1.2) (19) of 6 month- 6 year olds also in Thailand.
In the Western Pacific region of the world the reported prevalence of ‘fish/shellfish’
in 20-44 year olds in Australia was 2.1% (95% CI: 1.2-3.6) (20). In Taiwan in over 19
year olds, the prevalence was lower at 1.2% (95% CI: 1.0-1.4) when a clinician
diagnosis of fish allergy was used (21). The reported prevalence of childhood fish
allergy ranged from 4.3% (95% CI: 4.0-4.7) (22) in 14-16 year olds in the Phillipines
to 0.2% (95% CI: 0.1-0.5) (23) of 2-7 year olds in Hong Kong.
1 Ben-Shoshan (2010) prevalence and confidence interval are reported to two decimal places, as it was not possible to calculate the prevalence based on raw data and therefore we report as per the study.
19
Assessed using sensitisation
In Europe one study in Germany used SPT in an adult population (25-74 year olds)
showing 2.9% (95% CI: 2.2-3.9) (24) sensitisation to mackerel. In children the highest
sensitisation rate was found in Finland, where 2.7% (95% CI: 1.7-4.2) (25) of 15-17
year olds were sensitised to fish and the lowest sensitisation rate was seen in the
United Kingdom, where 0.0% (95% CI: 0.0-0.3) (26) of seven year olds were
sensitised to fish (cod specifically).
One study in the Americas region measured sensitisation using serum-specific IgE
tests and found that 0.0% (95% CI: 0.0-5.3) (27) of 20-44 year olds were sensitised to
fish.
The same study found 0.0% (95% CI: 0.0-2.1) (27) fish sensitisation in 20-44 year
olds in Australia. For children the sensitisation rate ranged from 0.2% (95% CI: 0.0-
1.4) (28) to 0.8% (95% CI: 0.2-2.5) (29) in China.
Assessed using clinical history and sensitisation
In Europe the highest prevalence was seen in Norway where 1.1% (95% CI: 0.4-3.1)
(30) of two year olds were sensitised to fish and the lowest was 0.0% (95% CI: 0.0-
0.1) (12) of 0-2 year olds in Israel. Adult fish allergy prevalence ranged from 0.8%
(95% CI: 0.2-2.5) (27) in 20-44 year olds in Germany, to 0.0% in several other
studies.
In South East Asia the prevalence was 0.2% (95% CI: 0.0-1.0) (19) of 6 month- 6
year olds in Thailand.
Assessed using food challenges
In Europe, with regards to open food challenges, only one study in Denmark reported
data for adult fish (cod) allergy; 0.1% (95% CI: 0.0-0.8) (10) of 22 year olds. For
children, the lowest confirmed prevalence was 0.0% (95% CI: 0.0-4.2) (31) of under
three year olds in Denmark and the highest was 0.1% (95% CI: 0.0-0.8) (11) of six
year olds in Finland. When a double-blind placebo-controlled food challenge was
used, in adults the rate of confirmed prevalence ranged between 0.2% (95% CI: 0.0-
0.9) (31) in Denmark and 0.0% (95% CI: 0.0-0.1) (32) in Turkey; and in children
20
from 0.3% (95% CI: 0.0-2.0) (33) in Iceland to 0.0% in Denmark (31), Turkey (34)
and the United Kingdom (35).
In South East Asia a prevalence of 0.2% (95% CI: 0.0-1.4) (18) was found for 3-7
year olds based on an open food challenge.
21
Figure 8 Shellfish allergy prevalence in Europe diagnosed by questionnaire-based methods
22
Figure 9 Shellfish allergy prevalence in other regions of the world diagnosed by questionnaire-based methods
23
Figure 10 Shellfish allergy prevalence in Europe diagnosed by sensitisation methods
24
Figure 12 Shellfish allergy prevalence in other regions of the world diagnosed by sensitisation methods2
2 No confidence intervals were available for Liu 2010
25
Figure 11 Shellfish allergy prevalence in Europe diagnosed by food-challenge methods
26
Figure 14 Shellfish allergy prevalence in other regions of the world diagnosed by food-challenge methods
27
Shellfish Allergy Prevalence
Assessed using questionnaire-based methods
In Europe with regards to adult crustacean allergy, one study was carried out in
Denmark which found 2.0% (95% CI: 1.2-3.3) (10) self-reported allergy to shrimp. In
children the reported prevalence ranged from 5.5% (95% CI: 4.3-7.1) (36) of 5-17
year olds in France to 0.1% (95% CI: 0.0-0.5) (37) of 5-12 year olds in Lithuania. The
reported prevalence of mollusc (oyster) allergy was 1.5% (95% CI: 0.9-2.4) (36) in 5-
17 year olds in France, for octopus allergy it was 0.4% (95% CI: 0.1-1.1) (10) of 22
year olds in Denmark, and for octopus and squid allergy combined in Portugal it was
0.5% (95% CI: 0.1-1.5) (38) of 39 year olds and above.
In the African region, one study could be found from Ghana which reported shrimp
allergy prevalence in 5-16 year old children to be 0.1% (95% CI: N/R) (13).
In the Americas region, one study, carried out in the United States, specifically asked
about crustacean allergy, finding that for adults the reported prevalence was 0.7%
(95% CI: 0.5-1.0) (39).The remaining studies report on ‘shellfish allergy’ collectively.
The highest reported prevalence seen in adults was 9.0% (95% CI: 6.7-11.9) (14) and
the lowest was 1.69% (95% CI: 1.39-1.98) (15). The highest reported shellfish allergy
in children was 2.0% (95% CI: 1.7-2.5) (40) and the lowest was 0.06% (95% CI:
0.01-0.10) (15).
In the South East Asia region the highest reported crustacean allergy was 3.1% (95%
CI: 1.8-5.3) (18) of 3-7 year olds (shrimp) and the lowest was 0.7% (95% CI: 0.2-2.1)
(18) of 3-7 year olds (crab). With regards to mollusc allergy, the reported prevalence
was 0.2% (95% CI: 0.0-1.4) (18) for 3-7 year olds and for ‘shellfish’ was 0.5% (95%
CI: 0.1-1.5) (19) of 6 month- 6 year olds.
In the Western Pacific region one study reported clinician-diagnosed prevalence for
adults in Taiwan with shrimp allergy affecting 3.3% (95% CI: 3.0-3.6), crab allergy
2.3% (95% CI: 2.0-2.5) and mollusc allergy 1.5% (95% CI: 1.3-1.7) (21). Crustacean
allergy in children was reported as high as 4% (95% CI: 3.7-4.4) for shrimp allergy
and low as 0.4% (95% CI: 0.1-1.2) for crab allergy (21). Mollusc allergy in children
was reported as high as 1.1% (95% CI: 1.0-1.3) in 4-18 year olds and low as 0.1%
(95% CI: 0.0-0.8) in under threes and (21).
28
Assessed using sensitisation
In Europe for crustacean allergy the highest sensitisation rate was reported in Italy in
adults (10.3%, 95% CI: 7.0-14.9) and the lowest in Switzerland (0.0%, 95% CI: 0.0-
2.3) (27).
In the Americas region the highest sensitisation rates were 6.1% (95% CI: N/R) (41)
of 6-19 year olds and 6.7% (95% CI: N/R) (41) of 40-59 year olds, and the lowest
were 5.2% (95% CI: N/R) (42) of under 18 year olds and 0.0% (95% CI: 0.0-5.3)
(27)of 20-44 year olds.
In the Western Pacific region, adult shrimp sensitisation was reported to be 2.3%
(95% CI: 0.8-5.5) (27) in Australia and in children the latest data from China
indicated it was 0.3% (95% CI: 0.0-1.7) (29).
Assessed using clinical history and sensitisation
In Europe when a clinical history was combined with a positive SPT result, a
prevalence rate of 0.2% (95% CI: 0.1-0.5) was found for crab allergy and 0.0% (95%
CI: 0.0-0.2) for mussel allergy, in all ages in Germany (43).
In the South East Asia region the sensitisation rates (including a clinical history) for
both shrimp and ‘shellfish’ were 0.3% (19).
Assessed using food challenges
Two studies in Europe (Denmark) utilised food challenges to confirm the prevalence
of shellfish allergy. Open food challenges were conducted by both studies and showed
a shrimp allergy confirmed prevalence rate of 0.0% (95% CI: 0.0-4.2) (31) for under
threes, 0.2% (95% CI: 0.0-1.0) (10) for 22 year olds, and an octopus allergy
confirmed prevalence rate of 0.1% (95% CI: 0.0-0.8) (10) for 22 year olds. One study
carried out double-blind placebo-controlled food challenges to shrimp which showed
a confirmed prevalence of 0.0% (95% CI 0.0-1.0) in three year olds and 0.3% (95%
CI: 0.1-1.0) adults (31).
In South East Asia challenge proven prevalence ranged from 0.3% (95% CI: 0.1-1.2)
(19) to 0.9% (95% CI: 0.3-2.4) (18) for shrimp allergy, and 0.2% (95% CI: 0.0-1.4)
(18) for crab allergy.
29
DISCUSSION
In summary, with regards to fish allergy, the reported prevalence assessed by
questionnaire-based methods ranged from 0.0% to 7.0%, sensitisation rates identified
in this review were between 0.0% and 2.9% and food challenge confirmed prevalence
rates were between 0.0% to 0.3%. With regards to shellfish allergy, the reported
prevalence assessed by questionnaire-based methods was 0.1% to 5.5% for crustacean
allergy, mollusc allergy ranged from 0.4% to 1.5%, and shellfish allergy was reported
in the range of 0.1% to 1.5%. Sensitisation rates ranged from 0% to 10.3% to
crustacean and 0% to mollusc and food challenges confirmed a 0% to 0.9%
prevalence of crustacean allergy and 0.1% prevalence of mollusc allergy.
We found a higher range of reported fish allergy prevalence compared to that of a
previous review (7) which found that the variation in reported prevalence of fish
allergy ranged from 0% to 2%. This is due to our inclusion of more recent studies,
including those from outside Europe; the higher prevalence’s in the current review
come from studies which have not been included in the review conducted by Rona et
al (7) (Kajosaari 1982; Kristjansson 1999; Martinez-Gimeno 2000; Mustafayev 2012;
Pyrhonen 2009; Touraine 2002; Young 1994). Sensitisation and food-challenge
confirmed fish allergy prevalence rates were similar to those reported previously
(0.5% or less and 0.4% respectively) (7). Rona et al (7) report a higher range of self-
reported shellfish allergy (0%-10%) due to their inclusion of a study which did not
meet the inclusion criteria for this review. We also found a higher rate of sensitisation
(GIVE DATA), due to our inclusion of more recent studies.
Our data suggest that the reported prevalence of fish and shellfish allergy is slightly
higher in children than in adults, however this could be due to the relative small
number of adult studies available for analysis which could result in an underestimate
of prevalence. More studies are needed to explore the self-reported prevalence of fish
allergies in adults across the world as the notion that fish allergy is more prevalent in
adults than children may not be accurate.
There was a significant paucity in food challenge data worldwide which makes
comparisons between children and adults, and different regions of the world
challenging. The limited data available suggests that fish allergy prevalence are
similar worldwide however shellfish allergy prevalence is higher in the South East
30
Asia region, perhaps due to the high consumption of shellfish in the local diet. Very
few studies investigated mollusc allergy, with the majority looking at crustacea or
shellfish combined (the study did not distinguish between crustacean and mollusc
allergy); further studies are needed which measure the prevalence of this allergy.
A strength of the current review is the rigorous search strategy used to identify
potential studies for inclusion. In addition, experts within the field of food allergy
epidemiology were contacted to ensure thoroughness of literature searches and in the
extraction and interpretation of the data. In most cases, we were able to present the
raw data from the studies and calculate the prevalence and 95% confidence intervals
to avoid misreporting. Nonetheless, there are some limitations to the current review:
we are aware that some potentially eligible studies were excluded due to the lack of
clarity of the results, and despite every efforts being made to contact the study
authors’ for clarity, not all responded to our request and thus the studies had to be
excluded from the review.
The current study provides comprehensive and up to date estimates of fish and
shellfish allergy across age groups and regions of the world. There is some evidence
to suggest that the prevalence of fish and shellfish allergy varies according to age and
region. However, there is a marked scarcity of high quality prevalence studies for fish
and shellfish allergy; only ten were included in the present review. Future research
should utilise more rigorous diagnostic methods and be conducted across all regions
of the world in both children and adults.
REFERENCES
1. Sampson HA. Anaphylaxis and emergency treatment. Pediatrics. 2003;111(6 Pt 3):1601-8.2. Skypala I, Venter C. Food hypersensitivity: diagnosing and managing food allergies and intolerance: Wiley-Blackwell; 2009.3. Lopata AL, Jeebhay MF. Airborne seafood allergens as a cause of occupational allergy and asthma. Curr Allergy Asthma Rep. 2013;13(3):288-97.4. Lopata AL, Lehrer SB. New insights into seafood allergy. Current Opinion in Allergy and Clinical Immunology. 2009;9(3):270-7.5. Ng IE, Turner PJ, Kemp AS, Campbell DE. Parental perceptions and dietary adherence in children with seafood allergy. Pediatric Allergy and Immunology. 2011;22(7):720-8.6. Johansson SGO, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. Journal of Allergy and Clinical Immunology. 2004;113(5):832-6.
31
7. Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, et al. The prevalence of food allergy: A meta-analysis. Journal of Allergy and Clinical Immunology. 2007;120(3):638-46.8. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy. Allergy. 2014;69(8):1008-25.9. Sakellariou A, Zannikos K, Tzannis K, Michopoulou C, Emmanouil E, Vassilopoulou E, et al. The prevalence of perceived food hypersensitivity in adults in the city of Athens. Allergy. 2008;63:583-.10. Osterballe M, Mortz CG, Hansen TK, Andersen KE, Bindslev-Jensen C. The prevalence of food hypersensitivity in young adults. Pediatr Allergy Immunol. 2009;20(7):686-92.11. Kajosaari M. Food allergy in Finnish children aged 1 to 6 years. Acta Paediatr Scand. 1982;71(5):815-9.12. Dalal I, Binson I, Reifen R, Amitai Z, Shohat T, Rahmani S, et al. Food allergy is a matter of geography after all: sesame as a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. Allergy. 2002;57(4):362-5.13. Obeng BB, Amoah AS, Larbi IA, Yazdanbakhsh M, van Ree R, Boakye DA, et al. Food allergy in Ghanaian schoolchildren: data on sensitization and reported food allergy. Int Arch Allergy Immunol. 2011;155(1):63-73.14. Greenhawt MJ, Singer AM, Baptist AP. Food allergy and food allergy attitudes among college students. J Allergy Clin Immunol. 2009;124(2):323-7.15. Ben-Shoshan M, Harrington DW, Soller L, Fragapane J, Joseph L, St Pierre Y, et al. A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada. Journal of Allergy and Clinical Immunology. 2010;125(6):1327-35.16. Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of seafood allergy in the United States determined by a random telephone survey. Journal of Allergy and Clinical Immunology. 2004;114(1):159-65.17. Al-Hammadi S, Al-Maskari F, Bernsen R. Prevalence of food allergy among children in Al-Ain city, United Arab Emirates. Int Arch Allergy Immunol. 2010;151(4):336-42.18. Lao-araya M, Trakultivakorn M. Prevalence of food allergy among preschool children in northern Thailand. Pediatr Int. 2012;54(2):238-43.19. Santadusit S, Atthapaisalsarudee S, Vichyanond P. Prevalence of adverse food reactions and food allergy among Thai children. J Med Assoc Thai. 2005;88 Suppl 8:S27-32.20. Woods RK, Abramson M, Raven JM, Bailey M, Weiner JM, Walters EH. Reported food intolerance and respiratory symptoms in young adults. Eur Respir J. 1998;11(1):151-5.21. Wu TC, Tsai TC, Huang CF, Chang FY, Lin CC, Huang IF, et al. Prevalence of food allergy in Taiwan: a questionnaire-based survey. Intern Med J. 2012;42(12):1310-5.22. Connett GJ, Gerez I, Cabrera-Morales EA, Yuenyongviwat A, Ngamphaiboon J, Chatchatee P, et al. A population-based study of fish allergy in the Philippines, Singapore and Thailand. Int Arch Allergy Immunol. 2012;159(4):384-90.23. Leung TF, Yung E, Wong YS, Lam CW, Wong GW. Parent-reported adverse food reactions in Hong Kong Chinese pre-schoolers: epidemiology, clinical spectrum and risk factors. Pediatr Allergy Immunol. 2009;20(4):339-46.24. Schafer T, Bohler E, Ruhdorfer S, Weigl L, Wessner D, Heinrich J, et al. Epidemiology of food allergy/food intolerance in adults: associations with other manifestations of atopy. Allergy. 2001;56(12):1172-9.25. Haahtela T, Bjorksten F, Heiskala M, Suoniemi I. Skin prick test reactivity to common allergens in Finnish adolescents. Allergy. 1980;35(5):425-31.
32
26. Roberts G, Peckitt C, Northstone K, Strachan D, Lack G, Henderson J, et al. Relationship between aeroallergen and food allergen sensitization in childhood. Clin Exp Allergy. 2005;35(7):933-40.27. Burney P, Summers C, Chinn S, Hooper R, van R, Lidholm J. Prevalence and distribution of sensitization to foods in the European Community Respiratory Health Survey: a EuroPrevall analysis. Allergy. 2010;65(9):1182-8.28. Chen J, Hu Y, Allen KJ, Ho MH, Li H. The prevalence of food allergy in infants in Chongqing, China. Pediatr Allergy Immunol. 2011;22(4):356-60.29. Hu Y, Chen J, Li H. Comparison of food allergy prevalence among Chinese infants in Chongqing, 2009 versus 1999. Pediatr Int. 2010;52(5):820-4.30. Ro AD, Saunes M, Smidesang I, Storro O, Oien T, Moen T, et al. Agreement of specific IgE and skin prick test in an unselected cohort of two-year-old children. Eur J Pediatr. 2012;171(3):479-84.31. Osterballe M, Hansen TK, Mortz CG, Host A, Bindslev-Jensen C. The prevalence of food hypersensitivity in an unselected population of children and adults. Pediatr Allergy Immunol. 2005;16(7):567-73.32. Gelincik A, Buyukozturk S, Gul H, Isik E, Issever H, Ozseker F, et al. Confirmed prevalence of food allergy and non-allergic food hypersensitivity in a Mediterranean population. Clin Exp Allergy. 2008;38(8):1333-41.33. Kristjansson I, Ardal B, Jonsson JS, Sigurdsson JA, Foldevi M, Bjorksten B. Adverse reactions to food and food allergy in young children in Iceland and Sweden. Scand J Prim Health Care. 1999;17(1):30-4.34. Orhan F, Karakas T, Cakir M, Aksoy A, Baki A, Gedik Y. Prevalence of immunoglobulin E-mediated food allergy in 6-9-year-old urban schoolchildren in the eastern Black Sea region of Turkey. Clin Exp Allergy. 2009;39(7):1027-35.35. Venter C, Pereira B, Grundy J, Clayton CB, Arshad SH, Dean T. Prevalence of sensitization reported and objectively assessed food hypersensitivity amongst six-year-old children: A population-based study. Pediatric Allergy and Immunology. 2006;17(5):356-63.36. Touraine F, Ouzeau JF, Boullaud C, Dalmay F, Bonnaud F. Survey on the prevalence of food allergy in school children. Revue Francaise D Allergologie Et D Immunologie Clinique. 2002;42(8):763-8.37. Kavaliunas A, Surkiene G, Dubakiene R, Stukas R, Zagminas K, Saulyte J, et al. EuroPrevall survey on prevalence and pattern of self-reported adverse reactions to food and food allergies among primary schoolchildren in Vilnius, Lithuania. Medicina (Kaunas). 2012;48(5):265-71.38. Falcao H, Lunet N, Lopes C, Barros H. Food hypersensitivity in Portuguese adults. Eur J Clin Nutr. 2004;58(12):1621-5.39. Vierk KA, Koehler KM, Fein SB, Street DA. Prevalence of self-reported food allergy in American adults and use of food labels. J Allergy Clin Immunol. 2007;119(6):1504-10.40. Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128(1):e9-17.41. Liu AH, Jaramillo R, Sicherer SH, Wood RA, Bock SA, Burks AW, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010;126(4):798-806.e13.42. Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124(6):1549-55.43. Zuberbier T, Edenharter G, Worm M, Ehlers I, Reimann S, Hantke T, et al. Prevalence of adverse reactions to food in Germany - a population study. Allergy. 2004;59(3):338-45.
33
34