Abstract
BACKGROUND: Clinical research on pediatric shrimp allergy is limited. OBJECTIVE: We sought to evaluate the diagnostic accuracy and safety of testing methods for shrimp allergy. METHODS: An oral food challenge (OFC) for shrimp was conducted on Japanese children with suspected shrimp allergy. Before the OFC, shrimp-, tropomyosin-, house dust mite-, and cockroach-specific IgE levels were measured, along with skin prick tests (SPTs). OFC results using epinephrine as a safety indicator determined persistent, mild, or tolerant shrimp allergy. RESULTS: Sixty-six children (median age, 6 years) underwent the OFC. All patients demonstrated house dust mite-specific IgE level exceeding 0.35 IUA/mL. Sixteen were diagnosed with persistent shrimp allergy, defined by Anaphylaxis Scoring Aichi scores greater than or equal to 10 or scores of 5 with urticaria. A 15-year-old required epinephrine for anaphylaxis. Eight children with negative results (scores ≤ 9) reported mild symptoms after repeated home ingestion following the OFC. Median SPT wheal diameters in persistent, mild allergic, and tolerant groups were similarly elevated (8.5 vs 9.5 vs 8.0 mm; P = .99). Patients with persistent shrimp allergy had higher median shrimp- and tropomyosin-specific IgE level than those classified as mild or tolerant (shrimp: 73.5 vs 30.0 vs 9.4 IUA/mL; P = .01; tropomyosin: 68.0 vs 41.9 vs 11.5 IUA/mL; P = .16). Receiver-operating characteristic analysis determined optimal IgE cutoff values as 58.2 IUA/mL for shrimp-specific IgE and 33.5 IUA/mL for tropomyosin-specific IgE. CONCLUSIONS: SPT showed limited symptom correlation, whereas shrimp-specific IgE demonstrated greater diagnostic value than tropomyosin-specific IgE. No IgE cutoff accurately predicts a successfully passed OFC.