Mite crustacean mollusc syndrome T78.1

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Definition
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Food allergy with primary sensitization to aeroallergens (especially house dust mite allergy). The cause is the structural relationship of tropomyosins, which are found in house dust mites and numerous seafood products.

Pathogen
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Crustaceans (Crustacea): crustaceans (e.g. crabs, shrimps)
Molluscs (Mollusca): Molluscs (e.g. clams, snails)

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Occurrence/Epidemiology
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In Germany (still) rare. Due to local eating habits higher incidence in France or Italy. With an increasing, more dynamic and exotic eating culture in Germany, this syndrome should be considered more from an allergological point of view!

Clinical features
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Diarrhoea, rhinorrhoea, generalized urticaria and respiratory distress may occur (see shock, anaphylactic).

Laboratory
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Increased total IgE, detection of specific IgE (especially against house dust mites).

Diagnosis
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Prick tests (with house dust mites, shrimp, mussels and additional, anamnesis-related allergens).
If the medical history is unclear, proof of the clinical relevance of house dust mite sensitization by means of provocation tests.
If necessary, lung function diagnostics.
Determination of RAST classes and total IgE.

Complication(s)
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S. shock, anaphylactic.

Therapy
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Consistent mite restoration in the residential environment (see encasing).
Specific immunotherapy (see SIT) against house dust mites.

Prophylaxis
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If clinically indicated, the issuing of an emergency kit should also be considered.

Diet/life habits
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In the case of contraindications to SIT with house dust mites, the absolute withdrawal period of the triggering foodstuff must be observed.

Case report(s)
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37-year-old patient presented because of an anaphylactoid reaction after shrimp consumption during a Corsican holiday. Diarrhoea, rhinorrhoea, generalized urticaria and respiratory distress occurred 3 hours after consumption of these shrimps.
After detailed enquiries, it was stated that he had recently been suffering from a blocked nose in the morning and breathing difficulties at night. In addition, he was occasionally short of breath under physical exertion. Further food intolerances were denied.
After skin tests, the patient was diagnosed with a clinically relevant type I sensitization to house dust mites.
After mite sanitation in the living environment and a 3-year specific immunotherapy, crabs could be consumed again by the patient without any problems.