Borres, Magnus P.

Lidholm, Jonas

Malinovschi, Andrei

Molin, Magnus

Moverare, Robert

Waern, Ida

English

Epsilon Open Archive

DOI: 10.1002/clt2.12198L E T T E RShrimp‐ and mite sensitization in a Swedish study: Influenceon allergic disorders and lung functionTo the Editor,Shrimp and house dust mite are common causes of allergic disease.Shrimp allergy represents one of the most prevalent food allergiesand allergic reactions in response to intake can generate a variety ofclinical manifestations, from mild symptoms in the oral mucosa, ur-ticaria to severe anaphylaxis.1 The major shrimp allergen is themuscle protein tropomyosin (Pen a 1). Food allergy is associated withsevere asthma and increased risk of asthma exacerbations.2 In aSwedish study on young asthmatics, 15% were sensitized to shrimp,but only 8% reported shrimp hypersensitivity.3The indoor allergen house dust mite is a major cause of allergicconditions, including rhinitis and asthma, and one of the mostcommon allergens to which asthmatic patients are sensitized.4 Inaddition to several house dust‐mite specific allergens, tropomyosinhas been identified as an allergen in house dust mites.5 The muscleprotein tropomyosin is not only expressed in shrimp and housedust mite, but homologous forms are also found in insects andmolluscs. Therefore, it is likely that patients sensitized to shrimpand house dust mites might be at risk for cross‐reactions to al-lergens from other species. In addition, other panallergens thantropomyosin have been associated with cross allergies.1 Allergicreactions mediated by cross‐reactive IgE can occur in individualsprimarily sensitized to airborne allergens, who also show sensitivityto proteins present in food. Broekman et al. have shown that IgEfrom shrimp allergic patients recognized proteins from insectextracts.6In this study, we aimed to assess the prevalence of shrimp andhouse dust mite sensitization in a large population‐based study andto compare IgE sensitization in relation to allergic disorders andrespiratory symptoms. Chi‐squared test and ANOVA was used todetect group differences in the univariate analyses, while logistic andlinear regression was used in adjusted analyses.A total of 4593 randomly selected adult subjects aged 50–64 years from the Swedish CArdioPulmonary bioImage Study (SCA-PIS), Uppsala cohort, took part in an extensive questionnaire, bloodsampling, physical examinations, lung function tests and imaging.7,8IgE sensitization was defined as having specific IgE ≥0.35 kUA/L,measured by ImmunoCAP (Thermo Fisher Scientific). Forced expi-ratory volume in 1 s (FEV1) and forced vital capacity after broncho-dilation was measured. Chronic airflow limitation (CAL) was definedas having an FEV1/FVC ratio below 0.70.Of all participants, 253 (5.5%) were IgE sensitized to shrimp(≥0.35 kUA/L), 191 (4.2%) were mite‐sensitized, and 104 (2.3%)were sensitized to both allergens. Of the shrimp sensitized pa-tients, 41% were sensitized to mite, whereas 54% of the mitesensitized patients were sensitized to shrimp. There was no sig-nificant association between the specific IgE titer against mite andbeing sensitized to shrimp in those that were mite sensitized(p = 0.37).Participants were divided into four groups based on theirsensitization to shrimp, house dust mite, shrimp and house dust miteor neither of them. The characteristics of these groups are presentedin Table 1. Significant group differences were found regarding theprevalence of asthma, allergic rhinitis, urticaria, angioedema, wheeze,and CAL.Being sensitized to both shrimp and mite was independentlyassociated with having angioedema, wheeze, and chronic airflowlimitation after adjusting for age, sex, birch, and cat sensitization.Being sensitized to mite alone was associated with having urticaria(Table 1). There was also an independent association between lowerFEV1 (% of predicted) and being sensitization to both shrimp andmite: −3.5 (−6.5, −0.5)% of predicted units.The main finding of this study is that approximately half of thosewith IgE sensitization to shrimp were also sensitized to mite and viceversa. We also found that participants that were sensitized to bothshrimp and mite were more likely to have respiratory symptoms,angioedema and airflow limitation.Our results suggest that patients presenting symptoms ofshrimp or mite allergy should be examined for sensitization andallergy to both allergens. Our results are also relevant when newfood products such as insects are introduced in our society becauseinsects express similar proteins, for example, the muscle proteintropomyosin, which is similar to tropomyosin allergens found inshrimp and mites.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, pro-vided the original work is properly cited.© 2022 The Authors. Clinical and Translational Allergy published by John Wiley and Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.Clin Transl Allergy. 2022;e12198. wileyonlinelibrary.com/journal/clt2 - 1 of 3https://doi.org/10.1002/clt2.12198 20457022, 2022, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/clt2.12198 by Swedish University Of Agricultural Sciences, Wiley Online Library on [01/11/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons LicenseTAB L E 1 Characteristics of study groups defined by sensitization to shrimp and/or house dust mite (% and mean � SD) and logisticregression adjusted for age, sex, and sensitization to birch and cat (odds ratio [95% confidence interval])Non‐sensitized(shrimp or mite)(n = 4253)Onlyshrimp‐sensitized(n = 149)Onlymite‐sensitized(n = 87)Sensitized toboth shrimpand mite (n = 104) p valueWomen (%) 52.6 38.3 43.7 43.3 0.001Age (yrs) 57.7 � 4.4 57.9 � 4.2 56.9 � 4.8 57.3 � 4.6 0.27Asthma (%) 5.7 5.0 17.1 16.5 <0.0001Allergic rhinitis (%) 19.9 28.3 46.2 34.8 <0.0001Urticaria (%) 26.5 35.6 44.9 36.4 <0.0001Angioedema (%) 5.2 9.7 11.4 13.2 <0.0001Wheeze (%) 6.4 5.0 9.9 16.3 0.001FEV1% predicted (%) 109 � 14 109 � 15 110 � 13 105 � 15 0.02Chronic airflowlimitation (%)7.4 4.8 6.1 15.2 0.02OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)Asthma 1 0.60 (0.27–1.34) 1.82 (0.95–3.48) 1.67 (0.88–3.17)Allergic rhinitis 1 1.01 (0.65–1.56) 1.64 (0.97–2.80) 0.91 (0.54–1.53)Urticaria 1 1.55 (1.05‐2.28) 2.19 (1.33‐3.60) 1.49 (0.93–2.41)Angioedema 1 1.66 (0.88–3.86) 1.83 (0.87–3.86) 2.28 (1.18‐4.39)Wheeze 1 0.70 (0.32–1.52) 1.36 (0.63–2.92) 2.47 (1.36‐4.47)Chronic airflowlimitation1 0.57 (0.26–1.24) 0.81 (0.32–2.05) 2.03 (1.11‐3.71)ACKNOWLEDGMENTThe main funding body of the Swedish CArdioPulmonary bioImageStudy is the Swedish Heart and Lung Foundation (Hjärt‐Lungfonden).The study is also funded by the Swedish Research Council Formas.Thermo Fisher Scientific has performed the specific IgE testing withina research collaboration agreement with Uppsala University.FUNDING INFORMATIONSwedish Research Council Formas; 2017‐00818. 10.13039/501100003793; Hjärt‐LungfondenCONFLICT OF INTERESTMagnusMolin, RobertMovérare, Jonas Lidholm andMagnus P. Borresare employed by Thermo Fisher Scientific. Ida Waern, Andrei Mali-novschi and Christer Janson have no conflicts of interest to declare.Ida Waern1Magnus Molin2Robert Movérare2,3Jonas Lidholm2Andrei Malinovschi4Magnus P. Borres2,5Christer Janson31Department of Anatomy, Physiology and Biochemistry, SwedishUniversity of Agricultural Sciences, Uppsala, Sweden2Thermo Fisher Scientific, Uppsala, Sweden3Department of Medical Sciences: Respiratory, Allergy and SleepResearch, Uppsala University, Uppsala, Sweden4Department of Medical Sciences: Clinical Physiology, UppsalaUniversity, Uppsala, Sweden5Department of Maternal and Child Health, Uppsala University,Uppsala, SwedenCorrespondenceIda Waern, Department of Anatomy, Physiology and Biochemistry,Swedish University of Agricultural sciences, Ulls väg 26, Box 7011,75007, Uppsala, Sweden.Email: ida.waern@slu.seORCIDIda Waern https://orcid.org/0000-0001-6526-4339Andrei Malinovschi https://orcid.org/0000-0002-4098-7765REFERENCES1. 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Importance of type and degree ofIgE sensitization for defining fractional exhaled nitric oxide refer-ence values. Respir Med. 2021;188:106621. https://doi.org/10.1016/j.rmed.2021.106621SUPPORTING INFORMATIONAdditional supporting information can be found online in the Sup-porting Information section at the end of this article.LETTER - 3 of 3 20457022, 2022, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/clt2.12198 by Swedish University Of Agricultural Sciences, Wiley Online Library on [01/11/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

Shrimp- and mite sensitization in a Swedish study: Influence on allergic disorders and lung function

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Shrimp- and mite sensitization in a Swedish study: Influence on allergic disorders and lung function

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