Fish and shellfish allergy
: a study of prevalence, clinical characteristics and health-related quality of life in adults

  • Harriet Rachel Moonesinghe

Student thesis: Doctoral Thesis


Fish and shellfish allergy is a leading cause of anaphylaxis. There is limited data providing accurate information on the prevalence, clinical characteristics and management guidelines for this type of food allergy. Furthermore, it is recognised that food hypersensitivity negatively impacts on the health-related quality of life (HRQL) of sufferers when compared to healthy controls, as well as those suffering from other chronic diseases. However, little is known about the HRQL of adults with a fish and or shellfish allergy and how this may differ compared with other allergies. As this is a food allergy with an often later onset and one which is persistent throughout an individual’s life, it is of interest to examine the associated effect on HRQL in order to build upon the existing knowledge of this type of food allergy.
programme of research set out to first determine the prevalence as this underpins the knowledge base for food allergy. Next, in order to diagnose food allergy appropriately, an in-depth knowledge of the mechanisms and clinical presentations is needed. Once diagnosis is made, the best ways of managing the food allergy, taking into account the health-related quality of life of an individual, need to be known.
This research was guided by a quantitative methodology and consisted of a systematic review of the prevalence of fish and shellfish allergy worldwide and a cross-sectional study of adult patients (≥ 16 years of age) with a record of fish and or shellfish allergy, from three NHS allergy outpatient clinics, as well as members of a patient support group (Anaphylaxis Campaign), which sought to describe the clinical characteristics and measure the HRQL of this sample.
The main findings of this research were that very few studies have established the prevalence of fish and shellfish allergy using the gold standard, double-blind, placebo-controlled 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%. It was shown that fish and shellfish allergy often co-exist, fish and shellfish allergic individuals frequently have other atopic conditions, and the clinical phenotype with regards to reactivity to vapours and tolerance of tinned fish varies between individuals. In addition, the associated HRQL of fish and shellfish allergic adults was found to be negatively impaired.
This research has identified some novel findings, which have both clinical and research implications. There is a need for the development of clinical guidelines for the diagnosis of fish and shellfish allergy, to ensure consistent dietary and avoidance advice as well as provide management strategies to reduce the associated effects on the individual’s HRQL. A promising new treatment for food allergy, oral immunotherapy, needs to be investigated further for its effectiveness in treating fish and shellfish allergy as this would improve HRQL further.
Date of AwardAug 2016
Original languageEnglish
SupervisorHeather MacKenzie (Supervisor), Tara Dean (Supervisor), Carina Venter (Supervisor) & Rebecca Stores (Supervisor)

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