Data from the European Anaphylaxis Registry has shown shellfish are a significant and increasing cause of food-induced anaphylaxis, with shrimp and finfish allergies particularly concerning.
A study carried out on registry data from anaphylactic reactions between 2007 to 2022 identified 462 cases of seafood-induced anaphylaxis, equivalent to 8.8 per cent of all food-induced anaphylaxis cases registered during that period. Of the seafood cases, shellfish was responsible for 68 per cent and fish for 32 per cent. Shellfish reactions were most prevalent in southern Europe, particularly Italy and Spain, with shrimp accounting for 76 per cent of these cases. In contrast, fish-induced anaphylaxis involved a broader range of species, including cod, salmon, and tuna.
Shellfish allergies were more common in adults, especially women, and often linked to larger portion sizes and suspected cofactors. While typically not life-threatening, the rates of these reactions have increased over time. Fish allergies, however, were more frequent in children and adolescents, particularly boys, and were triggered by smaller allergen doses. Despite prior reactions being reported in over half of all cases, adrenaline was underused, administered in only 33 per cent of adult shellfish cases and 24 per cent of fish cases in children.
The findings highlight distinct patterns in seafood-induced anaphylaxis based on age, sex, and geography. They also underscore the urgent need for improved management strategies, including better awareness and more consistent use of adrenaline in emergency responses.
Reference: Faust et al., Trends in seafood induced anaphylaxis: Data from the European Anaphylaxis Registry The Journal of Allergy and Clinical Immunology: In Practice (2025), DOI: 10.1016/j.jaip.2025.07.050. The paper is available with Open Access here.
