Sarcoplasmic calcium binding protein as a cause of anaphylaxis after eating shrimp in a patient with pollen food allergy syndrome- case report

Food consumption is the second most common cause of anaphylaxis among adults. There have been reported cases after eating seafood, which the most popular are shrimps. The most common allergen of shrimp is tropomyosin. A 22 years-old female experienced dyspnoea, edema of lips, tongue, eyelids and generalized urticaria with pruritus after eating bread with shrimp paste. Also, for 4 years, the patient has symptoms of rhinitis with conjunctivitis during spring and summer months and after eating unprepared apples, nectarines, hazelnuts and walnuts experiences itching of the lips, tongue and throat. The patients provided the results of specific IgE tests which showed positive results for pollen of birch, alder, rye, timothy grass, epidermis of dog, cat, horse, rabbit, egg yolk, shrimp and Alternaria alternata. During the diagnosis, skin prick tests with extracts of food and inhalant allergens were performed. A positive result was for the allergen extract from cat fur, grass mixture, rye, alder, birch, hazel and shrimp. We also established the level of IgE specific to allergen components using the ImmunoCap ISAC method. Allergen-specific IgE was elevated for the shrimp allergen Pen m 4 (sarcoplasmic calcium binding protein), allergens of timothy grass, bermuda grass, birch and cat, as well as cross-reacting allergens of alder, hazel, apple, peach, soy and peanuts. Considering the overall clinical picture the patient was diagnosed with a shrimp allergy and seasonal allergic rhinitis caused by allergy to birch and grasses. The patient was advised to exclude seafood from her diet and provided with adrenaline, steroids and antihistamines. According to our current knowledge, this is the first reported case of anaphylaxis after eating shrimp caused by allergy to Pen m 4.