House dust mite sensitization, eczema and wheeze increase risk of shellfish sensitization.

Shellfish allergy is more prevalent in South-East Asia (~5%1 ) than in Western populations (e.g. United States ~2-3%.2 ). Typically commencing in late childhood, it is the leading cause of anaphylaxis in adolescents and adults in Asia. Cross-sectional studies have demonstrated a high correlation between shellfish and house dust mite (HDM) sensitization in warm, humid climates and urban environments where HDM are ubiquitous. The major shellfish allergen, tropomyosin, shares ~80% structural homology with HDM tropomyosin, and primary sensitization to dust mite tropomyosin has been hypothesized to induce cross-sensitization to shellfish.