Dear Alice,

A few years ago I became allergic to seafood and shellfish. I miss eating seafood. Are there alternatives or remedies?

Dear Reader,

A frustrating part of developing an allergy as an adult, rather than as a child, is knowing what you’re missing! While allergies might be associated with children, there are some allergies — including ones to seafood and shellfish — that are actually more common in adults. For example, in the United States, 0.5 percent of adults are allergic to fish and 2.5 percent are allergic to shellfish, compared to only 0.2 percent of children allergic to fish and 0.5 percent allergic to shellfish. In some cases, adults may even have more severe reactions to allergens than ones experienced by children. It might also interest you to know that asthma, exercise, alcohol, and certain medications can increase sensitivity to various allergens. Unfortunately, the only proven way to treat seafood and shellfish allergies is to avoid them completely.

Being allergic to seafood or shellfish means a person who consumes or inhales even a tiny amount of it will have an anaphylactic reaction — which can be fatal — anywhere from a few minutes to eight hours after contact. Symptoms include swollen and itchy lips, mouth, and pharynx (inside the throat). Having intolerance to seafood or shellfish means a person will feel sick after eating it but will not go into anaphylactic shock. In general, adult-onset allergies are believed to occur due to cross-reactions, meaning that an allergy to one substance (like pollen) may eventually lead to an allergy to something with similar proteins (because the immune system hones in on them). Shrimp, crab, crawfish, lobster, squid, oyster, snails, mussels, clams, and scallops share the protein tropomyosinin common with cockroaches and dust mites. Studies have shown that a person who is allergic to one of these has a 75 percent chance of also being allergic to another from that same group . Being allergic to dust mites, for example, may later lead to an allergic reaction to shellfish.

Though complete avoidance of seafood and shellfish is recommended in the case of an allergy, you may need to be a bit of a detective to really be able to keep these foods out of your diet. Unfortunately, seafood or shellfish traces may be found in many products that would not seem suspicious, including but not limited to:

  • “Meatless” hot dogs, sausages, and pizza toppings
  • Worcestershire sauce
  • Some Caesar salad dressings
  • Vitamins
  • Soaps and cosmetics
  • Insecticides
  • Sauces and seasonings

Additionally, some restaurants may use oil to cook seafood and non-seafood dishes, which can lead to cross-contamination. A little bit of good news: iodine dyes used in medical procedures as well as the supplement glucosamine, are in fact safe for those with seafood or shellfish allergies, despite common misconceptions — whew!

Reader, you ask about remedies you can try to get rid of the allergy or alternatives you can eat when you miss the taste of seafood. One option, immunotherapy, or building up exposure to allergens little by little, has been shown to be beneficial in some cases and harmful in others. There is currently quite a bit of research on developing vaccines to prevent allergies and mutated versions of allergens that may be easier to tolerate than the original. At this time though, strict avoidance is the only sure way to prevent an allergic reaction to seafood and shellfish if you know you’re allergic. There are not many replacements for seafood or shellfish, because the meat is hard to replicate (in both texture and taste). Many vegetarian alternatives may have seafood or shellfish byproducts or flavorings, so it’s advised to avoid them if you’re allergic. There are also some vegan versions of shrimp and shellfish (that purport to contain no animal products or byproducts) available. Before heading to the supermarket, it might be good to speak with your health care provider about whether these options would be safe for you.

Making an appointment to get an allergy test from a specialist (if you haven’t already) is a good option to learn more about your specific allergies or intolerances. S/he can help you navigate your new dietary outlook and hopefully determine some safe and tasty alternatives!

Alice!

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