Limpet anaphylaxis: cross-reactivity between limpet and house-dust mite Dermatophagoides pteronyssinus

Background: Limpet is a mollusc that is frequently found along the shores of warm seas. Few allergic reactions to limpet have been described, and cross-reactivity with house-dust mites has not been established. Methods: We report five patients with anaphylactic reactions due to limpet ingestion. A limpet extract was prepared and skin prick tests (SPT), radioallergosorbent assays (RAST), sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE-immunoblotting were performed. In order to evaluate cross-reactivity, an immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done. Results: All patients were asthmatics sensitized to house-dust mites. In each case, severe bronchospasm was evidenced, and three required mechanical ventilation. Positive SPT with limpet extract was found in the four patients tested. RAST showed specific IgE on each patient's sera. Immunoblotting showed several allergenic fractions with a wide molecular weight range (15–250 kDa). D. pteronyssinus inhibited IgE-binding molecules above 50 kDa in the limpet extract, particularly one molecule of 75 kDa. Conclusions: We describe five patients with IgE-mediated limpet allergy. Severe bronchospasm was the most important symptom. Cross-reactivity with D. pteronyssinus was demonstrated.