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Another hypothesis is that adults who become allergic eat seafood on occasion rather than regularly, and that may affect their tolerance.
“For example,” Sicherer says, “we have seen some people re-develop a peanut allergy when they did not consume [peanut] for about a year after tolerating it in a doctor-supervised feeding test. Maybe not having these foods in the diet routinely allows the immune system to misdirect its responses – sort of forgetting that the food is `innocent’.”
The key allergic proteins in fish and shellfish are unrelated – so people are usually only allergic to one or the other seafood group. But if you’re highly allergic to shrimp and want to try eating a fish not in your diet, Sicherer recommends speaking to an allergist first and probably testing “to avoid surprises”.
He sees another confounding aspect of these allergies: there can be a great variability of triggers from person to person. You might, for instance, be allergic to caviar (fish eggs) of a fish, but not the fish’s meat.
In his review of studies, he noticed that those who commonly reacted to freshly prepared fish usually did not react to canned salmon and tuna. “To make it more complicated, the part of the fish could matter,” he says.
But what you can safely consume with a seafood allergy often depends, not only science, but on food preparation methods.
Allergic? What You Can Do
“Looking at our fatality data, we can see the risk of having a fatal reaction in a restaurant is higher than anywhere else where you might be eating food,” says Munoz-Furlong. And what do adults do all the time for business and socializing? They eat out.
The founder of FAAN says adults with seafood allergy should be able to carry on their lives as they were before diagnosis – except that they do have to learn the allergy basics: from reading food labels to always carrying epinephrine, and being highly selective of where they choose to dine.
She counsels against seafood houses. Then, once the allergic person has picked a restaurant that’s allergy-aware and light on seafood, she advises thoroughly informing the server of the condition, and avoiding sauces and fried foods – since you won’t know what’s in a sauce or what has been in that oilor on that grill.
Muňoz-Furlong is concerned that many seafood allergic adults are too cavalier, that they haven’t adjusted to the seriousness of allergic disease – and many don’t follow those basic allergy rules. “Most adults think they can manage their allergy in a restaurant,” she says.
“But does the cook get the message? Have the prep areas been separated so there’s no cross-contact?” The risks “are because of the mistakes other people will make on your behalf, not the mistakes you’re going to make.” The prevalence survey also showed an alarming number of these adults do not even own epinephrine auto-injectors.
Oleson is an example of someone with seafood allergy who gets it: he carries a kit with two auto-injectors, asthma coeds and Benadryl, and also has a kit in his car. He remembers his big scare clearly, and sure doesn’t want that to happen again.
The biggest challenge he has faced? “I had a rough time with some of the family,” he says with a note of sadness. One set of relatives is upset with him for no longer visiting despite the fact that they live “in the middle of nowhere and a hospital is 80 miles away.”
A skeptical brother-in-law even tried to serve him shrimp at a dinner. “It’s hard to understand other people who don’t understand,” he says.
Given his reaction history and asthma and the fact that he has had minor inhalant reactions at markets where crabs are being cooked, Oleson no longer eats out. Living in a capital of seafood cuisine, it’s not easy to locate a safe restaurant. But Oleson and his wife often have friends over instead, and he hasn’t stopped living because of seafood avoidance. “Learning to balance a new lifestyle is what allergy is for me.”
He’s also clearly kept a sense of humor, joining Allergic Living’s website forum as “surferdude” and introducing himself with a hearty “cowabunga dudes and dudettes!” Reminded of this, he chuckles. “You’ve got to have a sense of humor. You’ve got to take life with a grain of salt sometimes.”
For Cross-Reactions within seafood groups, read: Fast Facts About Seafood Allergies