Aspectos críticos en el consumo de pescados y mariscos ...

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Aspectos críticos en el consumo de pescados y mariscos ...

Critical Critical Aspects Aspects in in the the Consumption Consumption and and

Management Management of of Fish Fish and and other other Seafood Seafood

Allergy and other Associated

Conditions

Fernando J. López L pez-Malpica, Malpica,

M.D.


Consumption of Seafood is

Increasing Worldwide

• The sea is an abundant source of food

• Everything that moves in the sea can be consumed

Crustaceans, mollusks, fish, mammals

• World population is increasing

• Conscience about high fat and cholesterol rich foods

• Consider

– Seafood products and byproducts in other foods and

“medications

medications”

– Occupational disease

– Other reactions that can occur that have similar clinical

characteristics as allergies


Fruits of the sea


Mollusks

• Clams

• Oysters

• Snails

• “Babosas Babosas”

• Octopus

• Squids

• “Scallops Scallops”


Coelenterates

• Sponges, actinias and

medusas


Crustaceans


Crustaceans

• The majority of

animals in the world

are crustaceans, class

Copepods Copepods

• The subphylum subphylum have

26, 000 known

species


After the seafood platter…


29,000 cases

125-150 deaths

Per year in the

USA


Important antigen in the shrimp

• Tropomyosin

– Muscle protein

– Responsible for 85% of

reactions to shrimps and

other crustaceans

– Possible cross reactions

between the crustaceans

muscle protein and other

invertebrates like house

dust mite and cockroaches


Important antigen in fishes

• Calcium-binding

Calcium binding protein family, family,

denominated the parvalbumins

• This cross-reactivity

cross reactivity has been indicated to

be of clinical relevance for several species, species,

since patients with a positive double blind, blind,

placebo-controlled

placebo controlled food challenge to cod

will also react with other fish species, species,

such

as herring, herring,

plaice and mackerel.

mackerel


Cross reactions between species

• It has been estimated that if someone is

allergic to a fish they have a 50% chance of

being allergic to at least one other fish. fish

• If they are allergic to a shellfish they have a

75% chance of being allergic to another

shellfish. shellfish.

• There appears to be no cross-reaction

cross reaction

between fish and shellfish, shellfish,

but concomitant

allergy is possible, possible,

so all fish allergic patients

should be tested for shellfish and vice versa.


Delayed reaction,

5-8 hours after


GROUP CLASS SPECIES

CLASSIFICATION OF SEAFOOD CAUSING ALLERGIES

Mollusca Gastropod Abalone, Snails (Escargot)

Bivalve (Shellfish) Mussels, Oysters, Clams, Scallop, Cockle

Cephalopod Squids (Calamari), Octopus, Cuttlefish

Anthropod Crustacean Crabs, Lobsters, Shrimp, Prawn, Crayfish (freshwater), Rock Lobster

Chordate Laminiformes Shark

Salmoniformes Salmon, Trout, Pike

Gadiformes Cod, Haddock, Hake

Perciformes Snapper, Mackerel, Tuna, Bonito, Grouper

Pleurenectiformes Sole, Flounder, Halibut, Plaice

(Degree of relation can be judged from distance apart)


Allergy Symptoms

• Vast majority of reactions are mild but obvious

• Anaphylaxis is the worst manifestation due to

cardiovascular and respiratory complications

• A delayed reaction can occur 5-8 5 8 hours after

• Other associated symptoms

– Urticaria, angioedema, dizziness, difficulty thinking,

chest tightness, intense fear of dying, nausea and

vomiting, diarrhea and “sense sense of impending doom” doom

• Occasionally the reaction can occur upon contact

with fumes and vapors during the cooking

process or during manufacture (occupational

disease)


Seafood Allergy

• Usually is a lifelong problem

• Sensitivity is usually restricted to a group group

of seafood

• Seafood allergy does not increase the risk

to radiocontrast media reactions

• Is more common in adult than in children


Cross Reactions

• People sensitive to fish tend to be allergic

to other fishes and the ones allergic to

crustaceans tend have cross reactions to

other crustaceans

• Cross reaction risk is around 50-75% 50 75%

between same group of seafood

• This is important to consider when

designing a prevention plan


Cooking Temperature Effect

• Occasionally cooking the fish can

transform the allergen

• This explain why some people can tolerate

tuna and salmon when canned and not

the raw product


Seafood Allergy and Iodine

Reactions

• Although seafood are a good source of iodine,

seafood allergy have a different mechanism

from topical antiseptics (Betadine, Povidone)

and radiocontrast media dyes

• People allergic to seafood are not in greater risk

of developing reactions to iodine

• And vice v versa, a, people with reactions to iodine

are not at greater risk of allergies to seafood


The Fritter…


The hors d’oeuvres that

almost kills me …


BBQ’s, “parrilladas”, braises,

and batters


The savvy sauce…


Lactase Deficiency

• Unable to digest lactose

• Bloating

• Diarrhea 2 hours after

• Common

– In Puerto Rico probably 20% are, in some

degree, lactase deficient


In a Chinese Restaurant…


Monosodium glutamate

“Chinese Chinese Restaurant Syndrome” Syndrome

• Aji-no Aji no-moto moto

• Interferes with GABA metabolism during

nervous conduction

• Essential component of Chinese food

• Produces vasodilatation, weakness,

shortness of breath, asthma in some cases

• Symptoms occurs minutes after ingestion


All was due to the sushi…


Anisakis simplex

• Nematode (worm), fish parasite

• World wide distribution

• Found in 5-80% 5 80% of fish samples in

different studies

• Larvae are hard to kill

– Heat above 60 centigrade or industrial

refrigeration is needed to make the parasite

non infectious

• It can either produce allergies or infection


Infection with Anisakis simplex

(Anisakiasis)

• Develops due eating raw or partly cooked

fish (sushi)

• Nauseas, vomiting, abdominal pain, dolor

abdominal, and occasionally

gastrointestinal bleeding obstruction and

appendicitis

• Upper intestinal endoscopy helps in

diagnosis


Anisakis Anisakis simplex simplex Allergy

• Similar to other allergies

• Suspected when an allergic reaction to

seafood occurs and routine testing for

seafood allergy is negative

• Reactions occur intermittently

• Antigen is not destroyed by heat.

• Dead parasites can produce the reaction


Chitosan


Tuna and Anchovies…


Tuna and anchovies…


Scambroid Poisoning

• Symptoms similar to allergy

• Due to eating fish with high histamine

content

• Fish that have been dead for a while or

inadequate refrigeration techniques

• Bacteria in the fish gut degrades histidine

to histamine


Scambroid Poisoning

• Tuna, anchovies, mackerel, marlin,

arencas and sardines

• Affected fish have metallic taste

• Symptoms 30 min. after ingestion

• Pruritus, urticaria, vomiting, abdominal

pain, headache, and palpitations

• Severe episodes - asthma and low blood

pressure

• Treatment – antihistamines


After the snapper, what…?


Ciguatera poisoning

• Neurotoxin produced by algae and stored in fish

muscles

• The big fish eats the small one and the toxin is

concentrated in large, old fishes muscles

• Snapper, barracuda, captain, sea bass, mero,

anguilas

• Toxin is heat stable, not affected by cooking


Ciguatera Poisoning

• Symptoms start 2-3 hours after ingestion

• Tingling sensation in lips, severe abdominal

pain, diarrhea, muscular pain and hypoalgesia

• Cardiovascular collapse, coma and respiratory

failure

• Later, inverse neuropathies (cold-hot, hot cold),

that can last for months


Similar to ciguatera

but without the fish..


Paralytic Poisoning

• After ingestion of crustaceans contaminated with

saxitoxin, derived from algae

• Concentrated in animals that feed by filtration

• Symptoms similar to ciguatera

• Heat stable

• Toxin persist for weeks or months

• No know antidote

• Symptoms may persist for weeks or months


Surimi

- Is a processed food sold as imitation

crabmeat, crabmeat,

but contains fish and egg white. white.

Surimi and native codfish contain a

common allergen identified as a 63-kDa 63 kDa

protein


Management of Seafood Allergy

• Prevention - avoiding the food, is most

important

• Accidental exposure can occur, specially when

dining out,

– “Smorgasbords”

– Asiatic food (Chinese rice, soups)

– Anchovies in Caesars salads and Worstershire sauce

– Contaminated BBQ’s

– Fritters, batters fried in same oil

– “Medications” for arthritis or to lower ingested fat


Anaphylaxis Treatment

Epinephrine Use


Anaphylaxis Treatment

From treatment

to prevention


Non allergic reactions to seafood

• Scambroid poisoning

• Reactions to Anisakis

• Neurotoxins derived from algae

–Ciguatera

– Paralytic poisoning

• Other conditions

–MSG

– Lactase deficiency


Challenges 1

• Be aware of the myriad reactions

produced by seafood

• Legislate in order to have adequate

medications available in all restaurants

and food processing industry


Challenges 2

• Decrease the number of occupational

disease

• Decrease contamination in food handling

facilities

• Isolate and purify the specific antigens

responsible for reactions

• Develop hypoallergenic strains of seafood

by recombinant DNA technology (?)


Buen provecho…

Bon appetit …

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