Can you be allergic to crab and not shrimp

Shellfish Allergy

To prevent a reaction, it is very important to avoid all shellfish and shellfish products. Always read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.

Most people who are allergic to one group of shellfish are allergic to other types. Your allergist will usually recommend you avoid all kinds of shellfish. If you are allergic to a specific type of shellfish but want to eat other shellfish, talk to your doctor about further allergy testing.

Steer clear of seafood restaurants, where there is a high risk of food cross-contact. You should also avoid touching shellfish and going to fish markets. Being in any area where shellfish are being cooked can put you at risk, as shellfish protein could be in the steam.

Shellfish is one of the eight major allergens that must be listed on packaged foods sold in the U.S., as required by federal law.

Avoid foods that contain shellfish or any of these ingredients:

  • Barnacle
  • Crab
  • Crawfish (crawdad, crayfish, ecrevisse)
  • Krill
  • Lobster (langouste, langoustine, Moreton bay bugs, scampi, tomalley)
  • Prawns
  • Shrimp (crevette, scampi)

Your doctor may advise you to avoid mollusks* or these ingredients:

  • Abalone
  • Clams (cherrystone, geoduck, littleneck, pismo, quahog)
  • Cockle
  • Cuttlefish
  • Limpet (lapas, opihi)
  • Mussels
  • Octopus
  • Oysters
  • Periwinkle
  • Sea cucumber
  • Sea urchin
  • Scallops
  • Snails (escargot)
  • Squid (calamari)
  • Whelk (Turban shell)

*Note: The federal government does not require mollusks to be fully disclosed on product labels.

Shellfish are sometimes found in the following:

  • Bouillabaisse
  • Cuttlefish ink
  • Glucosamine
  • Fish stock
  • Seafood flavoring (e.g., crab or clam extract)
  • Surimi
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What Is a Shellfish Allergy?

A shellfish allergy is not exactly the same as a seafood allergy. Seafood includes fish (like tuna or cod) and shellfish (like lobster or clams). Even though they both fall into the category of “seafood,” fish and shellfish are biologically different. So fish will not cause an allergic reaction in someone with a shellfish allergy, unless that person also has a fish allergy.

Shellfish fall into two different groups:

  • crustaceans, like shrimp, crab, or lobster
  • mollusks, like clams, mussels, oysters, scallops, octopus, or squid

Some people with shellfish allergies are allergic to both groups, but some are allergic only to one.

Most allergic reactions to shellfish happen when someone eats shellfish. But sometimes a person can react to touching shellfish or breathing in vapors from cooking shellfish.

Shellfish allergy can develop at any age. Even people who have eaten shellfish in the past can develop an allergy. Some people outgrow certain food allergies over time, but those with shellfish allergies usually have the allergy for the rest of their lives.

What Are the Signs & Symptoms of a Shellfish Allergy?

When someone is allergic to shellfish, the body’s immune system, which normally fights infections, overreacts to proteins in the shellfish. Every time the person eats (or, in some cases, handles or breathes in) shellfish, the body thinks these proteins are harmful invaders and releases chemicals like

. This can cause symptoms such as:

  • wheezing
  • trouble breathing
  • coughing
  • hoarseness
  • throat tightness
  • belly pain
  • vomiting
  • diarrhea
  • itchy, watery, or swollen eyes
  • hives
  • red spots
  • swelling
  • a drop in blood pressure, causing lightheadedness or loss of consciousness (passing out)

Allergic reactions to shellfish can differ. Sometimes the same person can react differently at different times. Some reactions can be very mild and involve only one system of the body, like hives on the skin. Other reactions can be more severe and involve more than one part of the body.

Shellfish allergy can cause a severe reaction called anaphylaxis, even if a previous reaction was mild. Anaphylaxis might start with some of the same symptoms as a less severe reaction, but can quickly get worse. The person may have trouble breathing or pass out. More than one part of the body might be involved. If it isn’t treated, anaphylaxis can be life-threatening.

How Is an Allergic Reaction to Shellfish Treated?

If you have a shellfish allergy (or any kind of serious food allergy), the doctor will want you to carry an epinephrine auto-injector in case of an emergency.

An epinephrine auto-injector is a prescription medicine that comes in a small, easy-to-carry container. It’s easy to use. Your doctor will show you how. Keep it nearby, not in a locker or in the nurse’s office.

The doctor can also give you an allergy action plan, which helps you prepare for, recognize, and treat an allergic reaction. Share the plan with anyone else who needs to know, such as relatives, school officials, and coaches. Also consider wearing a medical alert bracelet.

Every second counts in an allergic reaction. If you start having serious allergic symptoms, like swelling of the mouth or throat or trouble breathing, use the epinephrine auto-injector right away. Also use it right away if your symptoms involve two different parts of the body, like hives with vomiting. Then call 911 and have someone take you to the emergency room. You need to be under medical supervision because even if the worst seems to have passed, a second wave of serious symptoms can happen.

It’s also a good idea to carry an over-the-counter (OTC) antihistamine, as this can help treat mild allergy symptoms. Use

after — not as a replacement for — the epinephrine shot during life-threatening reactions.

What Else Should I Know?

If allergy testing shows that you have a shellfish allergy, you must not eat shellfish. You also must not eat any foods that might contain shellfish as ingredients. Anyone who is sensitive to the smell of cooking shellfish should avoid restaurants and other areas where shellfish is being cooked.

For information on foods to avoid, check sites such as the Food Allergy Research and Education network (FARE).

Always read food labels to see if a food contains shellfish. Manufacturers of foods sold in the United States must state whether foods contain any of the top eight most common allergens, including crustacean shellfish. The label should list “shellfish” in the ingredient list or say “Contains shellfish” after the list.

Some foods look OK from the ingredient list, but while being made they can come in contact with fish. This is called cross-contamination. Look for advisory statements such as “May contain fish,” “Processed in a facility that also processes fish,” or “Manufactured on equipment also used for fish.” Not all companies label for cross-contamination, so if in doubt, call or email the company to be sure.

Manufacturers also do not have to list mollusk shellfish ingredients because mollusk shellfish (clams, mussels, oysters, or scallops) are not considered a major food allergen. When labels say a food contains shellfish, they refer to crustacean shellfish. Contact the company to see about cross-contamination risk with mollusks.

Cross-contamination often happens in restaurants. In kitchens, shellfish can get into a food product because the staff use the same surfaces, utensils (like knives, cutting boards, or pans), or oil to prepare both shellfish and other foods.

This is particularly common in seafood restaurants, so some people find it safer to avoid these restaurants. Shellfish is also used in a lot of Asian cooking, so there’s a risk of cross-contamination in Chinese, Vietnamese, Thai, or Japanese restaurants. When eating at restaurants, it may be best to avoid fried foods because many places cook chicken, French fries, and shellfish in the same oil.

When eating away from home, make sure you have an epinephrine auto-injector with you and that it hasn’t expired. Also, tell the people preparing or serving your food about the shellfish allergy. Sometimes, you may want to bring food with you that you know is safe. Don’t eat at the restaurant if the chef, manager, or owner seems uncomfortable with your request for a safe meal.

Also talk to the staff at school about cross-contamination risks for foods in the cafeteria. It may be best to pack lunches at home so you can control what’s in them.

Other things to keep in mind:

  • Make sure the epinephrine auto-injector is always on hand and that it is not expired.
  • Don’t eat cooked foods you didn’t make yourself or anything with unknown ingredients.
  • Tell everyone who handles your food — from relatives to restaurant staff — that you have a shellfish allergy.
  • Stay away from steam tables or stovetops when shellfish is cooked (especially places where food is cooked on a communal grill, like hibachi restaurants).
  • Carry a personalized “chef card,” which can be given to the kitchen staff. The card details your allergies for food preparers. Food allergy websites provide printable chef card forms in many different languages.
  • Shellfish ingredients also might be used in some non-food products, like nutritional supplements, lip gloss, pet foods, and plant fertilizer. Talk to your doctor if you have questions about what is safe.

Reviewed by: Stephen F. Dinetz, MD Date reviewed: August 2018

Allergies & the Immune System

About Shellfish Allergy

A shellfish allergy is not exactly the same as a seafood allergy. Seafood includes both fish (like tuna or cod) and shellfish (like lobster or clams). Even though they both fall into the category of “seafood,” fish and shellfish are biologically different. So fish will not cause an allergic reaction in someone with a shellfish allergy — unless that person also has a fish allergy.

The two different types of shellfish allergy are:

  1. crustaceans (like shrimp, crab, or lobster)
  2. mollusks (like clams, mussels, oysters, or scallops)

Some people with shellfish allergies are allergic to both groups; some are allergic only to one. Although most allergic reactions to shellfish happen when someone eats shellfish, sometimes a person can react to touching shellfish or breathing in vapors from cooking shellfish.

Shellfish allergy can develop at any age. Even people who have eaten shellfish in the past can develop an allergy. Some people outgrow certain food allergies over time, but those with shellfish allergies usually have the allergy for the rest of their lives.

A shellfish allergy can cause a very serious reaction, even if a previous reaction was mild. So anyone with a shellfish allergy should completely avoid shellfish.

If your child has been diagnosed with a shellfish allergy, keep injectable epinephrine on hand in case of a severe reaction. This is a medicine that your doctor can prescribe. Communicate emergency plans with anyone who will be taking care of your child, including relatives and school officials. Also consider having your child wear a medical alert bracelet.

What Happens in a Shellfish Allergy

When someone is allergic to shellfish, the body’s immune system, which normally fights infections, overreacts to proteins in the shellfish. Every time the person eats (or, in some cases, handles or breathes in) shellfish, the body thinks these proteins are harmful invaders.

The immune system responds by working very hard to fend off the invader. This causes an allergic reaction, in which chemicals like histamine are released in the body. The release of these chemicals can cause someone to have these symptoms:

  • wheezing
  • trouble breathing
  • coughing
  • hoarseness
  • throat tightness
  • stomachache
  • vomiting
  • diarrhea
  • itchy, watery, or swollen eyes
  • hives
  • red spots
  • swelling
  • a drop in blood pressure causing lightheadedness or loss of consciousness

Your child could have different reactions to different types of shellfish or react differently at different times. Some reactions can be very mild and involve only one system of the body, like hives on the skin. Other reactions can be more severe and involve more than one part of the body.

Anaphylaxis Is a Life-Threatening Reaction

Shellfish allergies can cause a severe reaction called anaphylaxis. Anaphylaxis can begin with some of the same symptoms as a less severe reaction, but then can quickly worsen, leading someone to have trouble breathing or to pass out. If it is not treated, anaphylaxis can be life threatening.

If your child starts having serious allergic symptoms, like swelling of the mouth or throat or difficulty breathing, give the epinephrine auto-injector right away. Every second counts in an allergic reaction. Then call 911 or take your child to the emergency room. Your child needs to be under medical supervision because even if the worst seems to have passed, it’s common for a second wave of serious symptoms to occur.

An epinephrine auto-injector is a prescription medicine that comes in an easy-to-carry container about the size of a large marker. It’s simple to use. If your child needs to have it on hand, your doctor will show you how to use it. Kids who are old enough can be taught how to give themselves the injection.

Staff at your child’s school should know that your son or daughter has a serious food allergy. You should agree upon a plan in case of a serious reaction and the injectable epinephrine must be available at all times. If your child is old enough to carry his or her own epinephrine, it should not be in a locker, but in a purse or backpack that’s with your child at all times.

Your child’s allergy plan also could include giving an over-the-counter antihistamine for milder allergy symptoms. But the antihistamine should be given after the epinephrine in the case of a serious, life-threatening reaction.

Shellfish Allergy Safety Tips

To prevent allergic reactions to shellfish, your child must not eat shellfish. He or she also must not eat any foods that might contain shellfish as ingredients. For detailed information, you can visit websites that your doctor recommends, such as the Food Allergies and Anaphylaxis Network.

Also, read food labels to see if a food is free of shellfish. Manufacturers of foods sold in the United States must state in understandable language whether foods contain any of the top eight most common allergens, including crustacean shellfish. The label should list “shellfish” in the ingredient list or say “Contains shellfish” after the list.

Also look for advisory statements such as “May contain shellfish,” “Processed in a facility that also processes shellfish,” or “Manufactured on equipment also used for shellfish.” These are cross-contamination warnings, but manufacturers are not required to list them.

Since products without precautionary statements also might be cross-contaminated and the company simply chose not to label for it, it is always best to contact the company to see if the product could contain shellfish. You might find this information on the company’s website or you can contact a company representative via email.

Manufacturers also do not have to list mollusk shellfish ingredients because mollusk shellfish (clams, mussels, oysters, or scallops) are not considered a major food allergen. When labels say a food contains shellfish, they refer to crustacean shellfish. Contact the company to see about cross-contamination risk with mollusks.

Even if a food did not cause a reaction in the past, it still could be a problem. Manufacturers may change processes or ingredients at any time.

Shellfish ingredients also might be used in some non-food products, like nutritional supplements, lip gloss, pet foods, and plant fertilizer. Talk to your doctor if you have questions about what is safe.

Cross-Contamination

Cross-contamination often occurs in restaurants, which is where many people often mistakenly eat shellfish. This happens in kitchens when shellfish gets into a food product because the staff use the same surfaces, utensils (like knives, cutting boards, or pans), or oil to prepare both shellfish and other foods.

This is particularly common in seafood restaurants, so some people find it safer to simply avoid these restaurants altogether. Since shellfish is also used in a lot of Asian cooking, there’s a risk of cross-contamination in Chinese, Vietnamese, Thai, or Japanese restaurants. It’s a good idea to avoid a restaurant’s fried foods, like French fries and fried chicken, because the restaurant may use the same oil to fry shrimp.

Eating Away From Home

When your child eats in a restaurant or at a friend’s house, find out how foods are cooked and exactly what’s in them. It can be hard to ask a lot of questions about cooking methods, and to trust the information you get. If you can’t be certain that a food is shellfish-free, it’s best to bring safe food from home.

Also talk to the staff at school about cross-contamination risks for foods in the cafeteria. It may be best to pack lunches at home so you can control what’s in them.

If your child will be eating at a restaurant, take these precautions:

  • Stay away from steam tables or stovetops when shellfish is cooked (especially places where food is cooked on a communal grill, like hibachi restaurants).
  • Tell the restaurant waitstaff that your child has as serious shellfish allergy.
  • Carry a personalized “chef card” for your child, which can be given to the kitchen staff. The card details your child’s allergies for food preparers. Food allergy websites provide printable chef card forms in many different languages.
  • Don’t eat at a restaurant if the manager or owner seems uncomfortable about your requests for a safe meal.

Reviewed by: Larissa Hirsch, MD
Date reviewed: September 2012

Seafood Allergies: Fact vs. Fiction

It’s no wonder that people who have a seafood or shellfish allergy are concerned and cautious about what they eat, where they eat, and what they’re exposed to: Seafood allergies often cause severe, life-threatening reactions to someone who is allergic to fish or shellfish.

But various myths and fallacies are associated with shellfish and seafood allergies. Though it’s true that people with seafood allergies must be extremely careful about their exposure, they also need to know what myths are in fact, myths.

Here’s the truth about shellfish and seafood allergies:

  • Shellfish allergy can occur any time in life. Adults and young adults may suddenly develop a shellfish allergy; it can appear at any age. They may never have had an allergic reaction to shellfish or seafood before, and suddenly have a severe reaction to shellfish. Shellfish allergy is rarely outgrown once it is developed, and generally extends to multiple types of shellfish. Crab, lobster, and shrimp are the most common allergens.
  • You can have an allergic reaction to shellfish without eating it. The proteins in shellfish and other seafood that trigger food allergies and allergy symptoms can be transmitted through the air when the fish is cooked. If you are in a restaurant or in the kitchen when shellfish are being cooked, you could still have an allergic reaction. Even just handling fish or smelling the steam of cooking seafood can trigger a serious allergic reaction in people who are extremely sensitive to seafood and shellfish.
  • Seafood allergies and shellfish allergy are not caused by iodine. You’re also not allergic to iodine just because you are allergic to shellfish or seafood. Shellfish and seafood also contain iodine, but that isn’t what’s responsible for food allergies. A recent study investigating the supposed relationship between iodine and seafood allergies found that there is not a relationship between reactions to iodine and seafood allergies. So you also don’t need to avoid iodine just because you have a seafood or shellfish allergy.
  • It’s safe to have a CT (computed tomography) scan with contrast dye when you have a shellfish allergy. The materials in the contrast dye used prior to a CT scan are not related to allergens in shellfish, and a recent study showed no increased risk of allergic reaction to contrast dye in people with shellfish allergy. Unless you have had an allergic reaction to contrast materials, you should not be worried about having a reaction just because you are allergic to shellfish.
  • You don’t need to avoid the ingredient carrageenan. Carrageenan is actually a type of algae that’s a common additive in a number of foods, including dairy products. Carrageenan is not associated with shellfish allergies and is safe to consume.
  • You can take the supplement glucosamine. Often used to promote joint health, glucosamine is derived from the shells of marine life, not the fish themselves. The protein that triggers allergic reactions isn’t included in the supplements, so glucosamine will not cause an allergic reaction in people with seafood allergies.

Seafood allergies are nothing to take lightly; it’s always better to err on the side of caution rather than risk having a severe allergic reaction from coming into contact with shellfish. Knowing the facts about these food allergies can help make them just a bit easier to deal with, as you will be more certain of your possible risk.

Learn more in the Everyday Health Allergy Center.

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The Groups

Cross-Reactions

Within a seafood group …

Dr. Scott Sicherer, author of Understanding and Managing Your Child’s Food Allergies and associate professor of medicine at the Mount Sinai School of Medicine’s Jaffe Food Allergy Institute, concludes from his 2006 review of seafood allergy studies:

– That 30 to 50 per cent of those with an allergy to one of the seafood groups will react to more than one type of fish or shellfish.

However, you can also be allergic to just one type of fish or shellfish. It’s even possible to be allergic to just one type of shrimp.

– That it is common for people to be allergic to more than one shellfish. Sicherer finds up to 80 per cent who are allergic to one crustacean may be sensitized to others, and “40 per cent may react upon ingestion.”

In one study reviewed, blood samples from nine patients with shrimp anaphylaxis reacted to the proteins of 13 crustaceans and mollusks. As well, he finds between 10 and 15 per cent allergic not only to other crustaceans, but to mollusks as well.

– That the risk of reacting to more than one fish is high. Sicherer suggests to speaking to your allergist: “Your allergist may take into consideration the severity of your allergy, test results, and dietary preferences to determine what it is you can and can not eat.”

– That about 50 per cent with a mollusk allergy react to more than one mollusk.

Between shellfish and fish …

According to Sicherer, only about 10 per cent react to both, which have quite different key allergenic proteins (tropomyosin in shellfish; parvalbumin in fish).

Remember, however, that there may be cross-contact between the two groups at grocery seafood counters or in restaurants.

Sources: UpToDate 2006; interview Dr. Scott Sicherer

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Types of seafood that can cause allergies

Allergic reactions can be caused by:

  • fish, either fresh or canned
  • shellfish such as prawns (sometimes called shrimp), crab, yabbies, lobster, crayfish, bugs (often called Balmain or Moreton Bay bugs) and marron
  • molluscs such as oysters, mussels, scallops, pipis, clams, octopus, squid, calamari and abalone
  • eels

If you are allergic to one type of seafood, you can’t predict whether you’ll be allergic to any other type of seafood. The only way to find out is through testing or experience.

Symptoms of seafood allergy

Most people who are allergic to seafood have mild symptoms such as:

  • hives
  • tingling in the mouth
  • some swelling in the face, lips or eyes
  • abdominal pain, vomiting or diarrhoea

But some people experience dangerous symptoms of anaphylaxis such as:

  • difficulty breathing
  • swelling of the tongue or tightness in the throat
  • hoarse voice, wheezing or difficulty talking
  • dizziness or collapsing due to a sudden drop in blood pressure

If you’re experiencing any of these dangerous symptoms, you need urgent medical assistance. Call triple zero (000) or go straight to the emergency department of your nearest hospital.

If you are allergic to seafood, symptoms usually appear within minutes, but some people (especially those with an allergy to oysters, abalone, squid or prawns) may not experience symptoms until hours later.

Diagnosing seafood allergy

Allergies are caused by a reaction to specific proteins in foods. If you suspect you have an allergy, see your doctor, who can arrange appropriate skin or blood tests, and can help you understand what these mean. Your doctor can also prescribe an EpiPen for emergencies, if necessary.

Seafood allergies are complex. Even among fish, there are different groups of fish, and if you are allergic to one group of fish, you may be able to safely eat fish from other groups.

Groups of fish:

  • shark (sometimes called flake and commonly used in fish and chips)
  • sardines, anchovies and pilchards
  • salmon, trout
  • cod, haddock (often sold as ‘smoked’ fish) or hake
  • barramundi, bream, flathead, mackerel, perch, snapper, tuna, whiting
  • sole, flounder

Allergy testing done under proper medical supervision is the only way to diagnose your specific seafood allergy.

Avoid testing methods advertised online or in print media. Tests that are considered unreliable include hair analysis, Alcat or Vega tests, kinesiology, iridology, reflexology, pulse and cytotoxic food tests.

How to avoid seafood

It’s easy to avoid cooking or buying seafood, but ingredients made from seafood are added to many foods that you might not expect. Check the labels on processed or packaged foods. Canned fish or shellfish are obviously sources of seafood; other products and menu items to watch out for include:

  • sauces such as oyster sauce and fish sauce (used in many Asian dishes)
  • marinara sauce (used on pasta or pizza)
  • fish paste
  • fish stock
  • prawn crackers and prawn crisps
  • sushi
  • Caesar salad (which may include anchovies)
  • pizza (which may come with anchovies or other seafood)
  • cooking oil previously used to cook fish
  • fish or krill oil supplements

If you order a stir-fried dish or meat curry in a restaurant, for example, it may have been cooked with fish sauce. Make it very clear to waiters that you have a genuine allergy and your meal must not contain any seafood, fish sauce or oyster sauce.

Fish oil supplements are unlikely to cause an adverse reaction, but it’s probably safest to avoid them.

Glucosamine supplements (sometimes used for osteoarthritis) are made from the shells of crustaceans and are not suitable if you are allergic to shellfish.

Isinglass is an additive used to stop beer and wine from going cloudy. It is made from the bladders of fish, but food authorities consider it is so unlikely to cause an allergic reaction that legally it doesn’t need to be included on the label.

A small number of people are so sensitive to any kind of fish that they can have a reaction to the steam produced when fish is being cooked. This is more likely in children who also have asthma.

July 13, 2004 — Shrimp, lobster, clams: Americans love seafood. But many adults will develop a severe allergy to shellfish as well as tuna and salmon.

Some 7 million Americans are thought to be affected, or 2.3% of the population, according to a nationwide survey.

“This study showed that seafood allergy often develops in adulthood, that most persons have multiple reactions, and that reactions often include severe symptoms,” writes lead researcher Scott H. Sicherer, MD, with the Mount Sinai School of Medicine in New York.

His study appears in this month’s issue of the Journal of Allergy & Clinical Immunology.

Researchers define “seafood” as finned fish (tuna, cod, salmon) and shellfish (shrimp, crab, lobster, scallops, clams, squid). An allergic reaction to certain proteins in seafood can cause life-threatening anaphylaxis — a sudden, severe, potentially fatal reaction that results in low blood pressure and throat swelling, making breathing difficult. Seafood allergies can also cause a severe skin reaction or can trigger an asthma attack.

According to the Food Allergy & Anaphylaxis Network, food-induced anaphylaxis causes approximately 30,000 emergency room visits and about 150 to 200 deaths each year in the U.S.

Despite the potential lethal nature of the reaction, few studies have looked at exactly how common seafood allergy is, Sicherer says.

His nationwide telephone survey involved almost 15,000 adults who answered detailed questions about finfish and shellfish — identifying individuals in their homes who had a seafood allergy, including positive allergy skin test reaction or blood tests or an allergic reaction from eating fish. The volunteers also produced information on the ages when these reactions first occurred.

Sicherer found that both fish and shellfish allergies were more commonly found among adults ages 40 to 60. Also:

  • 6% of households had at least one person with a seafood allergy.
  • 3% of adults had any seafood allergies, compared with 0.6% of children.
  • 4% of women had seafood allergies, compared with 2% of men.
  • 40% of fish allergies and 60% of shellfish allergies began in adulthood.
  • For about 10% of those surveyed, the worst reactions were caused by touching or smelling fish.
  • Hives, swelling, difficulty breathing, and tightened throat were the most common symptoms.
  • Salmon, tuna, catfish, and cod were the fish that most commonly caused reactions.
  • Shrimp was the most common type of shellfish that caused reactions.

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