The Hidden Allergy: A Comprehensive Report on the Sudden Onset of Adult Shrimp Allergy and its Link to House Dust Mites

Introduction

Experiencing a sudden, severe allergic reaction to a food you have enjoyed for years without issue can be a bewildering and distressing event. The "sudden" appearance of an allergy to specific foods like shrimp, particularly in adulthood, raises many questions. This is not a random occurrence but rather the result of dynamic changes within our body's immune system.1

This report aims to explore the in-depth causes of shrimp allergy, and by extension, crustacean allergies, that suddenly manifest in adulthood. Crustacean allergy is one of the most common food allergies to develop in adults and, unlike many childhood allergies, it tends to be a lifelong condition, making accurate understanding and management essential.3

The core thesis of this report is that the "sudden" onset of a shrimp allergy is, in fact, the clinical manifestation of a pre-existing, invisible process known as 'sensitization.' We will specifically propose that sensitization to inhaled allergens, such as house dust mites to which we are constantly exposed, may be a primary trigger for shrimp allergy through a mechanism called 'molecular mimicry'.6

This document will provide comprehensive information, starting from fundamental immunological principles, the molecular characteristics of allergens, the surprising connection with house dust mites, specific clinical symptoms, accurate diagnostic methods, and practical management and emergency response strategies. The goal is to help readers clearly understand this complex phenomenon and equip them with the knowledge to manage it safely and confidently.

Chapter 1: The Immune System's Shift: Understanding Adult-Onset Food Allergies

To understand why an allergy can suddenly appear in adulthood, we must first examine the fundamental mechanism of an allergic reaction and how our immune system changes throughout our lives.

1.1 The Basics of an Allergic Reaction: A Misfiring Defense System

An allergy is essentially an overreaction of our body's immune system to a generally harmless foreign substance, known as an 'allergen'.8 While the primary role of the immune system is to protect us from harmful pathogens like bacteria and viruses, in an allergic individual, this system mistakenly identifies a specific protein (e.g., a protein in shrimp) as a serious threat.

A key player in this process is an antibody called Immunoglobulin E (IgE).8 When the immune system recognizes a specific allergen as a threat, it produces large quantities of

$IgE$ antibodies that are specifically designed to bind only to that allergen. These $IgE$ antibodies then travel through the bloodstream and attach themselves to the surface of mast cells and basophils, entering a 'standby' state.

Subsequently, when the body is re-exposed to the same allergen, the allergen binds to the $IgE$ antibodies on the mast cell surface, activating the cell. This activation signals the mast cell to release a flood of potent inflammatory mediators, most notably histamine.8 The released histamine is the main culprit behind typical allergy symptoms: it dilates blood vessels, causes hives and itching on the skin, swells mucous membranes, and constricts the airways.11

1.2 A Two-Step Process: Sensitization and Reaction

An allergic reaction never develops after a single exposure. It follows a distinct two-step process: 'sensitization' and 'reaction.'

• Step 1: Sensitization
  Sensitization is the first and essential preparatory stage of an allergic reaction. It is the process where, upon initial or repeated exposure to a specific allergen, the immune system recognizes the substance as a threat and begins producing specific $IgE$ antibodies against it.8 This is a critical stage, but it is a 'silent' process with no external symptoms. The body is now primed to react, but the individual is completely unaware of it.
• Step 2: Allergic Reaction
  Once sensitization is complete, re-exposure to the same allergen triggers a clinical allergic reaction.8 The allergen binds to the
  $IgE$ antibodies attached to mast cells, causing the release of histamine and the immediate onset of familiar allergy symptoms like hives, swelling, and difficulty breathing.

This two-step process is the key to explaining why an allergy to a familiar food can appear 'suddenly.' The 'sudden' moment a person first experiences symptoms is not the beginning of the allergy, but rather the final, visible outcome of a hidden 'sensitization' process that may have been developing for months or even years.

1.3 Why in Adulthood?: The Dynamic Immune System

Immune tolerance, the state of not reacting to a particular substance, is not fixed for life. Our immune system is constantly changing and recalibrating in a complex interplay between genetic and environmental factors.12

• Genetic Predisposition: Having a parent or sibling with allergic diseases like asthma, atopic dermatitis, or allergic rhinitis does increase the risk of developing allergies.12 However, genetics do not determine one's fate with 100% certainty.
• Environmental Triggers: Changes in lifestyle, diet, exposure to new allergens, or even severe infections or stress during adulthood can disrupt the immune system's balance and lead to a loss of previously established immune tolerance.12 As a result, the immune system might suddenly start producing
  $IgE$ antibodies (sensitization) against shrimp, a food consumed without issue for decades. The next time shrimp is eaten, a clinical allergic reaction finally occurs.1
• Permanence of Adult Crustacean Allergy: A crucial clinical feature is that while childhood allergies to milk or eggs often resolve with age, crustacean allergies that develop in adulthood are typically lifelong.1 This implies that once it develops, it should be approached as a chronic condition requiring a long-term management plan, not just a one-time incident.

In conclusion, a 'sudden' shrimp allergy in adulthood is not an immune system failure. It is the predictable, albeit previously unseen, biological outcome of the immune system's recalibration, driven by changing environmental factors acting upon a genetic background.

Chapter 2: Anatomy of an Allergen: Tropomyosin and Crustacean Cross-Reactivity

Delving into the cause of shrimp allergy at a molecular level reveals that a specific protein, Tropomyosin, is at the center of it all. Understanding the properties of this protein is crucial for grasping the risks of shrimp allergy and its relationship with other seafood.

2.1 The Main Culprit: Tropomyosin, the Major Allergen in Crustaceans

Tropomyosin is a key protein that regulates muscle contraction in invertebrates, including crustaceans like shrimp, crab, and lobster, as well as mollusks like squid and clams.7 This protein is identified as the primary allergen, or the main culprit, in crustacean allergies due to its unique physicochemical properties.

• Key Property 1: Heat Stability
  Tropomyosin is a very heat-stable protein.3 This means its structure is not easily destroyed by common cooking processes such as boiling, steaming, grilling, or frying. In fact, some studies report that heat treatment can even enhance the allergenicity of tropomyosin.3 This is why some individuals may experience a more severe reaction to cooked shrimp than to raw shrimp 19, and cooked shrimp can be just as, or even more, dangerous than raw.
• Key Property 2: Water Solubility
  Tropomyosin is a hydrophilic (water-soluble) protein.18 This property has significant implications for allergy management. When shrimp is boiled or steamed, tropomyosin easily leaches into the broth or steaming water. If shrimp is fried, the protein can contaminate the cooking oil.3 Therefore, even without directly eating shrimp, a person can have a severe allergic reaction by consuming a soup made with shrimp-based broth or another food (e.g., french fries) cooked in the same oil used to fry shrimp.3 Furthermore, for highly sensitive individuals, simply inhaling the microscopic tropomyosin particles in the steam or fumes generated during active cooking of shellfish in a restaurant can trigger respiratory symptoms like asthma or rhinitis.3

These physical properties of tropomyosin clearly show that the risk of a shrimp allergy is not limited to eating the shrimp meat itself but extends to 'invisible contamination' through broth, oil, and even airborne particles from the cooking process. This is why allergic individuals must exercise a much higher level of caution when choosing food and navigating dining environments.

2.2 A Family Affair: Cross-Reactivity Among Crustaceans

Cross-reactivity is a phenomenon where the immune system's $IgE$ antibodies, created in response to a specific allergen (e.g., shrimp tropomyosin), mistakenly recognize and attack structurally similar proteins from other sources (e.g., crab tropomyosin).20 Because the amino acid sequence of tropomyosin is highly conserved evolutionarily, it has a very similar structure across different species, making it a potent trigger for cross-reactivity.18

• High Cross-Reactivity Within Crustaceans: It is known that a person with a shrimp allergy has up to a 75% chance of also reacting to other crustaceans like crab, lobster, and crayfish.6 This is because the structure of tropomyosin in these animals is nearly identical. Therefore, the standard medical advice for someone diagnosed with a shrimp allergy is to avoid all other crustaceans, even if they have not yet caused a reaction.3
• Lower Cross-Reactivity with Mollusks: Structural similarities also exist between the tropomyosin of crustaceans and mollusks (clams, scallops, mussels, squid, octopus), which can lead to cross-reactivity. However, the intensity is generally weaker than that among crustaceans.3 While not every patient will react, a potential risk exists and caution is warranted.
• Relationship with Finned Fish: Crustaceans (like shrimp) and finned fish (like tuna or mackerel) are biologically distinct species. Therefore, having a crustacean allergy does not mean one will also be allergic to finned fish.3 However, in seafood markets and restaurant kitchens, these two are often handled and cooked together, creating a high risk of cross-contamination through cooking utensils or oil, which requires careful attention during consumption.3

Chapter 3: The House Dust Mite Connection: A Case of Immunological Mistaken Identity

One of the most fascinating and important explanations for the sudden onset of shrimp allergy in adulthood is its hidden link to the 'house dust mite.' While they may seem like entirely separate issues, at the molecular level, they are connected by a single phenomenon: 'immunological mistaken identity.'

3.1 The Invisible Allergen: House Dust Mites

House dust mites are microscopic arthropods, invisible to the naked eye, that thrive in warm, humid environments like bedding, carpets, and upholstered furniture, feeding on human skin flakes.21 The primary allergens are not the mites themselves, but rather the proteins found in their feces and decaying bodies.21

When these allergen particles are inhaled, the immune system can overreact, causing chronic nasal congestion, a runny nose, sneezing, and itchy eyes (allergic rhinitis), or symptoms like coughing, wheezing, and shortness of breath (asthma).21 Many people dismiss these symptoms as a mild cold or simple rhinitis.

3.2 The Molecular Link: Mite-Crustacean Syndrome

The crucial link is the fact that house dust mites, just like shrimp, possess the protein tropomyosin.7 This molecular similarity gives rise to a phenomenon known as 'mite-crustacean syndrome,' and the causal relationship can be explained in the following steps:

1. Step 1 (Respiratory Sensitization): An individual is chronically exposed to house dust mite allergens in their home environment over many years. During this time, their immune system becomes 'sensitized' to the tropomyosin from the house dust mites inhaled through the respiratory tract, producing specific $IgE$ antibodies. At this stage, the person might experience mild, chronic respiratory symptoms like nasal congestion in the morning or occasional sneezing, but may not recognize it as a significant allergy problem.22
2. Step 2 (Food Ingestion): This sensitized individual eats shrimp one day.
3. Step 3 (Cross-Reactivity and Clinical Manifestation): The tropomyosin from the shrimp is absorbed through the digestive system. To the $IgE$ antibodies previously created because of the dust mites, this shrimp tropomyosin is a structurally indistinguishable 'invader'.18 As a result, the large number of
   $IgE$ antibodies already waiting on mast cells throughout the body bind to the shrimp tropomyosin, triggering a massive, systemic release of histamine.
4. Result: The individual experiences a sudden and severe systemic allergic reaction (hives, angioedema, difficulty breathing) to a food they had eaten their whole life without a problem. This is the scientific mechanism hidden behind the 'sudden' appearance of a shrimp allergy.22

A case reported in Germany clearly illustrates this mechanism. A 37-year-old man experienced systemic hives and difficulty breathing after eating shrimp and was initially suspected of having a simple food allergy. However, a detailed history revealed he had been experiencing morning nasal congestion. Allergy testing showed strong positive reactions not only to shrimp but also to house dust mites, and the root cause was diagnosed as cross-reactivity due to dust mite sensitization.22 It is known that up to 80% of adult food allergies are preceded by sensitization to airborne allergens, regardless of whether clinical symptoms were present, suggesting this pathway is not uncommon.22

Understanding this mechanism provides a critical insight into allergies: the site of initial sensitization (the respiratory tract) can be different from the site where the severe clinical reaction occurs (the digestive system and systemically). In other words, an 'allergy that starts in the lungs can explode in the blood vessels and skin.' This explains why a comprehensive evaluation of a patient's entire allergic history, not just the symptoms related to a specific site, is essential for accurate diagnosis and management.

3.3 Diagnostic and Therapeutic Implications

The existence of mite-crustacean syndrome has important implications for diagnosis and treatment.

• Diagnostic Approach: When an adult patient presents with a new crustacean allergy, physicians should inquire not only about their food intake history but also about any chronic respiratory symptoms like rhinitis or asthma.6 This helps explore the possibility of a hidden house dust mite allergy. Including both crustacean and dust mite allergens in skin prick tests or blood tests is beneficial for identifying the precise cause.
• Therapeutic Possibilities: Even more interestingly, treating the primary allergy may lead to an improvement in the secondary food allergy. The patient in the German case study was able to eat cooked crustaceans again without problems after receiving immunotherapy (desensitization therapy) for his dust mite allergy.22 While this may not be applicable to all patients, it suggests a novel therapeutic approach that could dramatically improve the quality of life for some individuals.

Furthermore, this phenomenon may be linked to broader public health trends. The 'hygiene hypothesis' suggests that excessively clean modern environments may hinder the normal development of the immune system, leading to an increase in allergic diseases.13 It is plausible that the rising trend of sensitization to indoor allergens like house dust mites, coupled with an increase in indoor lifestyles, could be a contributing factor to the growing incidence of adult-onset crustacean allergies. This implies that it may be a health issue linked not just to individual biology but to societal and environmental changes.

Chapter 4: Clinical Manifestations: From a Tingle in the Mouth to Anaphylaxis

The symptoms of a shrimp allergy can vary widely from person to person, ranging from mild discomfort to a life-threatening emergency. Knowing the types and severity of symptoms is the first step toward a swift and correct response.

4.1 Timing of Reactions

• Immediate Reaction: Most Immunoglobulin E (IgE)-mediated allergic reactions are immediate, with symptoms appearing within minutes to two hours after consuming the trigger food.3
• Delayed Reaction: Rarely, some patients experience a delayed reaction, with symptoms appearing more than two hours, and up to eight hours, after ingestion.23 Some literature mentions cases appearing one to two days later, but these may not be typical
  $IgE$-mediated reactions.14
• Exercise-Induced Anaphylaxis: In very specific cases, consuming a particular food like shrimp causes no symptoms on its own, but a severe allergic reaction (anaphylaxis) is triggered if the person exercises within a few hours of eating.24

4.2 The Spectrum of Symptoms

Shrimp allergy symptoms are not confined to one organ system and can appear simultaneously in the skin, gastrointestinal tract, respiratory system, and cardiovascular system. They can be classified as mild, moderate, or severe (anaphylaxis). The table below organizes these systematically.

Table 1: The Spectrum of Shrimp Allergy Symptoms

System	Mild Reaction	Moderate Reaction	Severe Reaction (Anaphylaxis)
Oral / Skin	• Tingling or itching in the mouth, lips, or throat 10	• Localized itching, mild flushing 26	• Widespread hives (Urticaria) 10	• Angioedema: Swelling of the lips, tongue, around the eyes, or face 10	• Skin symptoms accompanied by severe symptoms in other organ systems
Gastrointestinal	• Mild nausea	• Abdominal pain, cramping, vomiting, diarrhea 3	• Severe, repetitive vomiting or diarrhea can lead to dehydration or shock
Respiratory	• Nasal congestion, runny nose, sneezing 6	• Repetitive coughing, chest tightness	• Difficulty breathing, wheezing 3	• Throat swelling or tightening, airway constriction 3	• Hoarse voice
Cardiovascular / Systemic	• No specific findings	• Slight dizziness	• Sudden drop in blood pressure (hypotensive shock) 10	• Rapid, weak pulse, dizziness, fainting, or loss of consciousness 10	• Pale, cool skin • Sense of impending doom, anxiety 27

Anaphylaxis is the most severe, life-threatening allergic reaction, characterized by the rapid onset of the severe symptoms listed in this table across two or more organ systems.12 For example, if widespread hives (skin) occur along with difficulty breathing (respiratory), or vomiting (gastrointestinal) is accompanied by dizziness (cardiovascular), it should be immediately treated as anaphylaxis. Shrimp and other crustaceans are among the most common causes of food-induced anaphylaxis in adults, requiring extreme caution.3

Chapter 5: The Path to Diagnosis: How Allergies are Confirmed

When a shrimp allergy is suspected, obtaining an accurate diagnosis to confirm the trigger and rule out other possibilities is an essential first step for safe management. Diagnosis is primarily based on the patient's medical history and objective tests.

5.1 The First Step: Detailed Medical History

The most important diagnostic tool is the patient's detailed history. A physician will assess the likelihood of an allergy based on information such as 22:

• Food Consumed: What food was eaten, and how much?
• Timing of Symptoms: How soon after eating did symptoms appear?
• Specific Symptoms: What were the symptoms, how severe were they, and how long did they last?
• Past History: Have similar symptoms occurred before? Does the patient have other allergic conditions like asthma, rhinitis, or atopic dermatitis? (Chronic respiratory symptoms, in particular, may suggest a link to house dust mites).

5.2 Skin Prick Test (SPT)

• Principle and Procedure: A drop of purified shrimp allergen extract is placed on the skin of the forearm or back. A sterile lancet is then used to gently prick the skin's surface, allowing the allergen to come into contact with mast cells in the skin. If the patient's mast cells are armed with shrimp-specific $IgE$ antibodies, a "wheal and flare" reaction—a raised, red, itchy bump similar to a mosquito bite—will appear at the site within 15-20 minutes.14 This directly demonstrates that the body is primed for an allergic reaction.
• Pros and Cons: Results are available almost immediately, and the test is highly sensitive, making it one of the most accurate diagnostic methods. However, patients must stop taking antihistamines for several days before the test, and it cannot be performed on individuals with severe eczema or dermatographism.17

5.3 Specific IgE Blood Test

• Principle and Procedure: A small blood sample is drawn and analyzed to quantitatively measure the amount of specific $IgE$ antibodies to shrimp protein in the blood.6 It is known by various names, such as MAST, RAST, or ImmunoCAP, but the principle is the same.29
• Pros and Cons: This test can be performed regardless of the patient's skin condition or current medications, making it convenient. However, it may be slightly less sensitive than a skin prick test, and it takes time to get the results. It is also important to note that a positive blood test indicates 'sensitization,' which does not always perfectly correlate with a 'clinical allergy' (i.e., experiencing symptoms upon eating the food).17

5.4 Component-Resolved Diagnostics (CRD)

This is a more advanced and precise blood test. While a standard blood test looks for a reaction to 'shrimp' as a whole, CRD can identify which specific protein within the shrimp is causing the allergy.3 For example, by measuring the

$IgE$ level for 'rPen a 1 (tropomyosin),' it can be confirmed that the patient's allergy is due to tropomyosin. This provides valuable information for predicting the likelihood of cross-reactivity with house dust mites and assessing the risk of reacting to other crustaceans or mollusks.

Table 2: Comparison of Shrimp Allergy Diagnostic Methods

Method	Skin Prick Test (SPT)	Specific IgE Blood Test	Component-Resolved Diagnostics (CRD)
Principle	Directly stimulates specific $IgE$ on skin mast cells to observe a reaction	Quantitatively measures the amount of free-floating specific $IgE$ antibodies in the blood	Precisely measures $IgE$ against specific protein components (e.g., tropomyosin) in the blood
Time to Result	15–20 minutes	Several days	Several days
Accuracy	Very high (high sensitivity)	High (can be less sensitive than SPT)	Very high (identifies the causal protein)
Advantages	• Immediate results • Relatively low cost	• Unaffected by patient's condition/meds • Provides objective numerical value • No risk during testing	• Identifies cause of cross-reactivity • Useful for prognosis and risk assessment • Provides precise diagnostic information
Disadvantages	• Requires stopping antihistamines • Not for patients with severe skin conditions • Rare risk of systemic reaction	• Delay in getting results • Sensitization may not equal clinical allergy • Relatively high cost	• Highest cost • Not available for all allergens
References	14	6	3

By synthesizing the results from these tests, a physician can make a definitive diagnosis of shrimp allergy and create a personalized management and emergency action plan for the patient.

Chapter 6: The Framework of Management: Avoidance, Treatment, and Emergency Preparedness

As there is currently no cure for shrimp allergy, management after diagnosis revolves around three main pillars: 'strict avoidance' of the trigger, 'medication' for symptoms, and an 'emergency action plan' for life-threatening situations. This goes beyond simple medical prescriptions and requires a shift in lifestyle that allergic individuals must learn and practice to ensure their daily safety.

6.1 The Cornerstone of Management: Strict Avoidance

The most important and fundamental management strategy is the complete elimination of the allergen—shrimp and other crustaceans—from the diet.2 This requires a systematic effort that goes beyond simply not eating shrimp to block hidden risks.

• Reading Food Labels: It is essential to develop the habit of carefully reading ingredient lists on processed foods. Crustaceans like shrimp and crab are major allergens that must be legally declared. Pay close attention to precautionary statements like, "May contain traces of shrimp" or "Made in a facility that also processes shellfish".2
• Precautions When Dining Out: When ordering at a restaurant, always clearly inform the staff or chef of your allergy. Confirm whether the dish you want to order contains any shrimp or crustacean ingredients, including related broths. As mentioned earlier, since tropomyosin is soluble in oil, it is crucial to ask if foods like french fries are cooked in the same oil as fried shrimp.3
• Preventing Cross-Contamination: At home, efforts are needed to prevent cross-contamination. Cutting boards, knives, utensils, and dishes used to prepare crustaceans must be kept separate from those used for other foods and washed thoroughly.3

6.2 Symptom Control with Medication

• Antihistamines: For mild symptoms like hives, itching, or a runny nose, antihistamines can help by blocking the action of histamine and alleviating the symptoms.30 They can be taken as prescribed by a doctor when symptoms occur or preventively if exposure is anticipated.
• A Critical Limitation: It is crucial to remember that antihistamines cannot prevent or treat a severe systemic reaction like anaphylaxis. They are ineffective against symptoms like difficulty breathing or a drop in blood pressure and only serve to temporarily mask mild symptoms.3 Therefore, one should never rely solely on antihistamines and delay further action when the initial signs of a severe reaction appear.

6.3 Emergency Preparedness: The Anaphylaxis Action Plan

For individuals with a severe crustacean allergy, a clear action plan for anaphylaxis is a lifeline. This includes being mentally prepared to act quickly and decisively in a crisis without panicking.

• Recognizing Anaphylaxis: If skin symptoms (hives, swelling) are accompanied by either respiratory symptoms (coughing, wheezing, difficulty breathing) or cardiovascular symptoms (dizziness, fainting), it must be treated as anaphylaxis immediately.
• Epinephrine: The Only Lifesaving Treatment:
  The single most important and only first-line treatment for anaphylaxis is an injection of epinephrine (adrenaline).33 Epinephrine works rapidly to reverse the life-threatening symptoms of anaphylaxis by relaxing constricted airways to ease breathing, constricting blood vessels to raise blood pressure, and reducing swelling.37
• Epinephrine Auto-Injector:
  Patients diagnosed with a severe food allergy must be prescribed an epinephrine auto-injector (e.g., EpiPen®, Jext®) by their doctor and carry it with them at all times.3 The device is simple to use, but it is vital to be thoroughly familiar with the instructions in advance and to inform family, friends, and colleagues as well.
  • How to Use:
    1. Grasp the auto-injector in one fist with the needle end pointing down. Pull off the safety cap with the other hand.
    2. Press the tip firmly against the middle of the outer thigh until you hear a 'click'. (It can be administered through clothing.)
    3. Hold it in place for 5-10 seconds after the 'click'.
    4. Remove the injector and massage the injection site for 10 seconds to help the medicine absorb.36
• The Golden Rule: Inject First, Then Call for Help:
  If you believe anaphylaxis is occurring, do not hesitate—inject epinephrine immediately. A moment's hesitation to 'wait and see' can have fatal consequences.33 After injecting,
  call emergency services (e.g., 911, 119) immediately for medical assistance.37
• The Need for Hospital Observation: Even if symptoms improve after the injection, you must go to the emergency room. A biphasic reaction, where symptoms reappear hours after the initial reaction has subsided, can occur. It is safest to be monitored in a hospital for a period of time.33

Conclusion: Navigating a New Reality with Confidence

This report has established that the sudden onset of shrimp allergy in adulthood is not a matter of simple bad luck or chance, but a scientific phenomenon rooted in the complex and dynamic processes of the immune system. We have explored in depth how, in many cases, the underlying cause is chronic respiratory sensitization to house dust mite allergens, leading to a cross-reaction mediated by the common protein 'tropomyosin'—a condition known as 'mite-crustacean syndrome.'

Being diagnosed with an allergy to a once-loved food is a significant event that brings major changes to one's life. However, understanding the immunological principles behind this phenomenon, clearly recognizing the spectrum of symptoms, and mastering strategies for strict avoidance and emergency response can transform vague fear into concrete confidence.

Knowledge is the most powerful tool for management. If you have experienced a shrimp allergy or similar symptoms, it is crucial to see an allergist for an accurate diagnosis without delay. Consulting with a specialist to create a systematic management plan, establishing an anaphylaxis action plan, and obtaining a prescription for an epinephrine auto-injector to carry at all times are essential steps for safely navigating this new reality. Through these measures, patients can proactively manage their condition and continue to lead healthy, fulfilling lives.

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16. 서른에 발견한 식이 알레르기 | 보그 코리아 (Vogue Korea), 8월 14, 2025에 액세스, https://www.vogue.co.kr/2019/09/20/%EC%84%9C%EB%A5%B8%EC%97%90-%EB%B0%9C%EA%B2%AC%ED%95%9C-%EC%8B%9D%EC%9D%B4-%EC%95%8C%EB%A0%88%EB%A5%B4%EA%B8%B0/
17. [미디어로 보는 질병] 면역체계의 오해가 원인 '알레르기'를 말하다, 8월 14, 2025에 액세스, https://www.scourt.go.kr/portal/gongbo/PeoplePopupView.work?gubun=43&seqNum=2379
18. 알레르겐의 물리생화학적 특성 - KoreaMed Synapse, 8월 14, 2025에 액세스, https://synapse.koreamed.org/upload/synapsedata/pdfdata/0206aard/aard-4-157.pdf
19. 게나 새우 먹고 입술 부음, 알레르기 증상인가요? - 닥터나우, 8월 14, 2025에 액세스, https://doctornow.co.kr/content/qna/a6b2fa14a846469f8ad56642a9d66528
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21. 집먼지 진드기 알레르기: 원인, 증상, 치료 | 아폴로 병원 - Apollo Hospitals, 8월 14, 2025에 액세스, https://www.apollohospitals.com/ko/diseases-and-conditions/all-you-need-to-know-about-dust-allergies
22. 집먼지진드기, 음식교차 알레르기 유발 - 메디칼트리뷴, 8월 14, 2025에 액세스, http://www.medical-tribune.co.kr/news/articleView.html?idxno=22411
23. 조개갑각류 알레르기: 개요, 진단 및 치료 - Thermo Fisher Scientific, 8월 14, 2025에 액세스, https://www.thermofisher.com/diagnostic-education/hcp/wo/ko/allergy/food-allergies-diagnosis-treatment/shellfish-allergy-diagnosis-treatment.html
24. 음식물 알레르기 - 면역 질환 - MSD 매뉴얼 - 일반인용, 8월 14, 2025에 액세스, https://www.msdmanuals.com/ko/home/%EB%A9%B4%EC%97%AD-%EC%A7%88%ED%99%98/%EC%95%8C%EB%A0%88%EB%A5%B4%EA%B8%B0-%EB%B0%98%EC%9D%91%EA%B3%BC-%EA%B8%B0%ED%83%80-%EA%B3%BC%EB%AF%BC%EC%84%B1-%EC%A7%88%ED%99%98/%EC%9D%8C%EC%8B%9D%EB%AC%BC-%EC%95%8C%EB%A0%88%EB%A5%B4%EA%B8%B0
25. 알레르기 교차반응이란 무엇인가요?, 8월 14, 2025에 액세스, https://www.thermofisher.com/allergy/kr/ko/living-with-allergies/understanding-allergies/cross-reactivity.html
26. 알레르기 - 나무위키, 8월 14, 2025에 액세스, https://namu.wiki/w/%EC%95%8C%EB%A0%88%EB%A5%B4%EA%B8%B0
27. 식품알레르기 - 부산광역시 아토피·천식 교육정보센터, 8월 14, 2025에 액세스, https://allergyinfo.or.kr/disease/food_allergy_about.aspx
28. N의학정보 | 서울대학교병원, 8월 14, 2025에 액세스, https://www.snuh.org/health/nMedInfo/nView.do?category=DIS&medid=AA000508
29. 새우 섭취 후 알레르기 검사 추가로 무엇을 해야 하나요? - 닥터나우, 8월 14, 2025에 액세스, https://doctornow.co.kr/content/qna/00067770a4c248c9a8257923e38604ab
30. 새우 알러지에 대한 대처법과 약물 복용에 대한 조언은 무엇인가요 ..., 8월 14, 2025에 액세스, https://doctornow.co.kr/content/qna/5eb3cbbd34b84f97a10737c8abcf4eec
31. 새우 알러지 반응, 약 없이 어떻게 대처할 수 있을까요? - 닥터나우, 8월 14, 2025에 액세스, https://doctornow.co.kr/content/qna/63d8970be8044ca5880fddd0daff9239
32. 해외에서 새우 알러지 증상 지속 시 대처법은? - 닥터나우, 8월 14, 2025에 액세스, https://doctornow.co.kr/content/qna/1f671e84a3784baf9fa5cb28a99fa8eb
33. 한국 아나필락시스의 진료 - KoreaMed Synapse, 8월 14, 2025에 액세스, https://synapse.koreamed.org/upload/synapsedata/pdfdata/0206aard/aard-1-181.pdf
34. 아나필락시스 [anaphylaxis] - N의학정보 | 서울대학교병원, 8월 14, 2025에 액세스, https://www.snuh.org/health/nMedInfo/nView.do?category=DIS&medid=AA000538
35. 식품알레르기 - 충청북도 아토피 · 천식 교육정보센터, 8월 14, 2025에 액세스, https://www.cballergy.co.kr/illness/food_allergy_5.aspx
36. 경기도남부 아토피·천식 교육정보센터, 8월 14, 2025에 액세스, https://www.e-allergy.org/m/illness/anaphylaxis_5.aspx
37. 알레르기 상비약, 8월 14, 2025에 액세스, https://common.health.kr/shared/healthkr/pharmreview/%EC%95%8C%EB%A0%88%EB%A5%B4%EA%B8%B0%20%EC%83%81%EB%B9%84%EC%95%BD.pdf