# Food Allergies: Immunosensors and Management
## 5 Shellfish Allergy
### Management  
Precise diagnosis of FAs is very important for the selection of suitable treatment. Currently, the best recommended treatment of FAs is to avoid eating the allergenic foods. Nowadays, some primary allergens in shellfish have been discovered, including tropomyosin, arginine kinase, myosin light chain, sarcoplasmic calcium-binding protein, hemocyanin, troponin-C, myosin heavy chain, glyceraldehyde phosphate dehydrogenase, and ubiquitin. Elimination of the mollusk species of shellfish in the patient's diet is one alternative man agement approach for shrimp-allergic patients [56]. A decision tree has been developed to examine the promising cross-reactivity of shrimp mollusks in shrimp-allergic patients in order to conserve types of shrimp IgE-binding epitopes TM and AK in mollusk species. A patient's clinical history does not provide an exact conclusion in the detection of shrimp allergy. Sensitization assays to whole shrimp and specific allergens are required before an oral food challenge is undertaken. If the TM-specific IgE result is positive, with quantitative IgE levels with TM similar to the whole protein extract, immune dominant sensitization to mussel TM is possible, and broad (serological) cross-reactivity against other shellfish species should be performed. Analyzing the binding of IgE to the shrimp TM epitope can further assist the diagnosis of cross-reactivity. Inhalation during commercial processing may cause sensitization to seafood. Identification of food handling as the cause of adverse reactions is a route that is indistinguishable in all subjects and general reports of ingestion-related allergic information. The extractions of cooked foods have more IgE activity than raw foods, which may be attributed to general consumption of crab, shrimp or chemical modification of crustacean proteins on heating. The activity of IgE in clinically relevant crustacean extracts have been proven by functional basophil activation assay. The relative reactivity of crustacean species is very important to understand so that subjects who are allergic to shellfish receive the best clinical treatment on food avoidance [59]. Food processing can affect the identification of FAs by immune cells and the following allergic immune response. Food cooking can change the composition of the allergen because of protein denaturation, aggregation and chemical modification. These changes of molecular structure may result in the involvement of allergens with various receptors for immune cells [60]. Proliferation and effector cytokine profiles (IFN-\(\gamma\), IL-4) of CD4+, CD8+ and CD56+ cells, and the proportion of Foxp3+ Tregs have been compared. Detection of cellular responses to these processed crustacean allergens has informed the progress of safe and effective specific immunotherapies. Crustacean-allergic and non-atopic subjects have revealed similar lymphocyte proliferative responses to crustacean extracts but with a greater response to crude extracts. There is a tendency to decrease the proliferation of PBMCs in reply to cooked crustacean extracts. Treg induction is also decreased.