Advances in Shellfish Allergy Therapy: From Current Approaches to Future Strategies.

Shellfish allergy, triggered by immune reactions to crustacean and mollusk proteins upon consumption/inhalation, is one of the most severe and persistent food allergies, affecting approximately 1%-3% of the general population worldwide. Shellfish is among the "big nine" food allergens responsible for over 90% of food allergy cases worldwide. Its diagnosis poses major challenges due to regional species diversity and a lack of reliable diagnostic tools. Management strategies generally emphasize strict avoidance and provision of emergency adrenaline autoinjectors; however, these approaches are inconvenient and insufficient for both patients and healthcare providers. Given the rising prevalence of shellfish allergy, there is an urgent need for targeted therapies that focus on key allergens, particularly tropomyosin-a major pan-allergen. As the primary target in current immunotherapy approaches, tropomyosin plays a central role in driving shellfish-induced immune responses. Recent advancements in immunotherapy are exploring alternatives beyond avoidance, aiming for long-term desensitization. This review discusses progress with allergen-specific immunotherapy, hypoallergenic allergen variants, DNA-based vaccines, and innovative approaches involving immunoregulatory peptides and probiotics. These strategies collectively strive to desensitize patients, reduce allergic symptoms, and enhance quality of life. Although some therapies are in active trials, most are in the investigational stages and offer promising directions for effective, patient-centered long-term management of shellfish allergy.