Rising Tide of Crustacean Allergies in East Asia: a Comprehensive Review of Genetic Insights and Implications for Early Evaluation of Health Risks.

Amidst the exponential rise in crustacean production and consumption across East Asia, the population burden of crustacean allergies has intensified correspondingly. Therapeutic options remain limited, and contemporary risk stratification still relies predominantly on familial history, an approach whose predictive granularity is inadequate for precision public health. Converging evidence from twin and family cohorts indicates that crustacean allergies exhibit a high narrow-sense genetic heritability, underscoring the imperative to dissect its genomic architecture and to quantify downstream health sequelae. Here, we conducted a comprehensive review with an integrated methodological perspective, mainly synthesizing recent advances in the molecular genetics of crustacean allergies and delineating their translational ramifications for early-life risk prediction. This review primarily focused on the high prevalence of crustacean allergies in East Asia and the inadequacies of current early risk assessment systems, genetic loci associated with crustacean allergies and existing gaps in molecular genetic studies, the applications of polygenic risk scores in early risk assessment, and the evaluation of genetic causal effects of crustacean allergies on the risk of human common diseases. Leveraging two-sample Mendelian randomization anchored in large-scale East Asian genome-wide association study summary statistics, we demonstrated that genetically predicted shrimp allergy exerted significant causal effects on a spectrum of human common disorders spanning the respiratory, gastrointestinal, endocrine, musculoskeletal, nervous, cardiovascular, integumentary, and autoimmune systems. These findings underscored the necessity for comprehensive molecular genetic studies to develop an objective assessment framework that facilitates early identification of high-risk populations and evaluate their adverse effects on individual’s health, prioritizing precision immunomodulatory regimens targeting high-risk individuals before clinical manifestation.