Fish and shellfish allergies
We included two studies on fish and seven on shellfish allergies. Most studies focused on shrimp allergy, 3 studies of SPT to shrimp [158, 162, 165, 175], four of shrimp-sIgE [162, 165, 173, 175] and 3 of CRD to Pen m 1 [165, 173, 175] met inclusion criteria for shrimp allergy meta-analyses. SPT to shrimp had pooled sensitivity of 62% with specificity of 90% at the median 3 mm cut-off. sIgE-shrimp showed high sensitivity of 96% with a pooled specificity of 63% at a median cut of 1.2 kUA/L. Pen m 1 had a sensitivity of 62% and specificity of 89% (Table 2 ) and (Figure 2J) . The maximum sensitivity was ≥ 90% for shrimp-sIgE. The maximum specificity of ≥ 90% was for SPT shrimp. (Table S5 ). There was insufficient data for meta-analyses on other fish or shellfish allergies.