Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 22 2 2023 04 30 208 211 Simona Barni Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy Marta Vazquez-Ortiz National Heart & Lung Institute, Imperial College London, London, United Kingdom Mattia Giovannini 1 Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy AND Department of healt Science, University of Florence, Florence, Italy Giulia Liccioli Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy Lucrezia Sarti Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy Giulia Lascialfari Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy Laura Pisano Immunology and Molecular Microbiology Unit, Meyer Children's Hospital IRCCS, Florence, Italy Silvia Boscia Immunology and Molecular Microbiology Unit, Meyer Children's Hospital IRCCS, Florence, Italy Francesca Mori Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy 2022 06 07 2023 03 13 Shellfish is defined as any edible marine invertebrate and refers to crustaceans and mollusks. Crustaceans belong to the phylum Arthropods. Mollusks belong to the phylum Mollusca. This report illustrates a rare case of a 6-year-old girl with challenge-proven acute food protein–induced enterocolitis syndrome (FPIES) to cuttlefish (phylum Mollusca, class Cephalopoda), anaphylaxis to crustaceans (phylum Arthropoda), and tolerance to other mollusks, including clams and mussels (phylum Mollusca, class Bivalvia). The association of IgE-mediated food allergy and acute FPIES seen in this case is rare. To our knowledge, this is the first case of FPIES to cuttlefish reported in a child. This challenge highlights the need for further research into the allergens and mechanisms underpinning FPIES at a molecular level, enabling a better understanding of cross-reactivity patterns and the development of diagnostic and predictive tests to assist in clinical practice. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/3566 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/3566/1940